COVID's next battleground may be 'long-hauler' insurance claims

Much is still unknown about COVID-19, the novel coronavirus, and how best to treat it. For example, there is still no consensus on the length of vaccine protection, whether children should receive vaccines and their effectiveness against new variants. What’s also unknown, for now, is how long some individuals may feel the effects of “long-term COVID” and how insurers should handle claims.

“We’re seeing claims denied now for COVID-19” aftereffects, says Nainesh Kotak, founder of Kotak Personal Injury Law in Mississauga, Ont.

“The rationale is that there is insufficient medical evidence” to show that a sufferer is sick as the result of contracting COVID-19. Without formal diagnoses with specified criteria, “it’s very difficult for those people who are suffering” and denied benefits, he says.

The term “long-haul COVID” describes the lasting effects of the virus after an infection, sometimes for weeks or even months (it usually takes two weeks to a month to recover from all but the mildest cases of COVID-19).

Researchers at the British Medical Journal found that about 10 per cent of those who tested positive for the coronavirus continued to suffer its effects for months afterwards. Symptoms can vary widely and include low-grade fever, cough and fatigue, loss of sense of smell and taste, depression, anxiety and dizziness. As of July 30, there were 1,430,483 total cases of COVID-19 in Canada. At 10 per cent of cases, possible sufferers in Canada may number close to 150,000.

Although U.S. President Joe Biden said last week that his administration was pushing for people with long-term symptoms of COVID-19 to be protected against discrimination, “Canada’s been a bit behind” in recognizing and supporting COVID “long-haulers,” says Kotak. This lack of support forces individual long-haulers to establish and set up support groups.

Global statistics define “long-haul” as continuing to feel COVID-19 effects 16 weeks after infection.

“What we’re starting to see now is that folks are starting to call a lawyer to do [long-term disability] work because they’re having trouble accessing LTD,” says Steve Rastin, senior counsel and managing partner at Rastin Gluckstein in Barrie, Ont. Typically there is an “elimination period” of four to six months while waiting to access long-term disability benefits. In the meantime, they can normally access short-term disability or employment insurance benefits, or perhaps even Canada Emergency Response Benefit (CERB), he says.

But now, some long-term COVID sufferers have been getting “the run-around for a couple of months” from insurers and “are starting to come to us in numbers,” says Rastin, who places long-haul COVID in the same category as chronic post-infection diseases.

“Years ago, we started to talk about fibromyalgia and chronic pain problems,” Rastin adds. “The medical community doesn’t have a definition yet as to what constitutes post-COVID syndrome. They’re looking at a fourth wave, whether they should vaccinate children [or] whether we need booster shots. What constitutes long-term COVID: is it symptoms for three months, or for six months?” As well, there is “not one set of symptoms” for everyone.

But Rastin and Kotak agree that insurance should cover COVID “long-haulers,” whether this virus is novel or not.

People purchase insurance for peace of mind, and by and large, they don’t make claims, says Kotak. Employers offer group policies to attract employees to the workplace and protect them.

“Whether it’s heart disease, cancer, or viral, bacterial, or brain injury, those policies should be there to protect those who are insured, regardless of whether or not the illness is new in the population.”

Kotak advises that sufferers reach out to support groups, as well as see their family doctor to get prescribed medications and referrals to specialists, “so at least symptoms are well-documented, so you have an ally in the doctor, and can follow up with treatment recommendations.” When his firm gets an insurance benefits denial case, they will also ask the treating physician, or an expert, about how COVID-19 continues to affect a patient’s abilities to work and live.

“Disability policies are really about function,” he adds, with most policies having provisions for being totally disabled or able to perform functions of a job.

“I do see this as a phenomenon that is, unfortunately, going to be around for many, many years to come,” he says, and one can extrapolate the numbers of those who will continue to suffer the effects of COVID-19 in the long term from all those who have contracted COVID-19 across the country.