CWCI: Long COVID Accounts for Three Quarters of California Workers’ Comp COVID Claim Payments

OAKLAND, Calif.--(BUSINESS WIRE)--Only one out of every 21 California workers’ compensation COVID-19 claims from accident years (AY) 2020-2022 involved medical treatment beyond 90 days from the injury date, but that small number of “Long COVID” cases consumed 82.1% of the treatment payments on COVID claims and 73.7% of all COVID claim payments according to a new California Workers’ Compensation Institute (CWCI) study.

Long COVID claims comprised only 4.7% of all California workers' comp COVID claims but accounted for 82% of COVID claim medical treatment dollars.

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While the number of new COVID claims in California workers’ compensation has gone from a flood shortly after Governor Newsom declared a COVID-19 state of emergency in March 2020 to a trickle over the last year, the new study comes amid growing concern about a potential COVID surge after the CDC adopted new guidelines that may make it more difficult to obtain COVID-19 vaccines just as the summer travel season hits and the new NB.18.1 COVID variant has been detected in multiple locations around the U.S. The study, based on a review of 126,397 insured and self-insured COVID-19 claims found that most were relatively inexpensive due to little to no medical intervention (only 14.6% involved medical treatment), but 4.7% – or nearly 6,000 of them – were Long COVID claims that involved long-term medical conditions that impeded or prevented the claimants from returning to their jobs and resulted in significant costs. Medical payments for the COVID-19 claims in the study sample totaled $128.4 million, with Long COVID claims accounting for $105.5 million, or 82.1%; while total payments on the COVID-19 claims, including medical treatment, indemnity costs, and expenses, were $350.6 million, with Long COVID claims consuming $258.3 million, or 73.7%.

Overall, average medical payments were 105 times higher on Long COVID cases than on shorter duration COVID claims, and average indemnity payments were 37 times higher. Long COVID claim payments were significantly higher regardless of the body part involved, though the difference was most pronounced for injuries involving the lungs, multiple body parts, and “other” body parts. The top 10 diagnostic categories for Long COVID claims encompassed a wide range of organ systems, including respiratory (17.8%); circulatory (9.0%); nervous (8.7%); connective, soft tissue and bone disorders (5.2%); endocrine systems (4.9%); as well as mental health (4.4%), and digestive conditions (3.4%). Together the top 10 diagnostic categories associated with the Long COVID claims in the study sample accounted for 80.3% of all the diagnoses on these claims, highlighting the multisystem nature of Long COVID.

The Institute has included more details and graphics from the study in a report, Long COVID-19 Claim Characteristics and Treatment in California Workers’ Compensation. CWCI members and subscribers can log on to www.cwci.org, to access the report under the Research tab on the home page, others can purchase a copy from CWCI’s online Store.