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| Steve Rastin |
Some people experienced only mild disease; however, many others required hospitalization and extended stays in intensive care units if they were fortunate enough to recover. While the elderly and people with comorbidities were most likely to become seriously ill and/or die from a COVID-19 infection, previously healthy people have also experienced significant illness and/or death.
Moreover, mutations in the virus have resulted in variants of concern that are increasingly easy to transmit and may cause more severe illness in otherwise healthy people.
As millions of people grapple with COVID-19 infections, the medical community has learned more about the symptoms associated with periods of acute illness and the unpredictable path toward recovery. In this article, I’ll explain why a debilitating condition known as long-haul COVID will likely be one of the biggest insurance claims battlegrounds in the next few years.
Usual course of COVID-19 illness
It is very difficult to predict who will develop symptomatic COVID-19 illness, what kinds and combinations of symptoms they will have and how long the symptoms will take to resolve. The most common COVID-19 symptoms include fever, chills, dry cough, shortness of breath, gastrointestinal symptoms, muscle pain, fatigue, weakness, skin rashes and loss of taste and/or smell. Medical practitioners note that certain symptoms tend to appear in a particular order during initial symptomatic illness, though the course of illness can vary greatly.
Generally, symptoms from mild to moderate disease last between two weeks to one month from onset. Persons with more severe illness may continue to experience symptoms for a longer period and/or take longer to report a full recovery.
What is long-haul COVID and what do we know about it?
Within the first few months of the pandemic, many people who experienced a COVID-19 infection reported that some symptoms continued or recurred weeks or months after initial recovery. Other people experienced a plateau during recovery where they continued to feel some ill effects long after the acute infectious period.
Named “long-haul COVID” by people who founded support groups for victims, the medical community now refers to this condition as post-acute sequelae SARS-CoV-2 infection (PASC). Globally, statistics on long-haul COVID define it as still feeling COVID-19’s effects 16 weeks after infection.
The novelty of COVID-19 means there is many unknowns about this condition. Preliminary research has suggested that between 10 and 30 per cent of people who experience a COVID-19 infection will report long-haul COVID symptoms later (see “Management of post-acute covid-19 in primary care,” The BMJ). Remarkably, one study found that almost 30 per cent of persons reporting long-haul COVID were asymptomatic during the initial infection period, while others experienced only mild illness before developing more significant symptoms weeks or months later (see “Many ‘Long Covid’ Patients Had No Symptoms From Their Initial Infection,” The New York Times (nytimes.com)). Long-COVID has been reported in all age cohorts and tends to be slightly more common in women than in men.
Although vaccination significantly reduces severe COVID-19 symptoms that result in hospitalization, intensive care treatment or death, it is currently unknown whether fully vaccinated persons who experience “breakthrough” COVID infections could also experience long-haul-COVID (see “Can you get Long COVID if You’re Vaccinated?” Slate.com).
Like acute COVID infections, long-haul COVID sufferers may experience a variety of symptoms. Fatigue, shortness of breath, heart palpitations, “brain fog,” anxiety, fatigue, insomnia and gastrointestinal problems are commonly reported (see “What is Long COVID (PASC)?” Webmd.com). Some of these symptoms tend to appear frequently in clusters (see “Many ‘Long Covid’ Patients Had No Symptoms From Their Initial Infection”).
The insurance battleground
Long-haul COVID symptoms can be debilitating and disabling. Some people previously in the workforce have discovered that a return to work is not yet possible after they have exhausted short-term disability benefits and/or no longer qualify for federal programs such as the Canada Emergency Response Benefit (CERB) or the Canada Recovery Benefit (CRB).
But many long-term disability insurers have been increasingly giving their insureds the run-around as they apply for these benefits. The reasons for delays or denials often have to do with the novelty of this illness and ongoing discussions within the medical community to define the syndrome’s symptoms or, indeed, to determine whether it is a new pathophysiological syndrome or psychosomatic.
In the personal injury field, sadly, we’ve heard this story before. Countless individuals suffering from a novel or previously little-understood conditions such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia, chronic Epstein–Barr virus or post-treatment Lyme disease syndrome have fought for years for medical recognition of their genuine symptoms and resulting disabilities. When the medical community is still establishing the criteria for a condition or syndrome and there is no official diagnosis, insurers may point to a lack of medical consensus or evidence to deny a claim.
Moreover, even when long-haul COVID gains widespread acceptance as a pathophysiological syndrome, insurers may still demand proof of COVID-19 infection and medical documentation of symptoms. Unfortunately, some people may not have received a COVID-19 test — particularly if they were asymptomatic or had very mild symptoms initially — and others will not have had the ability to visit their doctors due to pandemic-related office closures and restrictions on in-person visits.
How you can assist long-haul COVID clients
With potentially tens of thousands of long-haul COVID cases causing pain, suffering and disability, this issue will become too large for insurers to ignore. Nevertheless, until the condition is well understood and well defined, and until diagnostic tests are established, victims may experience an uphill battle with insurers to receive the benefits they deserve.
A long-haul COVID long-term disability file will most definitely not be an open and shut case. Clients bringing these cases forward will significantly benefit from representation by specialists. By referring these files to personal injury lawyers or firms with experience handling chronic pain cases and other invisible disabilities, these clients will access tried and tested strategies for evidence gathering, negotiation and argumentation. It should make their uphill battle much less of a climb.
Steve Rastin is senior counsel and lawyer at Rastin Gluckstein Lawyers. His practice focuses on civil litigation, with a focus on personal injury, employment law and mass tort/class action.
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