Insurance companies make it hard enough as it is, but for people living as COVID-19 longhaulers, just thinking about managing yourself, your job, and your families can be very daunting to say the least.
We put this page together to help shed some light on the long-term disability (LTD) insurance claims and appeals process.
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Applying to the various disability benefits programs can seem overwhelming at first. Here are 10 tips from disability and ME/CFS experts on how to win a disability case.
- Obtain objective evidence. Explore tests that help to explain symptoms, such as CPET, tilt-table testing, and neuropsychological testing. When getting a CPET, Kantor strongly recommends seeking out practitioners who understand ME/CFS and use Workwell’s 2-day test-retest protocol to avoid misinterpretation of results. Because COVID affects many body systems, long-haulers may need testing from other specialties, depending on how the disease impacted different organs, especially the heart and lungs.
- Consider applying for benefits under the Family Medical Leave Act. The FMLA offers up to 12 weeks of leave for serious health conditions for those who meet eligibility requirements. This is often a good place to start and buys times to prepare applications for other disability benefits programs.
- Explore state disability benefits. Five states offer disability benefits. State disability can provide another temporary safety net. These programs provide a lifeline, but ultimately long-term programs, such as LTD or SSDI, are needed for those who remain chronically ill and too disabled to work.
- Read your long-term disability policy. Many employers offer long-term disability insurance, replacing a percentage of lost salaries due to illness. During the past four years, many insurance regulations have been rolled back, allowing for policies that provide less coverage and exclude preexisting conditions. Policies have become more restrictive of the types of conditions they cover, especially ones that cause fatigue, such as ME/CFS. During economic downturns, insurance companies tend to deny more claims. An increase in claims during the pandemic worsens this situation.
- Talk to a disability lawyer. Understanding an LTD insurance policy’s fine print is no easy task, especially the portions covering limitations and pre-existing conditions. Many attorneys specializing in this area offer a free consultation and can help translate LTD policy language as it applies to individual cases. Speaking to a lawyer about SSDI can also be helpful. Most attorneys specializing in these cases don’t engage with clients until the appeals phase, but it doesn’t hurt to give one a call to line up a firm and to know what to expect.
During the pandemic, layoffs could put LTD benefits at risk for some long-haulers since they are mostly tied to employment. According to Kantor, if a long-hauler had COVID before being laid off, an attorney can make a case for a post-dated claim if the disability occurred on or before the day the layoff occurred.
- Be honest about your condition. When preparing to make a claim, be direct with employers about accommodations needed, and ensure these efforts are documented. Being honest can also avoid “gotcha” moments by insurance companies who pay private investigators to spy on claimants. If you have better and worse days, be upfront about the variation you experience in your illness, but do not minimize the limit that “bad days” place on the ability to function.
- See your doctor regularly. COVID has made it far more difficult to see a doctor in person, leading people to access care less frequently and making it more difficult to get medical records. Although telemedicine appointments have become more widely available, they might not carry the same weight as an in-person exam and conversation with a physician.
Seeing a doctor regularly – by any means – is important for documenting medical conditions. In addition to seeing a doctor regularly, it is equally important to mention how symptoms affect daily living activities. When visiting a doctor, bring a short page noting how symptoms affect your ability to function and ask that they be added to the physician’s notes.
- Find a supportive doctor. Unsupportive doctors can refuse to refer patients to specialists and write strong support letters. Finding a doctor willing to listen and help get necessary medical testing can make a difference in a difficult case. If long-haulers suspect ME/CFS, see a physician who specializes in this disease.
- Request medical records. It is always a good idea to occasionally request medical records to make sure that your doctor accurately represents your condition. If records are incomplete or express doubt, patients need to know this before appealing decisions. Similarly, keep a daily journal of symptoms and how they impact function.
- Don’t give up. Insurance companies and the Social Security Administration look for ways to reject applicants, including those who are clearly disabled. According to Kantor, many people accept a negative ruling and do not file an appeal, something insurance companies count on. While appeals may delay benefits, ultimately, it is possible to prevail with strong medical evidence.
“Long-COVID” is a new condition, but the barriers to disability benefits facing people with viral illnesses are not. Long-haulers can find many resources from the ME/CFS community on how to succeed in getting benefits.
From The Mighty, November 14, 2020 |https://themighty.com/2020/11/covid-19-long-haulers-disability-benefits/
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