COVID Long Haul Disability Claims: A Ticking Time Bomb

There have been 29.3 million cases of COVID-19 in the United States since the coronavirus pandemic was first reported in early 2020, according to the New York Times. In addition to the staggering fatality rate in America, this post-viral syndrome has also created a group of legitimately sick workers known as “long haulers.”

Long haulers are the people who continued to suffer from physical, cognitive or mental nervous symptoms weeks or months after their initial COVID diagnosis. These lingering and debilitating symptoms restrict and limit their ability to perform their occupations. In theory, long haulers should be able to receive long-term disability benefits from their employers, or from their own private disability policies, due to COVID. DarrasLaw can shed some light on why so many denials have occurred as we are the largest individual and group long term care firm in America. Further, we’ll discuss some preemptive steps to take to manage expectations, should there be a wrongful claim denial.

A Brief Root Cause Analysis

Unfortunately, a COVID infection is not always a one-and-done, simple respiratory affair. The mental and physical effects and symptoms of COVID can last for an extended period of time. The most commonly reported long-term symptoms are fatigue, muscle weakness, difficulty sleeping, new or increased bouts of anxiety and depression, shortness of breath, and cognitive dysfunction.

While each type of individual or group disability plan is unique, the Social Security Administration’s (SSA) definitions and standards for disabling conditions may be helpful as a reference. The SSA uses three key factors to determine if you qualify for Social Security disability benefits:

• You must have a medical condition that prevents you from doing the work that you did in the past or adjusting to other types of work;
• You must have worked long enough — and recently enough — in jobs covered by Social Security; and
• Your physical or mental impairment(s) must have lasted or be expected to last at least a year or result in death.

The third bullet is the one currently causing problems for disability claimants; COVID-19 was declared a pandemic barely a year ago in March 2020 – so meeting the SSA time limit is not yet possible for many long haulers. Unfortunately, the SSA has not updated its standards to reflect the pain and suffering in real-time with the virus. This leaves long haulers in a very challenging position.

What You Can Do

While disability advocates and legislators are calling on the SSA to update their policies and offer guidance for applicants, there are steps you can take before submitting a Covid-19-related claim. It is important to manage your expectations by planning for a denial, since they occur quite frequently and particularly when pertaining to COVID.

 Tip 1. Familiarize yourself with what it means to be disabled under your private policy or group employer-sponsored coverage. Sometimes, the difference between an approval and a denial depends on how you and your treating doctor describe and document your disabling health condition, and why you are disabled from the physical, mental, and cognitive demands of your occupation.

Tip 2. Investigate the fine print. Some short-term disability policies exclude specific health conditions such as mental health from coverage. Long-term disability policies may include the coverage but limit benefits to 12 months, while others pay mental nervous or self-reported claims for 24 months.

Tip 3. Document everything. Keep a calendar of every symptom, in-person and telehealth visit, COVID test, and work days missed. Keep receipts for every visit, script, treatment, and get copies of any objective testing, including blood work, sleep studies, functional capacity exams, etc. Providing financial evidence will further strengthen your initial claim or appeal.

Tip 4. Understand that exclusion is not always the end of the road—the policy may exclude a specific disabling condition, but not a disabling symptom associated with that condition, or vice-versa. This is where the claims process can be particularly complex, and an experienced disability lawyer really helps.

COVID Long Haulers, Hire an LTD Lawyer to Help File Your Claim and Get Paid

Every short- and long-term group disability insurance policy contains a definition of what it means for a worker to be disabled and what is required to be eligible for benefits. A group disability insurance company will have concerns about disclosing particular information if it determines that your injury doesn’t fit their criteria or eligibility rules. An experienced disability lawyer can review your insurance policy to see if another covered injury, illness, or symptom might allow benefits.

The absolute best defense against a wrongful claim denial is to retain an experienced Employee Retirement Income Security Act (ERISA) attorney or bad faith lawyer to help you prepare your group or individual long-term disability benefits claim in the first place.

The award-winning individual and nationally renowned group long-term disability attorneys at DarrasLaw always offer a free disability policy analysis and free claim consultation. Our free service helps determine whether your individual, group or association related policy entitles you to short and/or long-term disability benefits. If you suffer from any type of mental or physical injury or illness that prevents you from performing the important duties of your occupation, call us today at (800) 898-7299 or contact us online.