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Employees who contract COVID-19 should be informed about what’s required to file a disability claim, insurers say, as cases and hospitalizations increase during a seventh wave of the virus.

What’s imperative when filing a COVID-related claim is whether or not the worker can indicate that they are able to perform their duties: “We relate the symptoms to the requirements of the job and can you or (can you) not do your job,” said Joan Weir, vice-president of group benefits at the Canadian Life and Health Insurance Association, a non-profit that represents most of Canada’s life and health insurance companies.

A certified physician must then back up what is said. Once that happens, Ms. Weir added, the individual should go to their insurer’s website to obtain the appropriate general form used for other disability claims and file it as soon as the doctor says they can’t go back to work.

She recommends the employee keep track of their health situation: “It helps if that person has been attentive and written down dates and experiences and symptoms and shortcomings in ability to do their work,” she said, adding that job details – do you sit down in an office, or do physical labour outside – are also useful to your benefits provider.

The window for submitting a claim is different for each insurance company, and a decision could be expected within weeks, according to Ms. Weir. In her view, a full denial would be a person the adjudicator deemed is capable of doing their job. A challenge, she said, is the evolving understanding of what COVID symptoms are compared to those of more clear-cut health issues such as cancer, a heart attack or stroke.

One myth is that proof of a positive COVID test result is currently needed. Although helpful, Ms. Weir said it’s not necessary because obtaining a test continues to vary across provinces. When cases skyrocketed across the country in December, 2021, testing policies changed and data entry slowed, resulting in underestimated case counts, according to the Public Health Agency of Canada.

COVID-19 data from PHAC published July 29 noted that there were 32,892 cases from July 17 to 23, an increase of about 1,500 from the previous week. The daily test positive rate the agency updated on July 29 was 14.5 per cent over the last seven days. PHAC stated that the total number of hospital beds with COVID-19 patients across Canada went up more than 400 to 5,225 from July 18 to 25.

When filing a claim, Stephanie Ipavec-Levasseur, a product director for prevention, absenteeism and disability at Desjardins Insurance, said it’s important for an employee to know their insurance plan and how much coverage they have.

Another insight she offers is to get in touch with a disability case manager who can refer health professionals and tools the employee might not be aware of. Also, while recovering, an employee could also prepare themselves to work from home.

With regard to a positive result, Ms. Ipavec-Levasseur said that information is changing all the time, given the lack of availability of PCR tests. However, when it is possible to get a test, a PCR usually is required at Desjardins, she said, adding that her company has had to adapt through each wave.

Marie-Chantal Côté, senior vice-president of group benefits at Sun Life, pointed out that even a positive test doesn’t necessarily mean a person can’t work; rather, they just can’t work from the office because they have to isolate. So having medical and occupational information supported by a doctor that an employee can’t perform their duties is critical for a disability claim.

Ms. Côté said most COVID-19 disability claims to her company have been short term. Desjardins found the same, with the majority being less than two weeks, according to Ms. Ipavec-Levasseur.

Throughout the pandemic, according to Ms. Ipavec-Levasseur, COVID-19 claims made to Desjardins went up and down with the waves. For example, she said, the first wave saw 10 times more claims filed specifically related to a diagnosis of infectious disease at Desjardins; from December, 2021 to March, 2022, they had 30 times more claims in the same category.

At this time, the overall volume of COVID-19 claims made to Desjardins and Sun Life appear to have stabilized. Ms. Weir said the CLHIA isn’t aware of a present surge either. Sarah Dulong, disability manager for Co-operators Group Ltd., is also seeing claims quiet down.

While there are “very few” long COVID-19 claims at Co-operators, a post-COVID-19 condition that PHAC says can occur weeks or months after infection, Mrs. Dulong said many individuals who contracted the virus are recovering before being eligible for disability benefits, given the typical seven-day waiting period for a claim to be made at her company.

Though there are “a lot of individuals doing home tests,” Mrs. Dulong said one isn’t currently a requirement at Co-operators for a claim. However, having the proper paperwork – a plan sponsor statement, plan member statement and physician statement – filled out is a requirement. The vital piece being a licensed doctor confirming work-preventing symptoms.

Early on in the pandemic, Mrs. Dulong said her company saw an increase in short-term claims from individuals who were not working because they were concerned about getting sick owing to an underlying health issue. Claims submitted as a precaution, or preventative measure against the virus, would not qualify for disability coverage, she said.

Another debilitating aspect of COVID-19 has been mental health. Prior to the pandemic, Ms. Côté said more than 30 per cent of long-term disability claims at Sun Life were related to mental health and that number is within the same space today – even “a little bit higher.”

At Desjardins, Ms. Ipavec-Levasseur said mental health made up 30 per cent of disability claims before the pandemic; now it’s almost 34 per cent. Mental health claims did go up and down a bit with the waves, however there was a notable spike in December, 2021 that continued to rise into March. She said they’re seeing a “delayed effect” in both short and long-term disability related to mental health.

“The really significant mental health impact is just coming out now and this is where we’re seeing really significant changes,” she said.

Desjardins saw a 5-per-cent increase overall in long-term disability claims from December, 2019 to December, 2021. And mental-health claims went up 20 per cent from March, 2020 to March, 2022.

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