If you suffer from a degenerative condition, how does continuing to work affect your ultimate application for long-term disability benefits? How do you keep working and protect your LTD benefits? Whether you suffer from Parkinson’s disease, multiple sclerosis, amyotrophic lateral sclerosis (“ALS” or Lou Gehrig’s Disease), rheumatoid arthritis, or degenerative cognitive disorders such as early-onset Alzheimer’s disease or other dementias, you may want to work as long as possible, but you don’t want your additional time working to make it more difficult to get your long-term disability benefits:
Clients in my long-term disability insurance practice in Connecticut regularly confront the consequences of working while disabled. What should you consider in deciding how long to work?
You may be able to keep working part-time and still get long-term disability benefits if you have a policy or plan that provides for partial disability benefits. With a partial disability benefit, if you are only working part time, you can get a partial benefit that makes up all or much of the decline in income. You can reduce your hours and duties, reduce your pay, and replace all or most of the lost income with a partial disability benefit. Since your employer can pay you less for the reduced hours you are working, it is more likely that they will keep you on.
This is a great provision, but the formulae for calculating the benefit for a given level of income can be complicated and the conditions to qualify for partial disability benefits can be complicated. If your plan has a partial disability benefit, it can be useful to consult with an experienced ERISA benefits attorney to have the best chance of qualifying for that benefit.
One of the most unfair consequences of working while disabled is that the insurer may conclude that if you are working, you must not be disabled. For instance, let’s say your medical records reflect a level of impairment in May 2021 that could support a finding of disability, and the records for each subsequent month report that you are “stable.” If you keep working until May2022, the insurer could say that the fact that you did work for a year shows that you are not disabled. The insurer may say the medical records reflect no change in condition that could explain why you could do the job from May 2021 – May 2022 but could no longer perform it at the end of the 12 months. With some conditions, like multiple sclerosis, there may be no obvious explanation for the degeneration in your condition, as your condition can degrade severely even if an MRI shows no additional lesions. Some courts haven’t bought the LTD insurers argument. As one judge wrote: “Hawkins may have forced himself to continue in his job for years despite severe pain and fatigue and finally have found it too much and given it up even though his condition had not worsened. A disabled person should not be punished for heroic efforts to work by being held to have forfeited his entitlement to disability benefits should he stop working.” Hawkins v. First Union Corp. Long-Term Disability Plan, 326 F.3d 914, (7th Cir. Ill. 2003). So, if you are making heroic efforts to stay in your job, there are things you can do, with the help of a knowledgeable ERISA long-term disability attorney, to protect your ultimate claim for long-term disability benefits.
Whether you are planning to receive partial disability benefits, or just trying to avoid having your insurer claim that you are not disabled because you have worked during your disability, here are the steps you should take to make sure working while disabled doesn’t hurt your long-term disability insurance claim:
Don’t let working while disabled turn into not working and not getting long-term disability benefits. Talking to your doctor and keeping a log will make it more likely you will prevail on an initial claim for long-term disability benefits or in an appeal of any denial. An experienced ERISA long-term disability attorney can work with you to develop a strategy to address your particular career and personal goals so that you can work as long as you want to and still receive the benefits you have earned.
Click on the link below for more articles on long-term disability benefits and moving from working to disability.
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
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
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.
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.
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.
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.