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Long COVID is an on-going, worrying and costly illness affecting workers and the workplace even as some people question if it is real.
It’s real, according to two recent studies that dig deep in to COVID-19 data to try to discover the prevalence of Long COVID and the implications that follow when some people infected with COVID-19 lag in regaining their pre-infection health.
One study, by the Workers Compensation Research Institute, describes Long COVID as a significant driver of costs in several ways.
The study found that claims citing Long COVID had higher average medical payments, higher average indemnity payments, and higher average durations of temporary disability than COVID-19 claims without Long COVID.
Hospitalizations and ICU care contributed to soaring costs. The average medical costs were $50,000 for hospitalized workers with Long COVID and more than $150,000 for workers with ICU care.
The average medical claim for Long COVID was more than $25,000 compared to the average medical claim of $3,000 without Long COVID.
“Our findings indicate that many workers with Long COVID had three months of temporary disability benefits within the first year after infection,” the study found. “This suggests that Long COVID may affect workers’ ability to work well beyond the acute period of infection.”
Both studies — the other was done by the New York State Insurance Fund — studied data gathered from workers early in the pandemic who were infected by COVID-19 and who received treatment and/or income replacement benefits from the workers’ compensation system.
“One big takeaway from the study is that Long COVID is real and its implications stretch from individuals and households to employers and the broader labor market,” said Gaurav Vasisht, executive director of NYSIF.
Vasisht said the New York study may have other implications for employers, such as raising the question of whether Long COVID is playing a role in on-going labor shortages.
“We hope these findings will help fill information gaps about the workforce and labor market, including what may be an underappreciated reason for declining labor participation rate since the emergence of the pandemic,” he said.
“We also wanted to highlight the emerging challenges employers face as a growing number of people return to work while still reeling from the effects of Long COVID.”
The WCRI study notes that the scientific community is still grappling to come to a consensus about what Long COVID is, and predicts the definition will continue to evolve.
Long COVID symptoms manifest as a variety of possible physical and mental health conditions which include, but are not limited to, chronic cough, ongoing shortness of breath on exertion, extreme fatigue, chest tightness, chest pain, muscle pains, headache, brain fog, insomnia, palpitations and/or tachycardia, myalgia, fever, abdominal pain, diarrhea, problems with memory and concentration and exhaustion.
When looking at all workers with COVID-19 claims in the study sample, the WCRI study found that 7% of them had not returned to their pre-injury health after infection within the time frame of the study, and they needed continuing treatment for Long COVID symptoms after the acute state of the illness was over.
Among claims with medical care, 20% received care for Long COVID symptoms. Among claims with medical care and indemnity benefits, 33% received care for Long COVID symptoms
Lung-related conditions were reported by 63% of those suffering from Long COVID, 38% reported other health issues, a third of workers reported conditions related to heart health, and 10% reported mental health issues.
The WCRI reports that there was little difference by gender when looking all claims. But women were more likely to have Long COVID when it looked at claims with medical care.
“Women were less likely to receive medical care after COVID-19, which may have contributed to the relatively more severe cases being included in the sample of those with medical care,” the study states.
The WCRI also reports that “the nature of the medical care that workers received early after the infection was a strong predictor of Long COVID. Workers who were hospitalized or had ICU care were substantially more likely to receive care for Long COVID symptoms than workers who had limited exposure to medical care early after the infection.”
The potential impact of Long COVID is immense, according to the New York study which describes the illness an “emerging threat to public health with ongoing, cascading and yet unclear implications for employers, households, individuals and the economy. Indeed, with each passing day, the number of people affected with Long COVID grows.”
During the period studied, The New York State Insurance Fund received 89,109 workers’ compensation claims, of which 5,798 related to COVID-19. Of those COVID-19 claims, NYSIF provided coverage to 3,139 established claims, with most of the remaining claims failing to meet the coverage guidelines of the Workers’ Compensation Board, the adjudicator of claims.
Almost one-third of all claimants, 31%, suffered or are suffering from Long COVID, though the percentage has fallen over time, inversely correlating with increased vaccination rates, the study reports.
The primary findings include:
“One of the most important, yet poorly understood, aspects of Long COVID is how it has affected the workforce, particularly as employees miss time from work or return with symptoms requiring medical treatment,” Vashist said. “Seventy-eight percent of these workers are under 60 years of age.”
While the study notes that the number of workers with Long COVID fell as the vaccine rate rose, it does not assert that vaccines are the only reason for the drop.
“As the study points out, vaccines may not be the only variable that impacted the drop in Long COVID,” Vasisht said.
The NSIF intends to continue to study other mysteries related to Long COVID including why essential workers had higher rates of the illness.
“Essential workers might not have been able to stay home from work beyond the required quarantine period and, in the case of health care workers, may have self-treated their symptoms,” Vasisht said. “If so, Long COVID rates, particularly for health care workers, may appear lower than they are. NYSIF intends to dig deeper to learn about essential workers’ experience with Long COVID.” &
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Businesses today move quickly. They may be on the verge of creating innovative, new products or they may be growing their enterprises through mergers and acquisitions. Whatever the case, companies are rapidly evolving and directors and officers (D&O) insurance policies are rising to meet their insurance needs.
There have been over 30 entrants into the D&O market over the past two years, according to Mark Butler, Vice President, Underwriting, D&O for AmTrust EXEC. Rates have dropped significantly as new entrants try to compete with more established insurers.
“Capacity is probably near an all-time high in D&O,” Butler said. “We’re now in a hyper-competitive environment, particularly for public D&O.”
With so many potential carriers in the field and a market that could shift as litigation picks up again as courts are reopening after COVID-19 closures, insureds need to carefully consider which insurer is the best fit for their business. To compete, carriers need to make decisive underwriting decisions and offer bespoke solutions.
“We really dig in, roll up our sleeves, and we look at each of these deals ultimately to try to help our trading partners with a solution for their client,” Butler said.
Mark Butler, Vice President, Underwriting, D&O, AmTrust EXEC
Over the past few years, carriers have seen an increased demand for D&O policies. The complex line of business has kept pace with a flurry of M&A activity and rising interest in special purpose acquisition companies (SPACs), which are formed by investor-backed management teams seeking to acquire a private company and take it public.
New entrants jumped on this opportunity, driving down D&O rates. Many were excited by the lack of class actions — due to delayed litigation as a result of COVID-19 — and they’ve created precipitous rate drops. Now, as litigation picks back up, Butler believes some carriers could decide to exit the D&O market over the next few years.
“I expect that losses will be higher than people have pegged,” Butler said. “In a few years, I think the rate environment will change and the competition landscape will change. I don’t know if that means certain carriers won’t be in the space anymore or if they’ll pivot to a different product line.”
SPACs and M&A activity are decreasing, too: “There’s no longer a flurry of SPACs coming in, less traditional IPOs, and considerably less M&A activity in general,” Butler said.
These ever-evolving business needs demand agile D&O underwriters who can readily craft inventive insurance solutions — and they need to be able to produce these quotes on a tight deadline. In these situations, underwriters are often trying to strike a balance between finding terms that suit their books while offering the best price and coverage to insureds.
“We can be thoughtful and creative on any deal and every deal,” Butler said. “Our job as underwriters is two prong: One, is superior service to your trading partners. At the same time, two, is balancing and being a responsible [financial] steward of corporate capital.”
Skilled D&O underwriters know that while the type and size of the business is important, they’ll need to consider each company’s unique position and situation. A thorough understanding of the company and their D&O and liability exposures allows underwriters to adequately price a particular business’ risk and determine what kind of terms it can offer.
“We don’t really sweep with a broad brush in terms of industry class or size,” Butler said. “What we like to do is underwrite the story, and we like to do it quickly.”
To make sure carriers understand their story, businesses should expect face-time with their underwriters as well as a robust analysis of their financial exposures. “It’s always the same EXEC people on your deals,” Butler said. “Your underwriter is your underwriter. And I think agents and brokers really appreciate that.”
Third-party resources like the S&P Capital IQ allow underwriters to quickly access financial data so they can evaluate a business’s liability exposures. Data and analytics also allow carriers to assess their book of business, so that they can be sure a particular risk is a good fit for them.
Crafting creative solutions is just one part of the process, however. Underwriters need the authority to act quickly so that insureds conducting fast-moving business deals can ensure their exposures are covered.
Point-of-sale underwriters have full authority to make decisions about what to offer insureds, allowing them to produce quick quotes for D&O risks. Whether a business needs to examine policy language for a merger or insure a complex transaction, fast underwriting decisions can help keep business deals moving.
“We try to be nimble,” Butler said. “If a broker knows they have a 24-hour turnaround, they’re going to hear from us.”
AmTrust EXEC is committed to providing its trading partners with a stable appetite for D&O risks. Its skilled, point-of-sale underwriters have the authority to produce creative insurance solutions at the speed needed in today’s conditions.
“AmTrust is entrepreneurial in spirit, from the top down,” Butler said. “We oftentimes will consider deals that standard carriers either don’t have the time or don’t have the experience to fully analyze in an efficient manner.”
Butler says AmTrust EXEC’s underwriting philosophy is underpinned by core values developed back when the arm was a sponsored MGA, which allowed it to build a lean team of skilled and agile underwriters who were comfortable making decisions on their own.
The book of business was brought in house in January of 2020 and since then, AmTrust had continued to empower its point-of-sale underwriters to make decisions without going through a lot of red tape.
“We’re set up as a lean organization,” Butler said. “Our differentiator is experienced underwriters at the point of sale with full authority.”
Even if the market changes, AmTrust EXEC is prepared to remain consistent for their clients and trading partners. “We’re not an organization that will make sweeping changes to our underwriting philosophy,” Butler said. “We’re not a market that’s going to be in and out of the space.”
AmTrust EXEC’s unique, point-of-sale underwriting system and their commitment to stable capacity have allowed them to add exceptional D&O services to their suite of liability products and solutions. “I expect us to be on a top five list for every agent or broker,” Butler said. “They will always want us in their back pocket for any deal that requires a timely, expert assessment.”
To learn more, visit: https://amtrustfinancial.com/exec. 
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with AmTrust Financial. The editorial staff of Risk & Insurance had no role in its preparation.
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