A thorough and meticulous investigation is required

Investigating long COVID claims requires a thorough and detailed approach:

Confirm a COVID infection: Ensure that the insured party has had a confirmed COVID-19 infection and determine its severity (mild, moderate, severe).
Review pre-existing conditions: Obtain up to five years of detailed medical history and records prior to the COVID diagnosis to assess pre-existing conditions that might be contributing to the long COVID symptoms.
Gather post-COVID medical records: To understand the condition's progression, collect all medical records post-COVID and long-COVID diagnoses.
Consult treating physicians: Engage with the primary treating physician to assess the claimant's ability to work, limitations, and the potential for an employer to make accommodations.
Requisition an independent medical exam: Recognize that many long COVID symptoms are common in the general population. Some of the same health issues also can be stress-induced. An independent medical exam (IME) often is necessary to determine the disability's true cause.

Long COVID claim numbers may be falling

Recent data compiled by KFF suggests that the incidence of long COVID may be diminishing. As of Jan. 2023, the percentage of people reporting long COVID symptoms has decreased over time, which underscores the need to stay up to date on evolving long COVID trends and statistics. As of:

June 2022, 35% of COVID survivors reported long COVID symptoms.
August 2022, 33% of survivors reported symptoms.
October 2022, 30% reported symptoms.
January 2023, 28% reported symptoms.

The percentage of adults reporting that they suffered from activity limitations due to long COVID, as of January 2023, broke along these lines:

27% experienced significant activity limitations.
52% had non-significant activity limitations.

Remember, however, that while its prevalence appears to be decreasing, long COVID remains a significant concern for COVID survivors and our industry.

Special Reports /

Lessons learned from adjusting long COVID insurance claims

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