Long COVID, also known as long-haul COVID or post-acute sequelae of SARS CoV-2 infection, refers to symptoms that linger long after a person has been infected by the COVID-19 virus. Long COVID can cause long-term symptoms and health problems which may be disabling. People with Long COVID may experience a range of symptoms, including long-term fatigue, anxiety, depression, difficulty sleeping, headaches, joint or muscle pain, difficulty breathing or shortness of breath, rash, changes in menstrual cycles, short term memory issues, difficulty thinking ("brain fog"), difficulty focusing or concentrating, decision-making problems, and other cognitive issues.
According to the Centers for Disease Control, the symptoms of Long COVID are similar to those reported by people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and other poorly understood chronic illnesses that may occur after other infections. People with these unexplained symptoms may be misunderstood by their healthcare providers, which can result in a difficulty obtaining a diagnosis, a delayed diagnosis, and difficulty receiving appropriate care or treatment.
Can I Receive Short or Long Term Disability Benefits for Long COVID?
Yes. Long COVID can result in long term disability and those affected may be eligible for long term or short term disability benefits, depending on their individual situation. The process of applying for short or long term disability benefits from your disability insurance company can be complex and may require the help of a disability attorney. Long COVID disability claims can be especially difficult to get approved, as insurance companies will often attribute Long COVID symptoms to other causes such as mental illness or burnout.
If short term or long term disability results from Long COVID, it is important to understand your rights if you are covered by long term disability insurance. Disability insurance plans can have different definitions of disability, so it is important to understand the particular provisions of your long term disability insurance policy.
How Do Disability Insurance Companies Evaluation Claims for Disability Due to Long COVID?
Applying for long term disability benefits due to Long COVID can present a lot of challenges.
First, many of the symptoms of Long COVID, such as fatigue and pain, are difficult to prove. Disability insurance companies will often look for objective evidence or other strong evidence that Long COVID is causing long term disability. Objective evidence includes test results that demonstrate symptoms. Other strong evidence includes physician notes, clinical tests, and contemporaneous recordings of symptoms that show long-term impairment due to Long COVID.
Second, there remains disagreement among healthcare providers as to how to diagnose Long COVID. According to the CDC, post-COVID conditions are not one illness. There is no test to determine if post-COVID symptoms are due to COVID-19. Long COVID diagnoses are made based on health history, including a diagnosis of COVID-19, as well as by doing a health examination.
Because there is no test, disability insurance companies therefore look at Long COVID diagnoses with skepticism.
Third, frankly, disability insurance companies are wary of the large pool of liability that will hit as Long COVID becomes a common diagnosis. Unlike many conditions that result in long term disability, Long COVID affects individuals with many years left before retirement. Of course, the size of the liability is not a term or provision in long term disability policies. They should not take the amount of time left to retirement into account. Long term disability companies nonetheless examine larger claims with much closer scrutiny.
Ultimately, your disability insurance company will evaluate your Long COVID claim to determine that you have a) sufficient medical evidence of your symptoms and b) sufficient vocational evidence that you cannot work due to your symptoms.
Sufficient medical evidence may include office visit notes from your treating doctors, diagnostic testing, in-person assessments, imaging, blood work, and other tests or evaluations from your providers. Your doctor will also be requested to complete an attending physician’s statement form from your insurance company that certifies your Long COVID disability.
Vocational evidence may include your resume, job description, witness statement from your employer/coworkers on how the onset of your Long COVID impacted your job performance, a personal statement describing your job role and material duties, and a report from a vocational expert that outlines your occupation and how your Long COVID prevents you from performing your occupational duties.
Your disability insurance company will review this evidence to confirm the diagnosis of Long COVID and to understand your symptoms and the impact of Long COVID on your ability to work. In addition, your insurance company may request additional examinations. For example, your disability insurance company may have you undergo an independent medical evaluation with one of their doctors. They may also have one of their vocational experts conduct an assessment to determine your ability to return to work and your potential for retraining or vocational rehabilitation.
If your insurance company believes your evidence is inadequate, and if their own experts determine your Long COVID is not disabling, your short or long term disability claim may be denied.
How Can The Maddox Firm Help Prove My Long COVID Disability Claim?
It is always best to speak with an experienced ERISA attorney who can help you navigate the disability claim process and get your Long COVID short or long term disability claim approved.
An ERISA attorney can help you with your Long COVID short or long term disability claim by representing you and advocating for your rights throughout the claims process. The experienced team at The Maddox Firm has helped many clients successfully file for short or long term disability benefits due to Long COVID.
The Maddox Firm can help you with your Long COVID short or long term disability claim in a variety of ways, including by:
Reviewing your disability insurance policy and evidence: The Maddox Firm can review your disability policy, medical records, and vocational evidence to evaluate the strength of your claim. We can then help you understand the process and the potential outcomes of your claim.
Your disability insurance policy will outline the eligibility requirements you must meet to be approved for benefits. Most policies will require you first prove you are disabled from your own occupation, and later down the line (typically 18-24 months), prove you are disabled from any reasonable occupation for your training, experience, and education. However, this definition of disability can vary depending on what kind of policy you have. Therefore, your policy will be key in developing the best strategy to filing your Long COVID disability claim.
Reviewing your existing medical and vocational evidence: From here, we can assess any inaccuracies, missing information, and determine how you can further develop documentation of your restrictions and limitations due to your Long COVID.
Helping you gather additional documentation: The Maddox Firm can help you gather additional medical documentation and testimony from your doctors to support your claim. This will ensure that you have presented the strongest possible case for disability benefits.
Additional medical documentation for Long COVID may include a Functional Capacity Evaluation (“FCE”), Cardiopulmonary Exercise Testing (“CPET”), or a Neuropsychological Evaluation.
An FCE is used to assess your ability to perform activities of daily living, such as dressing, grooming, and bathing, as well as your ability to perform work-related tasks, such as standing, walking, and lifting. Since the FCE uses objective testing of your functional ability, and includes validity testing to substantiate the results, your insurance company will accept this as objective evidence of your Long COVID disability.
A CPET is very helpful for Long COVID disability claims. The purpose of the CPET is to evaluate your respiratory, cardiovascular, and muscular systems react to exertion. The CPET measures how your body processes oxygen intake during activity. For Long COVID disability claims, the CPET results can demonstrate objective evidence of your exercise intolerance and resulting fatigue.
A Neuropsychological Evaluation can help substantiate cognitive issues caused by Long COVID, including brain fog, short term memory issues, decision-making problems, and difficulty focusing or concentrating. A proper Neuropsychological Evaluation will include embedded validity measures which will rule out any possibility of less than full effort.
The Maddox Firm can also coordinate with your doctors to obtain supplemental letters supporting your disability claim. Your doctor’s office notes are not created with the purpose of supplementing a disability insurance claim, and therefore they may not encompass the scope of your Long COVID disability. A letter from your doctor outlining your patient history, observations from in-person examinations, elaborations on your symptom severity, and their opinion on your ability to work with your Long COVID can be submitted to your insurance company as further medical evidence for your claim.
To help develop vocational evidence for your short or long term Long COVD disability claim, The Maddox Firm can assist you in obtaining witness statements from your coworkers, refer you to a vocational expert for a vocational assessment, and help you provide a personal statement that discusses the onset of your Long COVID and how your symptoms prevent you from working. This documentation can provide your insurance company with evidence of how your Long COVID interferes with your ability to perform your job duties in detail.
Communicating with the insurance company: The Maddox Firm will take over all communications with your insurance company on your behalf. We will ensure that all forms and paperwork are completed accurately and in a timely manner, and make sure that your insurance company meets all of their required deadlines. Should your insurance company request an interview, your attorney will prepare you beforehand and attend the meeting to safeguard you from any overstepping or inappropriate questions.
Filing an appeal, litigation, or negotiating a settlement: If your Long COVID short or long term disability claim is denied, The Maddox Firm can prepare and file an administrative appeal on your behalf. Typically, if a claim is denied or terminated, you must go through the internal appeal process with your insurance company. If your claim is denied on appeal, you can sue your insurance company for the wrongful denial. Your insurance company may also at some point offer a lump sum settlement to buy out your disability claim. The Maddox Firm routinely handles disability insurance appeals, litigation, and negotiations.
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We always recommend speaking with a trusted attorney before filing or appealing a Long COVID short or long term disability insurance claim. Whether you are looking for assistance in navigating the claims process, appealing a Long COVID claim denial, or litigating a final adverse decision, The Maddox Firm can help. The team at The Maddox Firm will look over your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim.
Contact us to help you file your claim, appeal, or litigation the right way.