Veterans of disability insurance will likely remember the uncertainty and disruption the industry experienced in the 1990s due to the rise of claims citing functional somatic syndrome (FSS), such as fibromyalgia, chronic fatigue syndrome, Lyme disease, irritable bowel syndrome, and several others. FSS refers to a group of chronic diagnoses with no identifiable organic cause, but rather that are reached by the exclusion of all other likely diagnoses. The subjectivity of these claims sent powerful ripples through the industry and caused us to reevaluate how we make disability claim decisions.
Nearly a year and a half into the COVID-19 pandemic, we are beginning to see the impact of long-haul COVID on LTD claim filings. As we consider these claims and the symptoms leading to functional limitations, we start to feel a certain sense of déjà vu. Shortness of breath, fatigue, difficulty thinking and concentrating, cough, chest and/or stomach pain, headache, heart palpitations, joint and/or muscle pain, pins and needles, diarrhea, sleep problems – a list of symptoms that, for all intents and purposes, could just as easily point to FSS.
As we approach what will most certainly be a landslide of long-haul COVID claims, it behooves us to take a look back and consider what we learned in the 90s and the decades that followed about how to manage FSS claims, including what worked and what we may need to reconsider in our new normal.
Contract Language
In response to the dramatic increase in FSS claims in the 90s, a number of carriers implemented a subjective symptom limitation provision to their policies. This clause can be invoked when a claimant describes a disability based on self-reported symptoms with limited to no objective medical evidence present. This can occur when there is no standardized test to confirm a diagnosis, when diagnostic tests are not conclusive, or the claimant’s medical record is simply incomplete as it relates to these symptoms. The provision allows the disability insurer to cap the benefit payment period, generally to 12-24 months.
This begs the question as to whether or not it will be appropriate to invoke this clause for long-haul COVID. Technically, many cases of long-haul COVID could apply to the strict definition of this provision – particularly when you consider that, early in the pandemic, many individuals couldn’t or didn’t receive a formal COVID-19 diagnosis, due to the shortage of tests. However, carriers will need to decide if this is culturally or ethically the right move for their organizations. Unlike FSS – especially in the early days – long-haul COVID is almost universally considered to be a legitimate and impairing condition. Limiting benefits to those impacted could be risky decision, as well as one with potentially unfavorable public opinion.
Clinical Evaluation
The surge of FSS claims in the 1990s was a great lesson in the importance of objectifying subjective medical reports, as it related to disability claims. It necessitated correlating patients’ self-reported symptoms with clinical observation and analysis, and to assess function in an unbiased manner. This demonstrated the critical need for individuals with this unique skill set and truly able to independently evaluate function as it related to symptoms. Subsequently, the need for outside, independent file reviews grew.
As we enter a period of evaluating long-haul COVID claims, we will need to keep to these strict disciplines of clinical review. Fortunately, one change in the medical community serves us in this mission. In the 90s, the “mystery” of FSS led to many claimants seeing multiple – and sometimes dozens – of individual specialists, as each sought to narrow down the root cause of the symptoms. Today, medical practitioners are more practiced at nebulous symptoms and often a single provider is capable of treating the whole person and their associated symptoms, leading to more streamlined medical records and the ability to conduct a more efficient review.
Consistent with both FSS and long-haul COVID, symptoms can be confusing, inconsistent, and overwhelming. This is fertile ground for claimants developing behavioral health concerns, including depression and anxiety, as comorbid conditions. This can serve to increase the complexity of evaluating and administering these claims, again pointing to the value of having seasoned, skilled professionals in the position of managing these claims.
Return to Work Accommodations
Given the similarity of symptoms, many of the return-to-work accommodations we would recommend for those suffering from FSS also apply to those contending with long-haul COVID. However, 30 years after the initial surge of these claims, our ability to provide accommodations has changed. In both cases, the limitations suggest that work functions requiring less energy, as well as more routine roles with fewer physical demands will be more successful for the claimants. Additionally, roles that can be performed from home and that limit travel are preferred.
Back in the 90s, “remote work” was a foreign concept and jobs that enabled claimants to work from their homes were few and far between. This led to longer claim durations and – often – meant that attempts to return to work were unsuccessful. We’re now in a far better position to offer ample accommodations to those experiencing long-haul COVID, vastly increasing the likelihood of getting claimants comfortably and sustainably back to work.
To date we have not contended with a high volume of long-haul COVID claims and this new reality will no doubt carry with it its own set of unique challenges and issues to solve. Taking pause to consider how we managed through past periods of uncertainty and learning from the successes within that history will most certainly serve us going forward and help to define what comes next.
