Have COVID-19? It's best to keep a record for potential insurance claims

As Omicron continues to drive COVID-19 cases and hospitalizations up across the country, eligibility guidelines for PCR tests have changed and rapid tests are becoming increasingly scarce. Regardless of whether your COVID-19 illness was confirmed by a test, experts say it is best to keep a record of your diagnosis or assumed infection in case it leads to a longer absence from work and the need to make an insurance claim down the line.

Partner and national leader in employment and labour law at KPMG Law, Lisa Cabel, said that it is generally up to an employer or an insurer to set the standard of what is required and decide if it is necessary to prove that an individual had the virus.

“Now, given that PCR testing is more unavailable and may not be an option in many provinces, then I think the more detail an employee can provide their employer should suffice to demonstrate they had the virus,” Cabel said in a telephone interview with CTVNews.ca Thursday.

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Cabel said that could look different in each province and territory, but using Ontario as an example, she said the employee might complete the COVID-19 assessment tool and record those results and then follow public health guidelines on isolation.

Workers could also document when they were notified that they may have come in close contact with someone with COVID-19, when they took a rapid test (if applicable), when they tested positive (if applicable), when their period of isolation begins and ends and when they start having symptoms (if applicable).

However, with rapid tests scarce and PCR testing out of reach for many, Cabel said “employees may find themselves in the position of having symptoms and not being able to definitively confirm they have the virus.”

“In many ways I think the testing, the adjustments and revised testing guidelines should be a warning to employers to sort of look at what their standards are and really adjust to reflect what the current public health guidance is now, including access to testing,” Cabel said.

Cabel said in the past, even when PCR testing was more available, many employers were not asking workers to prove they had COVID-19, taking them at their word and asking them to follow public health guidelines -- but in some cases there may be a request to disclose test results.

However, Cabel noted there is currently no case law on the matter because of how new and rapidly evolving the circumstances of the pandemic are. But “typically, the law does prevent an employer from asking for proof of a diagnosis,” she said.

“Rather, an employer’s focus should be on the prognosis of when an employee became ill and when they’re expected to return – including whether there are any restrictions once the person has returned to work,” Cabel said in a follow-up email to CTVNews.ca.

Comparing it to standard practices many workplaces have regarding needing a doctor’s note for continued absence due to illness, Cabel said “the focus should be on the clearance to return to the workplace.”

A paper trail may prove important for health insurance and disability claims in the future as well.

CTVNews.ca reached out to several leading providers of health and life insurance in Canada to ask about policies regarding proof of diagnosis.

In an emailed statement to CTVNews.ca Thursday, a spokesperson for Canada Life said when the company assesses a disability claim they “consider the information provided by the individual, their healthcare practitioners and employer, if applicable, and the terms of their group or individual disability policy. We ask for any COVID-19 test results, if available.”

Canada Life said in the absence of test results, it will assess a claim based on the symptoms, required period of any self-isolation and the “impact of the individual’s medical condition on their functional abilities.”

Desjardins said it assesses situations on a case-by-case basis.

“For disability coverage, employees that are unable to work due to their symptoms (including telework), may apply for coverage,” the company said in a statement. “If the employee can’t provide a PRC test due to unavailability, Desjardins will accept as proof of disability a self-declaration including a picture, dated and signed, of a rapid test done at home.”

If the employee is also unable to get a rapid test, Desjardins said the individual may apply for insurance with “only a self-declaration form during times where rapid home tests are difficult to get.” The self-declaration forms will only be accepted to recognize an initial disability period that matches provincial public health recommendations, the statement said, generally ranging from five to 10 days, and contractual waiting periods will apply.

Desjardins said that longer periods of disability will require additional medical proof, but did not provide details.

“Desjardins is adjusting to evolving COVID-19 conditions on an ongoing basis,” the statement said.

Sun Life told CTVNews.ca in a statement that the company has been monitoring the evolving environment, including the development of new variants like Omicron, but that currently there are no changes to their policies.

“Clients are not asked to prove (via a test) if they have or are recovering from COVID-19,” the statement reads. “With PCR test shortages and backlogs across the country, our Group Benefits business is now accepting a positive rapid antigen test as confirmation of a COVID-19 diagnosis for short-term disability (STD) claims.”

“Across Sun Life, we continue to take a long-term view of risk. It’s too soon to fully understand what permanent changes the industry may need to make to our guidelines or requirements,” the statement said.