A solid study found that the US infection rate is likely way higher than the official reports. The brainiacs at The Economist estimate almost one in every five of us has had the disease.

Coincidentally, I was talking with a client yesterday about his bout with what sounded a lot like COVID. Turns out his wife had it as well.  This is just one of several stories I’ve heard from folks who got sick as far back as last December or January.

The Economist has a very well done COVID tracker that provides data on excess deaths during the pandemic era, as well as a description of potential reporting issues and causes.

Before you scoff, read the article; the evidence is compelling that the pandemic has led to many more deaths than expected.

A study examining hospital readmission rates for COVID patients found more than a quarter died or returned to the hospital after their initial discharge. This sounds pretty high, but it is actually lower than longer-term death and readmission rates for heart failure and pneumonia patients.

Thanks to WorkCompWire for the piece on CWCI’s report on claims for public self-insureds for the fiscal year ending June 30, 2020. Recall that COVID hit California in early March, so the reports’ findings reflect 8 months of a “normal” year and 4 pandemic months.  Top takeaways:

• Claim counts dropped over 6%
• Indemnity expenses zoomed up almost 17%.

My view – it is highly likely the pandemic drove increased disability duration as patients couldn’t access care, facilities postponed elective procedures, and newly-injured workers found it harder to get appointments.

You’ll likely hear much more in a few months if you Save the Date for CWCI’s Annual Conference – on Thursday, March 11, 2021 the brilliant minds and best-presenters-in-the-industry will once again inform and enlighten.  Details forthcoming…topics to include a discussion on how the industry reacted to COVID and the results of current research.

Sticking with workers’ comp, a Kimberly George/Mark Walls piece in National Underwriter noted TPA Sedgwick has handled:

45,000 COVID-19 workers’ compensation claims for their clients. 78% of those are closed with an average paid of $1050. 54% of the claims had no payments made.

That’s pretty consistent with findings from my firm’s June 25 survey of 35 payers and service providers (summary report download at no cost); from an interview back in June:

a lot of claims are filed with no payments…[a] respondent stated “96% of claims cost less than $3,500, but 4% are expensive.”

Finally, the news that Moderna’s vaccine will likely be approved for use this week is excellent news indeed. The company participated in Operation Warp Speed, the Trump Administration’s effort to jumpstart vaccine development by funneling $18 billion in taxpayer funds to organizations and companies working on vaccines.

One of the most positive signs is Moderna’s vaccine showed equal effectiveness among white and non-white subjects. As COVID has been particularly devastating in communities of color, this is critically important.

This from the NYTimes:

There was also no significant difference between its protection for men and women, or between healthy volunteers and those at risk of severe Covid-19 who had conditions like obesity and diabetes. For people 65 and older, the trial provided an estimated efficacy of 86.4 percent, lower than the overall estimate of 94.1 percent. But the apparent difference was not statistically significant.

So far, two potential differences between the vaccines have emerged from the F.D.A.’s reviews, but the findings may [emphasis added] reflect a shortage of data rather than genuine differences. The Pfizer-BioNTech trial showed that their vaccine started to protect against the coronavirus within about 10 days of the first dose. The trial of Moderna’s vaccine, by contrast, did not reveal such a striking effect after the first dose.

What does this mean for you?

Wear the mask and be very careful. This is  very far from over.

Almost 400,000 surgeries (of all types) were cancelled each week during the 12-week COVID peak this spring. 

In North America, almost 1.2 million orthopedic surgeries were cancelled – the vast majority in the US. Across all countries, the orthopedic cancellation rate was 82%, the highest percentage of any type of surgery.

It’s time to dig back into how and where COVID is affecting workers comp. As this is very much a state-specific situation, we first need to understand what’s happening around the country.

That’s difficult at best.

(if you just want key takeaways, scroll to the bottom)

For starters, it can be quite difficult for a worker to get coverage for COVID; in most cases a worker must:

• have a positive PCR test or a COVID diagnosis by a physician, and
• be an “essential worker”, and
• work in a state with some level of presumption.

Tests were hard to come by – and many were inaccurate – back in the initial March – to – May wave. Presumption laws have been a moving target and are subject to interpretation, as is the determination of who is – and is not – an “essential worker”.

Okay, the data… 

States’ data below are NOT directly comparable; states report things differently and totals are from different time periods. For example, Florida’s data includes only lost time claims that have been accepted or denied. California, Hawai’i, and New York include all claims filed. Can’t tell much from PA’s data…

Remember, occupational disease is NOT handled the same as an occupational injury; in laymen’s terms, in most cases the burden of proof is on the patient to show COVID was contracted in the workplace and not at home.  This from Florida statute:

“occupational disease” shall be construed to mean only a disease which is due to causes and conditions which are characteristic of and peculiar to a particular trade, occupation, process, or employment, and to exclude all ordinary diseases of life to which the general public is exposed, unless the incidence of the disease is substantially higher in the particular trade, occupation, process, or employment than for the general public.

California

CWCI’s reporting of COVID and related data is timely, robust, and accessible. As of November 30 – 2 days ago – there were 56,854 claims reported. Almost 19,000 were among healthcare workers and 7,700 suffered by public safety and government employees.

note the light blue indicates projected total claims; dark blue indicates reported claims

A lot of claims incurred in November aren’t included in those figures as they aren’t officially reported yet. So, looking at projections for the period ending October 31, CWCI projects there will be a total of 58,136 COVID claims.

68.1% of claims that have been assessed have been accepted, a rate higher than in most other states.

Overall, claim counts are down 12.9% for the year; that’s a loss of one of every eight claims.

New York

Over 12,000 COVID-related claims were filed, as of October 8,  the vast majority still pending.  To date, about 8,000 of the claims filed are lost time, 184 are receiving indemnity payments and another 5,000 claimants received “voluntary” wage replacement payments from insurers/their employer.

Around 1,230 claims were initially denied…and again, about 3/4ths are still pending.

Hawai’i

On the other side of the country, only about 400 claims have been filed in Hawai’i through October. About half were initially denied, and most are still under consideration. Not surprisingly, a plurality (166) were from healthcare or social workers.

Florida

As of October 31, the Sunshine State has accepted or denied 23,000 COVID-related lost time (LT) claims filed, 13,000 have  been ruled compensable and the rest denied. Key findings include:

• COVID claims account for 31% of all LT claims filed but only 8% of payments
• Paid amounts to date show 94.6% of COVID claims cost <$5,000
• 6 claims of the 23.452 have resulted in benefit payments over $500,000; the average is $800,000
• the average benefit paid for all closed COVID LT claims is $1,092.

Pennsylvania

PA had 9,510 COVID-related claims as of 11/29/2020;  no indication if those are filed, accepted, include all claims or not.

Texas

Our friends on the border reported 25,571 claims as of September 27, 2020 – the vast majority have not been accepted or are still being adjudicated. Similar to other states, Texas’ data indicates an early peak in April followed by a much higher one in July. Notably there are no data for the last two months.

Although Texas’ Division of Workers’ Compensation refers to the reporting entities as “insurance carriers”, the data actually include self-insured employers’ results.

• Over a third of claims included a positive lab test for or diagnosis of COVID, but less than half of those were accepted by the insurer/employer (14% are still under investigation)
• Half of all claims were incurred by workers in healthcare or social service, or first responders
• The 2,065 accepted claims have driven $4.44 million in medical payments (as of September 27). That number, an average of $2,170 per patient, will certainly increase.

There are a bunch of other states reporting COVID claims, a vast improvement over what we had earlier this year. However, the different criteria used, different timeframes, different claim types and data provided make it difficult to get a clear picture of just how many claims have been reported, accepted, and denied; how many are med onlies vs lost time, how costly they are and on and on.

Key takeaways

1. My best guess is between 200,000 and 300,000 COVID claims were filed by October 31.
2. Going way out on a limb here, it looks like about a third have been or will be accepted.
3. Benefit costs remain pretty low – significantly lower than other indemnity claims – although that opinion is based on slim data about claims still open.

Hope your holiday was excellent, and above all safe. Had a very small family gathering here in New Hampshire; brined turkey was deliciously moist.

Okay, back to work; here’s what I found in the inbox.

Congratulations to Kathy Antonello; she will take over as CEO of Employers Holdings early next year.  An actuary by education and former Chief Actuary at NCCI, Kathy is very knowledgeable, deeply experienced, and an excellent communicator. I’ve always been impressed by Kathy, good news for all that she is ascending to a leadership position.

Hospitals are hurting

Elective services have plummeted as patients seem to be avoiding medical facilities. Orthopedics suffered the most; admissions during the first two weeks of October were down almost 15% from the two weeks prior.

It is all but certain things have gotten worse over the last six weeks.

Implication – patients are avoiding treatment for musculoskeletal conditions.

Over the last decade, 134 rural hospitals have closed, with Texas leading the way with 21 closures followed by Tennessee with 14.

Implication – Problems accessing care will result in poorer health and higher mortality for rural folks.

Research roundup

CWCI’s latest  Bulletin (available to members only) reports the Golden State:

• accounted for 12% – one of every eight – US jobs covered by workers’ compensation; and
• 19.5% – almost one of every five – dollars of benefits in 2018.

If you are curious why everyone pays a lot of attention to California – now you know.

By the way, New York was second with $6.3 billion in paid benefits with Florida earning bronze with $3.6 billion.

Kudos to Alex Swedlow and colleagues for the heavy lifting on this; CWCI’s folks extracted the data from the National Academy of Social Insurance’s annual WC report. (I am a member of NASI but did not have anything to do with the report.)

Thanks to WorkCompWire for letting us know the fine folk at WCRI published their latest on the impact of early PT for low back injuries; WCRI is hosting a webinar on the topic December 17; sign up here.

Top takeaways, early PT is associated with:

• shorter disability duration
• lower medical costs
• lower utilization

Implication – get low back pain patients into PT as quickly as possible.

Coming up this week – COVID status update. Argh.