Long COVID-19 and Long-term Disability Insurance Claim Issues

With the arrival of COVID-19, the world as we knew it changed, and with it, some legal processes are changing as well. One new concern that people and insurance companies may need to handle differently involves the effects of Long COVID-19 and insurance claim issues related to long-term disability. While most people who have had COVID have recovered within a few weeks, some people are experiencing long-term effects and have been unable to return to work.

Currently, there are three main sources of disability insurance: (1) employer-paid disability, such as short and long-term disability and workers compensation; (2) Social Security disability insurance; and (3) individual income insurance policies. While each has its benefits, the root of the problem lies with obtaining long-term disability for people suffering with debilitating symptoms of Long COVID. For example, Social Security offers long-term disability only. To be eligible for Social Security long-term disability, the applicant must show that they cannot work in substantial gainful activity, work their normal job, or adjust to a different job because of their outstanding medical condition. They must also show that their condition is expected to last at least one year or result in death.

The problem that many applicants are having relates to how to prove they are “disabled” to meet the definition for eligibility. The list of Long COVID symptoms is lengthy and varied, ranging from severe cardiovascular issues to kidney dysfunction, and even includes symptoms like depression and anxiety. Each person has unique symptoms or a series of symptoms that affect their ability to work, which makes it difficult for doctors to predict whether those conditions will continue and when people can return to work.

Additionally, each type of long-term disability provider has a required waiting period before eligibility for long-term disability may begin. These periods also vary and may be thirty, sixty, or ninety days. With COVID-19 still being a new disease, and with no current studies available to establish how long the symptoms of Long COVID may last, it is also difficult for doctors to properly certify that patients are not able to work when the eligibility waiting period expires or that their condition is expected to last for at least one year. Doctors can easily disagree professionally as to whether or not a person’s symptoms should keep that person from being able to work.

Unfortunately, many people do not have the luxury of not working for up to three months while waiting for their disability benefits to begin, which poses an additional problem – if someone is attempting to work while waiting for benefits, that ability to make money could work against them. Another problem posed in Workers Compensation scenarios is how to prove that a patient caught COVID while at work and not outside of the office.

If you are experiencing symptoms of Long COVID that are affecting your ability to work, it is important to collect documentation before submitting your claim. First, review your insurance policy to discover how disability is defined and the eligibility requirements to identify any exclusions or limitations. Then, after you satisfy the thirty, sixty, or ninety-day waiting period, you may submit your claim with all of your documentation.

Important documentation you will need includes all of the symptoms related to your condition, as well as witness statements to support how COVID health problems have affected your ability to work. The insurance provider will also want to see your job description and medical records. Make sure that you document any verbal calls that you have with your medical provider, and always send a follow-up email to recap the conversation. In addition, try to avoid using words like “never” and “always” in your documentation and do not exaggerate or overstate your symptoms. And, of course, in this world of social media, it is equally important that your social medial postings be consistent with your condition. If an insurance company decides that you have exaggerated or lied about your medical condition, they may deny your claim entirely.

There are organizations that are seeking to help Long COVID survivors. The Long COVID Alliance and Survivor Corps are dedicated to providing education and resources for COVID-19 patients, and connecting them with medical and scientific research efforts to help with the national response. Survivor Corps may be found at www.survivorcorps.com. Body Politic is another organization that offers a COVID-19 support group for both patients and caregivers to provide emotional support, resources, community, and opportunities for advocacy. Body Politic may be found at www.wearebodypolitic.com.

Bill Hesch is a CPA, PFS (Personal Financial Specialist), and attorney licensed in Ohio and Kentucky who helps clients with their financial and estate planning. He also practices elder law, corporate law, Medicaid planning, tax law, and probate in the Greater Cincinnati and Northern Kentucky areas. His practice area includes Hamilton County, Butler County, Warren County, and Clermont County in Ohio, and Campbell County, Kenton County, and Boone County in Kentucky.

(Legal Disclaimer: Bill Hesch submits this blog to provide general information about the firm and its services. Information in this blog is not intended as legal advice, and any person receiving information on this page should not act on it without consulting professional legal counsel. While at times Bill Hesch may render an opinion, Bill Hesch does not offer legal advice through this blog. Bill Hesch does not enter into an attorney-client relationship with any online reader via online contact.)