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Long COVID-19 & LTD Claims: Peril And Opportunity

COVID-19 and the emergence of long COVID has introduced a new medical condition into the world of long-term disability insurance: Long COVID. 

The potential chronic conditions caused by COVID-19 is at once one of the scariest aspects of the COVID-19 pandemic and the most unsettled, as shown by the many names for it: Long COVID, long-haul COVID, post-acute COVID, long-term effects of COVID, chronic COVID, and PASC (for Post-Acute Sequelae of SARS-CoV-2 infection). The community of Long COVID suffers commonly call themselves “long haulers.” The prevalence of Long COVID in different studies has ranged from 30% to more than 50% of those diagnosed with COVID-19.1 Major media outlets have already noted the problems long haulers have getting long-term disability benefits under group long-term disability plans and private disability insurance (“LTD claims”). 2 This article will discuss the challenges of establishing Long COVID LTD claims. I will also discuss how the research and awareness of long COVID might help claimants with other types of conditions with similar symptoms.

The list of Long COVID symptoms is extensive. The Centers for Disease control have identified that following Long COVID symptoms: difficulty breathing; tiredness and fatigue; brain fog; post-exertional malaise (symptoms that get worse after exercise); cough; chest or stomach pain; headache; heart palpitations; joint or muscle pain; pins-and-needles; diarrhea; sleep problems; fever; lightheadedness; rash; mood changes; change in smell or taste; change in menstrual cycles.3

Long COVID Symptoms Are Similar to Other Conditions that LTD Insurers Are Skeptical Of

Anyone experienced with long-term disability appeals who reviews this list will immediately see why many COVID long haulers are likely to have the same challenges experienced by claimants with conditions like fibromyalgia, chronic fatigue, or the early stages of chronic diseases such as multiple sclerosis or Parkinson’s disease. Cognitive issues and brain fog are common to all these conditions. But proving brain fog is difficult, as these cognitive impairments are not the type of extreme cognitive deficits that can be shown by a neuropsychological exam, but they can make it very difficult to work. Fatigue can also be hard to prove, as there is no objective measure for fatigue, and it can vary day to day. As an experienced long-term disability appeals lawyer, I expect that insurers will make the same arguments to deny claims of disability based on long COVID as for these other conditions.

Some victims of Long COVID should not have these challenges if they have symptoms that can be shown with objective testing: lung damage can be shown on MRIs and lung function can be measured objectively by tests such as spirometry. Cardiac damage can be shown by cardiac MRIs or cardiopulmonary exercise tests.4 But studies have shown that fewer than half of COVID Long Haulers have verifiable organ damage. Those who have functional impairment which may not be subject to objective testing could have a harder time getting long-term disability insurers to accept their claim.5

How to Prove I Have Long COVID?

For some Long Haulers, even establishing that one has Long COVID will be a challenge. It may be a challenge to even establish that you had COVID, much less that you suffer from Long COVID. One Stamford Connecticut long-term disability client of mine believes he had COVID early in the outbreak, but he did not have a fever. In the early days of the outbreak doctors believed a fever always accompanied COVID and sought to conserve scarce COVID testing resources by only testing if the patient had a fever. So, this client can’t even establish that he had COVID. He has several other conditions that we were able to prove, and we won his appeal. But others might not have such conditions and would have great difficulty proving that they even had COVID, much less establishing that they are disabled due to COVID.

How Long COVID is diagnosed can also be a challenge. Long COVID can be a “disease of exclusion,” which means it’s a diagnosis made after excluding all possible alternative diagnoses that could cause the symptoms.6 In my LTD appeal practice, I’ve found insurers are particularly skeptical of diagnoses of exclusion, as they want to explain symptoms that are not tied to a specific diagnosis to malingering or mental illness rather than an illness.

How to Prove Long COVID Disables You from Your Job?

With every long-term disability claim or appeal, the diagnosis is only the first step.  As the insurers like to say, a disability does not equal a disability – you must still show that the diagnosed condition keeps you from performing your job. 

  • Long Haulers who can show impaired cardiopulmonary function, as discussed above, shouldn’t have a challenge establishing that they suffer from Long COVID.  But it is important to show how the impairments specifically relate to your job. For instance, I won an appeal for a security guard whose job was mostly sedentary but did require the ability to run to respond to emergencies occasionally.  By having her take a spirometry test, we were able to show she could not do this aspect of the job. 
  • Brain fog is one of the most difficult impairments to prove.  It is a common symptom of many other conditions, including chronic fatigue syndrome and early stages of other chronic diseases.  Neuropsychological exams are used to diagnose the existence and severity of neurocognitive disorders like brain fog, and it is hard to get insurers to accept cognitive problems without a neuropsych exam showing impairment.  But, as I tell my clients, neuropsych exams are a rough ruler, and may not show some cognitive impairments that are too subtle to show up on the test but can still be quite disabling.  For a Wall Street bond trader, a 5% reduction in cognitive ability, while unlikely to show up on a neuropysch, can slow her down enough that she can no longer perform her job.   A symptom log, specifically describing incidents that illustrate your cognitive impairments, can be useful, as well as statements from those who know you, particularly work supervisors, who can submit a statement of what they have witnessed about your impairments.  As a Connecticut LTD appeal lawyer, I can recommend great neuropsychologists in the area that I have worked with, but sometimes a neuropsych exam isn’t sensitive enough to show a disabling cognitive impairment. 
  • Fatigue can also be a challenging impairment to prove due to the lack of objective evidence of fatigue.  A cardiopulmonary exercise test can sometime show exertional malaise or other cardiac dysfunction if the heart over or under reacts to exercise, but that is not always the case.  If not, again a symptom log can be a great way to establish fatigue as a disabling condition.
  • General pain can also be difficult to prove.  Sometimes a functional capacity exam (a test of the physical aspects of a job) can show incapacity to do physical tasks, but some people may be able to do physical tasks, but at the cost of great pain.  Again, an impairment log that discusses specific things that cause disabling pain can be useful.

To successfully file a claim for LTD benefits for Long COVID or to win an appeal of a denial requires an individual and comprehensive strategy to prove a diagnosis and the impairments resulting from the diagnosis that prevent you from performing your job.  This differs for every claimant.  A long-term disability lawyer who has experience proving disability from difficult conditions can develop this strategy, which can include testing to establish a diagnosis and quantify impairments, statements from doctors, and functional tests. 

What Are the Opportunities Long-COVID Presents?

Insurance companies, doctors, courts and the general public have been skeptical of conditions like chronic fatigue syndrome or fibromyalgia/myalgic encephalomyelitis that do not have a clear physical cause. In my experience, those who suffer from these conditions avoid discussing them because they don’t want to be its “just in your head.” The impairments these conditions cause can cause sufferers of the conditions to lead isolated lives. That means many people may not realize they know people who suffer from these conditions. Lastly, funding levels for these conditions have been subject to controversy.

I believe the publicity regarding Long COVID and funding for research could help those who suffer from other conditions that don’t have a clear physical cause. Due to the extent of the COVID pandemic and the coverage of the great suffering it has caused, many more people are likely to personally know someone who is suffering from Long COVID than these older conditions. It is easy to dismiss a condition that affects an unknown person across the country. When it affects someone you know, it is much harder to be skeptical. Media outlets from The Washington Post and the New Yorker to People Magazine have covered it. I hope the public’s acceptance of the reality of Long COVID will lead more people to accept the reality of these other conditions.

Money has poured into Long COVID research. Congress has provided $1.15 billion to the National Institutes of Health to study Long COVID. This research could help establish physical causes of some of the symptoms of these other conditions.

To help COVID Long Haulers, lawyers handling long-term disability applications and long-term disability appeals will have to use all the knowledge and tools they have developed over their careers helping those with claims insurance companies love to deny. We can all hope, however, that due to the knowledge and research generated by Long COVID, these hurdles for both COVID Long Haulers and victims of these other conditions will become easier to overcome.

  1. []
  2. “Covid long-haulers face grueling fight for disability benefits” Washington Post, 3/8/22. []
  3. []
  4. (lung damage); (heart damage []
  5. []
  6. The World Health Organization has adopted the following definition of “post-COVID-19:” “Post-COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis.” Link here. []

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