Insurance companies base the premiums they charge based on their “expectations.” Expectations as to how many people will become disabled and make claims for benefits. The sudden appearance of Long COVID threw the proverbial monkey wrench into insurance company statistics. The vast majority of people who became ill were sick for less than ten days and went back to work, which did not require the insurance company to pay any disability or life claims. But a very small percentage of those who became ill DID NOT FULLY RECOVER. Called sufferers of LONG COVID, their symptoms lingered and, in some cases, prevented them from returning to work. The insurance industry did not know what to make of these people. Would they stay ill for years? Would the insurance company be required to pay millions of dollars in unanticipated claims? In many cases, the reaction of the insurance industry was just to deny the existence of the condition and deny claims as being objectively unprovable, despite the overwhelming evidence of extreme fatigue, lung issues, or cognitive impairments.
However, the medical community and the Federal Judges who decide ERISA benefit claims don’t doubt the existence of Long Covid, and they will be looking closely at insurance companies who reject claims without any basis to do so.
The rampant misinformation that spread online about COVID-19 has had alarming repercussions for many victims of the virus. This includes long COVID disability claimants.
Of course, the consequences of the COVID-19 pandemic extended beyond those who contracted the virus. Lockdown-fueled isolation exacerbated the side effects of serious mental health issues and made access to treatment much harder to obtain. But perhaps the most lasting, yet least understood, condition resulting from the pandemic is long COVID.
If you’re trying to manage the debilitating symptoms of long COVID, it can be disheartening to encounter the systemic minimization of the condition across the insurance industry. But more importantly, it can also be dangerous for you.
That said, denied insurance claims aren’t the end of the line. With proper legal representation, you can assert your rights and secure your long COVID disability benefits.
Understanding Long COVID as a Disabling Condition
The World Health Organization (WHO) has developed a definition of long COVID in an attempt to create clearer diagnostic parameters. Namely, the WHO categorizes long COVID as symptoms that either return or persist three months after you become infected with the virus.
Now, this is clearly just a working definition, as the novelty of long COVID casts doubt on the current medical understanding of its presentation. Practically speaking, the syndrome has an extensive range of symptoms that include general fatigue, fever, shortness of breath, heart palpitations, neurological cloudiness, dizziness, depression, digestive issues, skin conditions, and muscle pain. Note that these are just a few impacts on the long list of potential effects.
The duration of the condition is also difficult to determine. Long COVID may last a period of weeks, months, or years depending on the individual. Individuals who have benefit claims to make should not be discriminated against because the course of their disease and recovery is unknown.
For some, the condition constitutes a disability and significantly impacts their lifestyle, working capacity, and well-being. In such cases, long COVID disability benefits are necessary.
The Consequences of Denied Long COVID Disability Claims
The U.S. Department of Health and Human Services estimates that around 23 million people are suffering from long COVID. Out of these cases, the Brookings Institution used data from the U.S. Census Bureau to estimate that anywhere from 2 to 4 million long COVID disability patients are out of work because of the condition.
Considering the ubiquitous nature of long COVID throughout the workforce, why is it so hard to obtain benefits? Well, the answer is the lack of solid diagnostic criteria.
Insurance companies can leverage the fact that there’s no undisputable test to determine that you have long COVID to deny your claim. Remember, insurers are financially incentivized to deny disability claims. So, any gap in medical evidence is likely to be exploited, even if you believe you should qualify based on your plan’s terms and conditions.
Needless to say, the financial, medical, and emotional consequences of a denial can be devastating. But the good news is that an initial rejection of your claim isn’t final. In fact, a denied long COVID disability claim is just the beginning of the process for many people.
The Role of Lawyers in Handling Denied Long COVID Disability Claims
The process of filing a long COVID disability claim might seem relatively straightforward on its face. But the strict administrative guidelines hidden deep in the terms and conditions of your policy make it easy to include simple mistakes in your paperwork. The errors you make can lead to a denial.
Then, the appeals stage is even more difficult to undergo on your own, not to mention the possible legal proceedings you may need to initiate.
The reality is that, regardless of the severity of your condition, the insurance company may consider your proof medically tenuous. So, you need someone on your side who’s familiar with the intricacies of the legal and policy systems you’re up against.
Long-term disability lawyers can act as expert advocates. They leverage their knowledge to negotiate with insurance companies and, if necessary, appeal denials with a robust and impeccably crafted submission of evidence which will sway a Federal Judge if the insurance company won’t alter its denial, and the case proceeds to trial. A knowledgeable attorney will know what experts to consult, whether they be neuropsychologists to prove cognitive impairment, pulmonologists to establish lung issues, or experts who can objectively prove a client’s fatigue using state of the art testing equipment. Their construction of your claim, or eventual appeal, is informed by pertinent laws and regulations. In short, should it come to it, they can defend your rights in court.
Legal and Medical Complexities in Long COVID Disability Claims
Overcoming the complexities that a long COVID disability claim presents is a matter of offering proof. You’ll need to submit medical evidence that documents your condition's cause, severity, and duration.
At the same time, you must ensure that the evidence you submit meets your policy’s specific criteria. For instance, if your policy requires proof that your condition significantly impairs your daily function, you’ll need to provide documentation. This evidence may come as testimonials from friends, colleagues, and medical professionals.
To ensure that you’re meeting all the rules and regulations guiding the administration of your benefits, comb through all the plan information you’ve been provided.
Ideally, you should include a complete medical record outlining your condition, testimonials, and a written daily account of how long COVID impacts you. But depending on your policy and the details of your case, you may need additional supporting documentation as well. So, it’s best to contact a legal professional before filing your initial claim.
Kantor & Associates’ Expertise in Handling Denied Long COVID Disability Claims
Long-term disability is its own area of the law. It requires specific experience to successfully navigate.
The average lawyer likely doesn’t have the in-depth knowledge or experience to handle relatively niche cases such as a long COVID disability claim. So, you’ll want to reach out to a firm with an extensive and exceptional track record in this specific area of the law like Kantor & Kantor.
Kantor & Kantor already know the ins and outs of your legal rights to benefits. They’re extremely familiar with navigating the internal policies of insurance companies and have successfully handled numerous long COVID claims.
Empowering Individuals with Denied Long COVID Claims
Long COVID can extend the feeling of isolation that so many went through during the early phases of the pandemic. So, while you fight for your benefits, make sure you also seek support.
Communities such as the Long COVID Alliance offer extensive resources for those who have had their claims denied. Engaging in self-care practices like gentle activity, meaningful rest, and stress management can also be crucial.
Finally, if your insurer dismisses or denies your condition, don’t give up. Many people have challenged their insurers and won. You’re not alone.
Obtaining Long COVID Disability Benefits
The harsh reality is that obtaining disability benefits for long COVID is often harder than it should be. Your insurer may use the nebulous diagnostic criteria of the condition to deny your claim. So, it’s paramount that you have an attorney with experience fighting these challenges.
Kantor & Kantor attorneys specialize in these types of cases. We know how to communicate your unique circumstances to insurers or in court effectively and can hold your policy to its terms and conditions.
Reach out to set up a consultation with a Kantor & Kantor attorney today.
