Many healthcare professionals who catch COVID-19 on the job receive some coverage from worker’s compensation while their symptoms persist. However not all physicians and nurses have access to these benefits, and those professionals who develop “long COVID” symptoms may wonder if they’re covered by their private or group disability insurance.

Worker’s compensation benefits can vary depending on where the professional lives and whether or not they work as a practice owner. Some states (like Texas) do not require employers to carry worker’s compensation at all, while others (like California) require it even if there is only one employee.

In addition, physicians who are practice owners may choose to  purchase worker’s compensation only for their employees as required by law, and to not purchase it for themselves. These physicians may be relying on disability benefits as their sole means of financial protection for any long-hauler symptoms that may develop during the pandemic. 

Additionally, workers compensation insurance typically does not include terms and provisions appropriate to the healthcare professional. An example would be the definition of disability.  A healthcare professional needs this tailored to the specific procedures (e.g., beyond general medical specialties) he or she performs in the practice.

A COVID-19 long-hauler is someone who survives a COVID-19 infection but continues to have ongoing symptoms – sometimes severe or debilitating ones – many months later. These symptoms may prevent the sufferer from working or from functioning normally in their day-to-day life. For healthcare professionals, there are a few scenarios in which they may look to disability insurance because of long-hauler symptoms after the acute phase of their illness has passed:

1. Their worker’s compensation has declined further payouts for their disability, but they are still unable to work
2. They have no worker’s compensation insurance, and instead wish to file a claim with their disability insurance for ongoing symptoms that prevent them from working
3. Their symptoms have changed from a short-term illness to a long-term disability, and are still preventing them from returning to work

Long-haulers who work outside of the healthcare industry often lack private disability insurance coverage and instead look to Social Security Disability Insurance (SSDI) for help, although there is an ongoing discussion about their ability to qualify for benefits due to COVID-19. But for healthcare professionals with their own private insurance or with coverage through employer group plans, can they expect to receive benefits for a long-hauler disability?

The Answer: It Depends on the Policy

For a healthcare professional to receive benefits for any illness or accident, they must prove to the insurer that their condition is disabling. This is much easier to do when COVID-19 is in its acute phase and an employer-imposed quarantine prevents them from working, although elimination periods can still be problematic for illnesses like the coronavirus.

The challenge with long-haulers is that many of them cannot prove their ongoing disability through laboratory or other standard testing methods. Some symptoms, like fatigue or brain fog, may be considered “subjective” by the insurer even if they are disabling. So it is important for insurance brokers to look at the individual policy language to see if their clients are covered for long-hauler symptoms. Some trends to note:

1. Some individual disability insurance (IDI) policies will cover COVID-19 disabilities that extend beyond the waiting period, as long as the healthcare professional meets the policy’s definition of disability
2. Some short-term disability (STD) and long-term disability (LTD) policies will cover COVID-19 just like any other illness, and no change to the policies is needed
3. Some LTD policies will only cover the long-hauler if they develop a different and medically-verifiable disease as a result of their COVID-19 exposure
4. Some disability insurance policies may offer partial benefits to the long-hauler if they can work part-time but are still suffering from severe symptoms

The best strategy for brokers is to review their clients’ disability insurance policies for pandemic-related exclusions or even specific COVID-19 language.  Check the exclusions and what is covered policy sections.  You can then recommend options to bolster protection.  One nuance to check for is how the policy will address new virus variants, which could cause a future infection or disability, and a subsequent request for benefits.

Checking the policy language for COVID-19 coverage also helps you narrow your policy offerings to those that are the best options for future healthcare clients, because you can find the policies that are most favorable to the risks of the healthcare profession. Gaining this knowledge is an important step in becoming a trusted advisor to individuals and employers looking to change or upgrade their policy offerings, and should ultimately help you grow your business.