Long COVID and Returning to Work: A Hard, Frustrating Road

Many patients with long COVID, struck down by the condition on the job, remain out of work and are still waiting on the finalization of workers’ compensation claims. Several new studies suggested the problem may be striking more workers than previously estimated.

Around 16 million workers have been affected nationwide by long COVID. Many who initially contracted the virus as a result of their jobs are left with the additional burden of proving that they acquired the condition in the workplace. Without it, they may be unable to file a claim for workers’ compensation insurance, which provides benefits to employees who are injured or become ill on the job.

Patients with long COVID are costly because they see doctors more often and are less likely to have their claims covered by workers’ compensation insurance. Experts contend that, in order for claims to be covered by insurance, physicians need standardized diagnostic tests to prove patients have the condition as well as FDA-approved treatments that insurance companies are more likely to cover, and regulations that mandate coverage either federally or at the state level. This way, patients can get the care they need to return to work.

Many Workers Sickened on the Job

In states like California, patients with long COVID claims made up 5% of all California workers’ compensation claims but accounted for a whopping 82% of medical treatment dollars. In New York, an analysis from the New York State Insurance Fund found more than 3100 workers’ compensation claims, and among them, 18% were unable to work for more than a year because of ongoing long COVID symptoms.

In all, around 6% of workers’ compensation claims nationwide have been for long COVID, but many of these patients have had trouble collecting benefits. An additional 4% of Medicare patients, a large percentage of whom are retired, have been diagnosed and not recovered from long COVID. Many patients may have been close to retirement and decided to retire after a struggle to get better.

“In California alone, long COVID workers’ compensation claims have cost upwards of $350.6 million, and it’s only going to get worse,” said Grace McComsey, MD, who leads one of the 15 nationwide long COVID centers funded by the federal Researching COVID to Enhance Recovery Initiative in Cleveland.

McComsey said that treatments will remain costly without more research to solve the problem of long COVID for the millions of workers who remain sick and can’t go back to work.

Charlie McCone, 35, of San Francisco, is one of those patients. He lost his job due to long COVID and now depends on his partner financially. He said he’s seen upwards of 30 physicians and goes to the doctor weekly, and more recently, monthly, in an effort to find effective treatments for his debilitating condition.

“As somebody who has never had any health problems before, you go from interacting with the healthcare system once a year to weekly,” said McCone. “It’s why long COVID patients are so costly.” McCone has yet to receive any disability benefits for his condition.

Tina Ridler, of Rochester, Minnesota, has been living with long COVID after a serious bout with acute COVID-19 in 2020. She went from working 60-80 hours weekly as a self-employed wellness center owner to a maximum of 20 hours.

“When you’re already sick, it’s scary to watch your access to treatment in flux,” said Ridler. At 60 years old, she’s on the cusp of retirement, but with so many bills to pay, she’s constantly financially stressed.

Patients Need Standardized Diagnostic Tests

Many of the patients filing workers’ compensation claims were in healthcare and consumer-facing businesses, such as workers in the restaurant and airline industries, said Nisha Viswanathan, MD, director of the University of California, Los Angeles Long COVID Program.

Long COVID is still a “diagnosis of exclusion,” so in order for patients to gain coverage, physicians must do a number of tests to rule out other undiagnosed medical conditions to help prove that long COVID is causing their symptoms.

“While I’m glad that these patients are getting recognition that their long COVID was a result of their jobs, I still see a lot of struggles,” said Viswanathan. 

Workers’ compensation companies have been pushing back on paying patient bills because there aren’t any diagnostic tests for long COVID, and workups for patients can be costly, and often, they’re still not covered, said Viswanathan.

FDA-Approved Treatments Are More Likely Covered

Viswanathan said that there’s no incentive for workers’ compensation companies to pay for treatments that they deem experimental and costly, which can be problematic when there are no FDA-approved long COVID treatments. A mandate of some sort of coverage at the state or federal level would also be helpful to protect patients, she added.

Treatments like low-dose naltrexone, which Viswanathan has found helpful for some of her patients suffering from pain, sleep issues, and fatigue, for example, aren’t approved long COVID treatments, and therefore, patients must pay for them out-of-pocket.

“What we really need are studies that validate treatments so that commercial insurance and workers’ compensation companies will cover them,” said Viswanathan.

That’s been a chicken-and-egg problem from the start because without research dollars, patients can’t secure approved treatments, and without approved treatments, patients can’t get better and go back to work full-time.

At the same time, the Trump Administration has slashed research funding along with access to treatments. In March, it closed the federal government’s Office of Long COVID Research and Practice as part of a larger restructuring of health agencies. Additionally, its 2026 budget plan included a 40% cut in National Institutes of Health spending and a 55% cut in the National Science Foundation budget.

Older Workers and Retirees Hit Hard

A study published in The Journals of Gerontology found that of 3,588,671 Medicare recipients, nearly 4%, or 140,000 patients, had been diagnosed with long COVID and had their symptoms for over a year. Medicare does cover treatments for long COVID, though not all patients have access to the specialists required for treatment.

According to the research, long COVID diagnoses in Medicare claims were common in a large sample of older adults. For David Putrino, PhD, a national leader in the treatment of long COVID at Mount Sinai Health System in New York City, it shows that older patients are still struggling. Many patients likely chose to retire because of their health. “The Medicare numbers are eye- catching,” said Putrino.

For physicians and patients alike, there’s a frustration that patients can’t get back to normal life because they’re not able to get better, and at the same time, the cost for their treatments is mounting.

“Understanding how costly this disease is, we should be all-in when it comes to researching effective treatments,” said McComsey.