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飽受“長期新冠”后遺癥困擾,算工傷嗎?

飽受“長期新冠”后遺癥困擾,算工傷嗎?

Megan Leonhardt 2021年08月17日
能否因為新冠肺炎長期癥狀而獲得勞工賠償,取決于你所從事的工作和你的居住地。

距離凱麗?馬丁從一名假陰性患者那里感染新冠病毒,已經過去了大約10個月的時間。在此期間,她一直沒有工作。

在新冠肺炎疫情爆發之前,馬丁主要在新生兒重癥監護病房擔任呼吸治療師。但隨著越來越多的新冠肺炎患者涌入她工作的薩克拉門托醫院,對她的技能的需求越來越高,馬丁在重癥監護室和退伍軍人新冠病毒病房服務,使她站在疫情的第一線。

去年11月,她有兩個晚上都在治療一名患者。這名患者最初新冠檢測呈陰性,但最終檢測卻變成了陽性。馬丁告訴《財富》雜志:“有一天晚上我回家后就病倒了,因為我感覺不太好,頭痛得厲害。第二天早上起床之后,我已經失去了嗅覺或味覺,當時我的想法是:‘壞了,我感染新冠病毒了。’”

在最嚴重的初期癥狀消失之后,馬丁繼續在家等待康復,她表示自己還是感覺不佳。事實上,她在12月擔心自己患上了肺栓塞,曾經去醫院就診。醫生沒有發現栓塞,但掃描發現她的心臟有炎癥。

55歲的凱麗?馬丁于2020年11月在工作中感染了新冠肺炎。在那之后,她一直備受長期新冠肺炎癥狀的折磨。圖片來源:Courtesy of Kary Martin

她此后一直承受著長期新冠肺炎癥狀的影響,即所謂的“新冠肺炎急性期后綜合癥”。這意味著馬丁一直在看專家、接受肺臟康復和去一家神經科診所治療,主要接受物理治療、職業療法和語言矯正,以幫助緩解腦霧和記憶問題。馬丁說:“有一個很棒的團隊一直在幫助我,但他們也是在不斷學習。”

她希望能夠在年底之前回到工作崗位,但目前她覺得自己無法勝任曾經的工作。馬丁表示:“現在我對于患者而言并不安全。”她目前的收入來自勞工賠償,包括60%的工資,以及所有醫療費用。

馬丁稱:“這是一筆沉重的經濟負擔。”但她也認為自己很幸運,不必為了爭取勞工賠償向雇主抗爭,而且雇主盡快批準了所有治療方案。

最近,像馬丁這樣的上班族申請勞工賠償變得更容易,但并非所有人都如此幸運。你能否因為新冠肺炎長期癥狀而獲得勞工賠償,取決于你所從事的工作和你的居住地,結果存在巨大差異。

各州規定不同

馬丁在美國加州工作,該州在2020年9月通過了多項法律,要求大部分雇主認定感染新冠病毒的現場員工,包括急救人員、農業工人、食品雜貨店員工和倉庫員工等,系在工作場所染病,因此有權獲得勞工賠償。

各州對于勞工賠償的規定差異巨大。據美國國家賠償保險委員會(National Council on Compensation Insurance)統計,約有16個州頒布或通過立法,認定感染新冠肺炎等傳染病的員工系在工作場所染病,并允許其申領勞工賠償。

許多法律為護士、醫生、急救人員和餐廳與零售員工等必要工作者,在感染新冠肺炎之后申領勞工賠償提供了便利。但這些法律并沒有覆蓋所有人。

美國國家賠償保險委員會的高級部門主管杰夫?埃丁格告訴《財富》雜志:“各州法律規定不同,但如果員工可以證明其在雇傭期間感染新冠肺炎,他們就有權領到賠償。”

申領新冠補助存在特殊的難度

將新冠確診病例與工作直接關聯很有挑戰性。新冠病毒很容易傳播,尤其是新的德爾塔變種病毒,因此要證據確鑿地證明一名員工在工作中感染了病毒往往并不容易。正如埃丁格所說,員工可能是在派對、運動會或者音樂會上染病,那么他們該如何向雇主證明自己是在工作中被感染的呢?

此外,有些員工可能并沒有提交初步申領表,因為他們感染之后的癥狀并不嚴重。他們在幾個月后申請賠償,是由于持續的長期新冠肺炎癥狀。利寶互助保險(Liberty Mutual)指出,保險公司需要經過長時間調查才能夠確定是否理賠。

但在申領勞工賠償方面,新冠肺炎感染者也是一個特例。Sedgwick Claims Management Services的首席理賠官馬克思?庫恩斯說:“絕大多數[勞工賠償]索賠都與肌肉損傷有關。這類損傷有明確的治療方案;對于使用的藥物有循證用藥指南,因此你對于索賠處理和藥物治療方案有明確的把握。”

然而,新冠病毒是一種新型病毒,有多種癥狀,持續時間長度不同,而且有各種潛在治療方案。庫恩斯稱:“常見的勞工索賠所涉及的損傷并不會像新冠肺炎一樣出現長期癥狀或表現。”

《華爾街日報》(Wall Street Journal)在2月發現,大部分與新冠肺炎有關的勞工賠償索賠被拒絕理賠,比例高達56%。韋萊韜悅(Willis Towers Watson)的報告發現,一家大型理算公司的拒賠率更低:全國新冠相關索賠的拒賠率為37%,但在新冠肺炎疫情之前的拒賠率為11%。

2020年,美國國家賠償保險委員會的行業狀況報告顯示,2020年與新冠肺炎疫情有關的勞工索賠數量超過45,000件。

但埃丁格表示,絕大多數索賠的數額較小,有些病例不需要住院治療,索賠者只是暫時離崗幾天或一周時間。

他補充說,事實上只有約1%的索賠數額較高,總計超過10萬美元,提起這類索賠的勞工已經罹患新冠肺炎較長時間。但這1%的索賠占了總賠償金額的60%。

埃丁格稱:“盡管有些索賠數額巨大,但由于數量較少,因此我認為這不會對勞工賠償系統的總體成本產生影響。”

并非所有人均申領了勞工賠償

勞工賠償系統并沒有因為勞工的索賠而崩潰,部分原因可能是有些勞工沒有嘗試提交申請。弗蘭?希爾豪斯是賓夕法尼亞州一家殘疾人護理機構的護理員。11月,包括希爾豪斯在內有多名員工感染新冠病毒。

她感染之后的初期癥狀非常嚴重,接受了住院治療,被迫停工了約四個月。但雇主拒絕承認她是在工作場所感染了新冠病毒,甚至不支持她申領失業補助。希爾豪斯回憶說:“他們在我住院期間要我提交資料,但我隨身攜帶的只有一部手機。在住院期間我什么也做不了。”

在《家庭和醫療假期法案》(Family and Medical Leave Act)規定的無薪假期結束之后,希爾豪斯說她不得不回到工作崗位。她表示:“他們說:‘你的假期已經結束了,回來上班,否則你將被開除,但我們非常歡迎你再次申請這個崗位。’”由于擔心失業或陷入財務困境,希爾豪斯說她別無選擇,只能回去上班,盡管她一直存在腦霧和疲勞等癥狀。

依舊是未知領域

雖然到目前為止,與新冠肺炎有關的大部分索賠金額相對較小,但隨著長期新冠肺炎感染病例增多,這種情況可能會發生變化。英國發布的一份報告估計,存在長期新冠肺炎癥狀的患者占檢測呈陽性患者的2.3%至37%。

如果存在長期新冠肺炎癥狀的患者比例繼續提高,它可能產生廣泛的影響。加利福尼亞州勞工賠償保險費率管理局(Workers’ Compensation Insurance Rating Bureau of California )分析了潛在成本影響,并預計假定員工在工作中感染新冠病毒,保險業將為勞工賠償索賠支付的成本高達12億美元。與此同時,美國國家賠償保險委員會在去年發現,保險公司申報的因為新冠肺炎疫情而導致的總損失為2.6億美元。

但庫恩斯指出,到目前為止的數據顯示勞工賠償系統中并沒有出現大量存在長期新冠肺炎癥狀的患者。他說:“我認為存在長期新冠肺炎癥狀的患者數量會有一定程度的增加,但我無法確定增長的幅度。”

新冠肺炎疫情的不確定性意味著有許多勞工很難得到急需的幫助和支持。馬丁是長期新冠肺炎癥狀聯盟(Long COVID Alliance)的成員,她表示自己曾經見過令人心碎的故事。該聯盟是旨在幫助人們應對長期新冠肺炎癥狀的支持小組。

馬丁表示:“有許多人渴望得到醫療救助,但他們沒有保險,或者雇主不承認他們在工作中感染病毒。人們的遭遇很可怕。我確實非常幸運。”

她希望能夠在幾個月后重新回到工作崗位,但她依舊無法確定具體的時間。馬丁說:“我一直在嘗試做到積極樂觀,因為這是一段負面的經歷。”她補充說自己需要確信在黑暗盡頭還有一線光芒。(財富中文網)

翻譯:劉進龍

審校:汪皓

距離凱麗?馬丁從一名假陰性患者那里感染新冠病毒,已經過去了大約10個月的時間。在此期間,她一直沒有工作。

在新冠肺炎疫情爆發之前,馬丁主要在新生兒重癥監護病房擔任呼吸治療師。但隨著越來越多的新冠肺炎患者涌入她工作的薩克拉門托醫院,對她的技能的需求越來越高,馬丁在重癥監護室和退伍軍人新冠病毒病房服務,使她站在疫情的第一線。

去年11月,她有兩個晚上都在治療一名患者。這名患者最初新冠檢測呈陰性,但最終檢測卻變成了陽性。馬丁告訴《財富》雜志:“有一天晚上我回家后就病倒了,因為我感覺不太好,頭痛得厲害。第二天早上起床之后,我已經失去了嗅覺或味覺,當時我的想法是:‘壞了,我感染新冠病毒了。’”

在最嚴重的初期癥狀消失之后,馬丁繼續在家等待康復,她表示自己還是感覺不佳。事實上,她在12月擔心自己患上了肺栓塞,曾經去醫院就診。醫生沒有發現栓塞,但掃描發現她的心臟有炎癥。

她此后一直承受著長期新冠肺炎癥狀的影響,即所謂的“新冠肺炎急性期后綜合癥”。這意味著馬丁一直在看專家、接受肺臟康復和去一家神經科診所治療,主要接受物理治療、職業療法和語言矯正,以幫助緩解腦霧和記憶問題。馬丁說:“有一個很棒的團隊一直在幫助我,但他們也是在不斷學習。”

她希望能夠在年底之前回到工作崗位,但目前她覺得自己無法勝任曾經的工作。馬丁表示:“現在我對于患者而言并不安全。”她目前的收入來自勞工賠償,包括60%的工資,以及所有醫療費用。

馬丁稱:“這是一筆沉重的經濟負擔。”但她也認為自己很幸運,不必為了爭取勞工賠償向雇主抗爭,而且雇主盡快批準了所有治療方案。

最近,像馬丁這樣的上班族申請勞工賠償變得更容易,但并非所有人都如此幸運。你能否因為新冠肺炎長期癥狀而獲得勞工賠償,取決于你所從事的工作和你的居住地,結果存在巨大差異。

各州規定不同

馬丁在美國加州工作,該州在2020年9月通過了多項法律,要求大部分雇主認定感染新冠病毒的現場員工,包括急救人員、農業工人、食品雜貨店員工和倉庫員工等,系在工作場所染病,因此有權獲得勞工賠償。

各州對于勞工賠償的規定差異巨大。據美國國家賠償保險委員會(National Council on Compensation Insurance)統計,約有16個州頒布或通過立法,認定感染新冠肺炎等傳染病的員工系在工作場所染病,并允許其申領勞工賠償。

許多法律為護士、醫生、急救人員和餐廳與零售員工等必要工作者,在感染新冠肺炎之后申領勞工賠償提供了便利。但這些法律并沒有覆蓋所有人。

美國國家賠償保險委員會的高級部門主管杰夫?埃丁格告訴《財富》雜志:“各州法律規定不同,但如果員工可以證明其在雇傭期間感染新冠肺炎,他們就有權領到賠償。”

申領新冠補助存在特殊的難度

將新冠確診病例與工作直接關聯很有挑戰性。新冠病毒很容易傳播,尤其是新的德爾塔變種病毒,因此要證據確鑿地證明一名員工在工作中感染了病毒往往并不容易。正如埃丁格所說,員工可能是在派對、運動會或者音樂會上染病,那么他們該如何向雇主證明自己是在工作中被感染的呢?

此外,有些員工可能并沒有提交初步申領表,因為他們感染之后的癥狀并不嚴重。他們在幾個月后申請賠償,是由于持續的長期新冠肺炎癥狀。利寶互助保險(Liberty Mutual)指出,保險公司需要經過長時間調查才能夠確定是否理賠。

但在申領勞工賠償方面,新冠肺炎感染者也是一個特例。Sedgwick Claims Management Services的首席理賠官馬克思?庫恩斯說:“絕大多數[勞工賠償]索賠都與肌肉損傷有關。這類損傷有明確的治療方案;對于使用的藥物有循證用藥指南,因此你對于索賠處理和藥物治療方案有明確的把握。”

然而,新冠病毒是一種新型病毒,有多種癥狀,持續時間長度不同,而且有各種潛在治療方案。庫恩斯稱:“常見的勞工索賠所涉及的損傷并不會像新冠肺炎一樣出現長期癥狀或表現。”

《華爾街日報》(Wall Street Journal)在2月發現,大部分與新冠肺炎有關的勞工賠償索賠被拒絕理賠,比例高達56%。韋萊韜悅(Willis Towers Watson)的報告發現,一家大型理算公司的拒賠率更低:全國新冠相關索賠的拒賠率為37%,但在新冠肺炎疫情之前的拒賠率為11%。

2020年,美國國家賠償保險委員會的行業狀況報告顯示,2020年與新冠肺炎疫情有關的勞工索賠數量超過45,000件。

但埃丁格表示,絕大多數索賠的數額較小,有些病例不需要住院治療,索賠者只是暫時離崗幾天或一周時間。

他補充說,事實上只有約1%的索賠數額較高,總計超過10萬美元,提起這類索賠的勞工已經罹患新冠肺炎較長時間。但這1%的索賠占了總賠償金額的60%。

埃丁格稱:“盡管有些索賠數額巨大,但由于數量較少,因此我認為這不會對勞工賠償系統的總體成本產生影響。”

并非所有人均申領了勞工賠償

勞工賠償系統并沒有因為勞工的索賠而崩潰,部分原因可能是有些勞工沒有嘗試提交申請。弗蘭?希爾豪斯是賓夕法尼亞州一家殘疾人護理機構的護理員。11月,包括希爾豪斯在內有多名員工感染新冠病毒。

她感染之后的初期癥狀非常嚴重,接受了住院治療,被迫停工了約四個月。但雇主拒絕承認她是在工作場所感染了新冠病毒,甚至不支持她申領失業補助。希爾豪斯回憶說:“他們在我住院期間要我提交資料,但我隨身攜帶的只有一部手機。在住院期間我什么也做不了。”

在《家庭和醫療假期法案》(Family and Medical Leave Act)規定的無薪假期結束之后,希爾豪斯說她不得不回到工作崗位。她表示:“他們說:‘你的假期已經結束了,回來上班,否則你將被開除,但我們非常歡迎你再次申請這個崗位。’”由于擔心失業或陷入財務困境,希爾豪斯說她別無選擇,只能回去上班,盡管她一直存在腦霧和疲勞等癥狀。

依舊是未知領域

雖然到目前為止,與新冠肺炎有關的大部分索賠金額相對較小,但隨著長期新冠肺炎感染病例增多,這種情況可能會發生變化。英國發布的一份報告估計,存在長期新冠肺炎癥狀的患者占檢測呈陽性患者的2.3%至37%。

如果存在長期新冠肺炎癥狀的患者比例繼續提高,它可能產生廣泛的影響。加利福尼亞州勞工賠償保險費率管理局(Workers’ Compensation Insurance Rating Bureau of California )分析了潛在成本影響,并預計假定員工在工作中感染新冠病毒,保險業將為勞工賠償索賠支付的成本高達12億美元。與此同時,美國國家賠償保險委員會在去年發現,保險公司申報的因為新冠肺炎疫情而導致的總損失為2.6億美元。

但庫恩斯指出,到目前為止的數據顯示勞工賠償系統中并沒有出現大量存在長期新冠肺炎癥狀的患者。他說:“我認為存在長期新冠肺炎癥狀的患者數量會有一定程度的增加,但我無法確定增長的幅度。”

新冠肺炎疫情的不確定性意味著有許多勞工很難得到急需的幫助和支持。馬丁是長期新冠肺炎癥狀聯盟(Long COVID Alliance)的成員,她表示自己曾經見過令人心碎的故事。該聯盟是旨在幫助人們應對長期新冠肺炎癥狀的支持小組。

馬丁表示:“有許多人渴望得到醫療救助,但他們沒有保險,或者雇主不承認他們在工作中感染病毒。人們的遭遇很可怕。我確實非常幸運。”

她希望能夠在幾個月后重新回到工作崗位,但她依舊無法確定具體的時間。馬丁說:“我一直在嘗試做到積極樂觀,因為這是一段負面的經歷。”她補充說自己需要確信在黑暗盡頭還有一線光芒。(財富中文網)

翻譯:劉進龍

審校:汪皓

It’s been about 10 months since Kary Martin caught COVID-19 from a patient who had a false negative. And since then, she hasn’t worked.

Prior to the COVID-19 pandemic, Martin served primarily as a respiratory therapist in a newborn intensive care unit. But with her skills in high demand as more and more COVID patients flooded the Sacramento-based hospital where she worked, Martin served in intensive care and step-down COVID units, putting her on the front lines of the pandemic.

Last November, she spent a couple of nights working with a patient who initially tested negative for COVID, but eventually tested positive. “I ended up going home sick one night because I just was not feeling good—I had this massive headache. The next morning I woke up, and I couldn’t smell anything or taste anything, and I’m like, ‘Shit, I’ve got COVID,’” Martin told Fortune.

Even once the worst of her initial COVID symptoms had passed while she convalesced at home, Martin said she still didn’t feel right. In fact, she went to the hospital in December worried she had a pulmonary embolism. While they didn’t find an embolism, scans showed heart inflammation.

Since then, Martin has been dealing with the effects of long COVID, also known as post-acute COVID-19 syndrome. That means Martin has been doing everything from seeing specialists to attending pulmonary rehab and a neuro clinic, which focus on physical therapy, occupational therapy, and speech therapy to help relieve some of the brain fog and memory issues. “I have a great team that’s helping me, but they’re all learning,” Martin said.

She’s hopeful that she’ll be back to work by the end of this year, but right now, she doesn’t feel she can do her job. “Right now I’m not safe with patients,” Martin said. Instead, she’s on workers’ compensation, which pays about 60% of her salary and takes care of the medical expenses.

“It is a financial burden,” Martin said, but added that she’s lucky—she didn’t have to fight with her employer to provide workers’ comp, and it has approved every treatment without pushback.

It’s recently become easier for workers like Martin to file for workers’ comp, but not everyone is so fortunate. Whether you can get workers’ comp for long COVID varies widely, depending on your job and where you live.

Different states, different rules

Martin works in California, which passed laws in September 2020 that require most employers to presume an in-person worker who contracts COVID-19—including first responders, farmworkers, grocery store employees, and warehouse workers—did so in the workplace and is therefore covered by workers’ comp.

Workers’ comp rules vary dramatically state by state. About 16 states have introduced or passed legislation that would allow employees who suffer from a communicable disease like COVID-19 to file workers’ compensation claims presuming they contracted their illness at work, according to the National Council on Compensation Insurance.

Many of these laws have made it easier for essential workers—nurses, doctors, first responders, and restaurant and retail employees—to receive workers’ comp after falling ill with COVID-19. But not everyone is covered.

“State laws do differ, but if an employee can show that they contracted COVID In the course of their employment, then their claim will be paid,” Jeff Eddinger, NCCI’s senior division executive, told Fortune.

COVID claims can present unique challenges

Tying a case of COVID-19 directly to work can be challenging. Because this virus is contracted so easily, especially the new Delta variant, proving beyond a shadow of a doubt that an employee caught it at work can often be tricky. As Eddinger noted, workers can potentially catch it anywhere—at a party, a sporting event, or a concert—so how do they prove to their employer that they caught it on the job?

Additionally, some employees may not have filed an initial claim form because they didn’t get a severe case when they contracted COVID. Instead, they file a claim months later because of ongoing symptoms of long COVID. Liberty Mutual notes that deciding whether or not to accept these types of claims may involve extended investigation.

But COVID cases are also a different breed when it comes to navigating the workers’ comp system. “The vast majority of [workers’ comp] claims are really muscular type injuries,” said Max Koonce, chief claims officer with Sedgwick Claims Management Services. “When you look at those injuries, they have a very established protocol as to how they’re treated; they have evidence-based medicine guidelines that they use, so you have a pretty good idea of the way the claim is going to go as far as with medical treatment,” Koonce noted.

With COVID, however, it’s a brand-new virus with multiple symptoms, varying lengths, and a whole host of potential treatment options. “Your typical workers’ compensation injuries don’t have these long-term symptoms or conditions that you’re seeing creep up within the COVID environment,” added Koonce.

The Wall Street Journal found in February that a significant number of workers’ comp claims related to COVID-19 have been denied—up to 56% in some instances. A report from Willis Towers Watson found that the denial rate at one major claims adjuster was much lower: 37% COVID-only claims were denied nationwide, compared with denial rates of 11% prior to the pandemic.

Overall, workers filed more than 45,000 COVID-related claims in 2020, according to NCCI’s State of the Line report.

Yet the vast majority of those COVID-19 claims are very small, Eddinger said, noting that those cases are ones that don’t require hospitalization in which workers are only out of work for a few days or a week.

In fact, only about 1% of claims turned into expensive claims totaling over $100,000 where a worker was sick with COVID-19 for a very long time, he added. But those 1% of claims accounted for 60% of the total payouts.

“Even though there are some claims that ended up being very expensive, because there’s so few of them, I wouldn’t expect there to be a measurable impact on the total workers’ comp system costs,” Eddinger said.

Not everyone files for workers’ comp

Part of the reason that these COVID claims aren’t overwhelming the system could be that some workers aren’t even bothering to attempt to file. Fran Highhouse works as a caregiver at a Pennsylvania-based facility for those with disabilities. In November, a few workers came down with COVID-19, including Highhouse.

Her initial infection was so bad that she was hospitalized and ended up out of work for about four months. But her employer refused to admit she contracted COVID at work and even fought her unemployment claim. “They were demanding documentation while I was still in the hospital, and the only thing on me was a cell phone. I wasn’t capable of doing anything while I was in there,” Highhouse recalled.

Once she had used up her unpaid time off through the Family and Medical Leave Act, Highhouse said she had to return to work. “They said, ‘Your FMLA is up, you come back to work or you’re terminated, but you’re more than welcome to apply again,’” Highhouse said. Worried she wouldn’t get unemployment or disability, Highhouse said financially, she had no option but to go back, despite lingering brain fog and fatigue.

Still in uncharted territory

While most of the COVID claims have been relatively small so far, there’s a chance that could change as long COVID cases develop. Estimates of the number of patients who suffer from long COVID range from 2.3% to 37% of those who test positive, according to a report published in the U.K.

If the percentage of patients who suffer from long COVID ends up on the higher side, it could have widespread consequences. The Workers’ Compensation Insurance Rating Bureau of California examined the potential cost impact and estimated that presuming employees contracted COVID at work could cost the industry $1.2 billion in workers’ comp claims. Meanwhile, NCCI found that last year, carriers reported $260 million in total COVID-19 incurred losses.

But so far, Koonce says that the data doesn’t show an overwhelming number of long COVID cases in the workers’ comp system. “I think inevitably there will be some type of uptick," he said, "and how big it is, I don’t know.”

Yet the uncertainty of COVID means there are many workers out there who are struggling to get the help and support they need. A member of the Long COVID Alliance, a support group for those navigating the effects of long COVID, Martin says she’s seen heartbreaking stories.

“There are so many people that are just desperate for medical help, and they don’t have insurance or their job does not acknowledge their exposure for work. There are horror stories. I’m really blessed,” Martin said.

She hopes to be back to work in a few months, but she’s still unsure of that timeline. “I’m trying to be really positive because this has been such a negative experience,” Martin said, adding she needs to believe there’s a light at the end of the tunnel.

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