There is no sugarcoating it – the COVID-19 pandemic has been catastrophic. As reported by multiple news outlets, in less than one year, more Americans died as a result of COVID-19 than during World War I, World War II, and the Vietnam War combined. While COVID-19 still remains a threat, thankfully the introduction of vaccines and booster shots has made it possible for most to combat this horrific virus. Unfortunately, there is still no end in sight to the suffering for those of you known as COVID-19 Long Haulers (“Long Haulers”), who continue to experience debilitating symptoms long after the disease has been considered eliminated from your bodies. It will also not end the suffering of the friends and family members who are caring for Long Haulers and find themselves filing and attempting to navigate disability insurance claims.
The official medical term for the diagnosis given to Long Haulers is Post Acute Sequelae of SARS-CoV-2 or PASC — but the diagnosis is more commonly referred to as Long COVID. To be clear, Long COVID does not discriminate; it affects: both those who suffered from severe cases and required hospitalization and those who experienced mild cases with few or no symptoms at all; adults of any age regardless of whether they had a pre-existing or co-morbid condition (this article does not address Long COVID in children); and both men and women (although it does tend to affect women more than men). Despite ongoing research, medical professionals do not yet understand the cause of Long COVID or why some people suffer from Long COVID and others do not; and there is still no set diagnostic standard, and no universal strategy for how to treat Long COVID patients.
Given this circumstance, Hiller, PC has been seeing an increasing number of private group long term disability (“LTD”) claims resulting from Long COVID – claims that we are uniquely qualified to handle. In many ways, many symptoms of Long COVID resemble those of patients suffering from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (“ME/CFS”) – the main symptoms of which also include chronic fatigue, post-exertional malaise (that is, the inability to recover normally from even minor exertion), body aches and pains, headaches, and cognitive deficits. Inasmuch as the attorneys at Hiller, PC handle claims involving all types of disability, including claims involving Long COVID and ME/CFS, we know what is necessary to prove your entitlement to long term disability benefits resulting from PASC.
Symptoms of Long COVID
As with any disability, it is important to understand the symptoms of Long COVID. While there is still much to learn about Long COVID, doctors agree that many Long Haulers routinely experience, among others, the following symptoms:
These symptoms can make it difficult for Long Haulers just to get out of bed and perform routine activities of daily living, let alone perform the duties of their occupation; clearly, Long COVID symptoms can be disabling. And, what’s worse is that no one knows how long PASC symptoms will last; they could last for weeks, months, or a lifetime – only time will tell. As a result, if you are a Long Hauler, it is important to keep track of your symptoms; discuss them with your doctors; and obtain necessary treatment.
Proving Your Long Term Disability Due to Long COVID
Despite the severity of Long COVID symptoms, insurance companies have been giving Long Haulers a hard time when they file a claim for their disability benefits. This stems from the fact that this disease presents mostly with subjective or self-reported, as opposed to objective, symptoms. Simply stated: insurance companies routinely deny claims for disabilities that cannot be verified by testing, physical examination findings, and other objective measures. So, what can you do to help increase the chances of having your claim approved? How can you prove that your symptoms result in restrictions and limitations that prevent you from working? In addition to the first step of finding a good lawyer to help, the following are some tips to help when applying for long term disability benefits as a result of Long COVID:
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- Prove that you did contract COVID-19 by obtaining and providing the results of your PCR (polymerase chain reaction) test and/or Antigen test. If you did not get tested, identify the specific COVID-19 symptoms that led your doctors to diagnose you with COVID-19;
- List all of your Long COVID symptoms and be sure to keep a Symptom Log/Diary detailing the specific symptoms you experience at various times throughout the day and night.
- Explain in excruciating detail all of the duties of your job and how your symptoms prevent you from performing them. When it comes to filing disability claims involving chronic fatigue and exhaustion, for example, many people think: “I’m exhausted all the time, I can’t think straight, and, on most days, I can barely get out of bed. My insurance company is not going to deny my claim.” As a result, they list their symptoms on their LTD application, answer the other questions, and call it a day. But, sadly, simply listing your Long COVID symptoms on your LTD application is not enough. Regardless of how severe your symptoms are, insurance companies look to deny claims, especially those that fail to explain the “Why” – e.g., why are you unable to return to work? Don’t assume that the insurer will infer the limiting effects of your symptoms;
- Follow your doctors’ treatment recommendations. While as of yet there is no cure and no set treatment plan for Long COVID patients, insurance companies look to see that you are at least trying to improve your condition, and can use non-compliance with treatment as a reason to deny your claim. So, it is important to listen to, and follow your doctors’ instructions;
- Obtain objective testing when possible. While objective evidence can be hard to come by due to the subjective nature of most Long COVID symptoms, there are some objective tests that can be used to prove the presence of certain Long COVID symptoms. For example:
- If you suffer from cognitive deficits (e.g., problems with concentration, focus, memory, processing information, etc.), a Neuropsychological Evaluation may be helpful. A neuropsychological evaluation consists of a series of detailed tests administered by a neuropsychologist and designed to assess your level of cognitive functioning. A full battery of testing will measure your functioning in the following areas: intelligence (e.g., an IQ test); memory; both short-term and long-term; concentration; attention; processing speed; executive functioning; visual and spatial perception; judgment; reasoning; decision-making; problem-solving; organization; academic skills (e.g., reading speed and math); and personality;
- If you are experiencing chronic fatigue and an inability to exercise, consider a Two-Day Cardiopulmonary Exercise Test or CPET. The CPET is considered the “Gold Standard” for measuring disability in patients with ME/CFS. Given the similarity in symptoms between ME/CFS and Long COVID, a CPET may also be helpful in proving disability due to Long COVID. The test consists of two separate CPETs administered 24 hours apart. During the tests you walk on a treadmill or ride a stationary bicycle while breathing through a mouthpiece. The workload on the treadmill or bicycle is gradually increased until you reach maximum effort and are forced to stop the test (typically 8 to 12 minutes). Throughout the test, the following data points are measured: peak oxygen consumption (that is, your functional capacity to do work); heart rate; blood pressure; and oxygen saturation. The first CPET is used to measure your baseline and provoke your symptoms. The second CPET is used to determine your symptoms’ impact on your functional capacity;
- A Tilt Table Test can be used to objectively determine whether you suffer from dizziness and lightheadedness. During the test, you start by lying on your back on a special table or chair. The table is tilted to an angle of approximately 60 degrees or more. Throughout the test, a nurse will measure your blood pressure, heart rate, and oxygen levels to detect any changes. If your vitals drop, the table will be lowered to the horizontal position and the test will stop. If your vitals remain stable, the nurse will administer a medication to cause your heart to beat faster and harder to mimic the effects of exercise. The test is repeated to determine if your vitals drop.
While the severity of the COVID-19 pandemic has slowed in recent months, Long Haulers continue to suffer; some are even forced to stop working and apply for LTD benefits due to the severity of their ongoing symptoms. Unfortunately, proving a long term disability claim due to Long COVID will be challenging given the subjective nature of its symptoms and the fact that much about the disease is still unknown.
Therefore, Long Haulers should hire an attorney to help before submitting the claim! When submitting your claim, you and your attorney should not leave any stone unturned; you should submit a comprehensive disability claim to the insurance company. In addition to proving that you did indeed contract COVID-19 and listing your Long COVID symptoms, you must explain exactly how your symptoms prevent you from performing your job duties. You should also make sure to follow your doctors’ treatment advice, and try to obtain objective evidence of your symptoms, when possible. While by no means a guarantee that your disability claim or appeal will be approved, the tips in this article will help improve your chances of a successful outcome.
The attorneys at Hiller, PC are experienced in handling disability claims and appeals resulting from Long Hauler symptoms. We can help you devise a claim or appeal strategy designed to give you the best chance of obtaining your Long Term Disability benefits without the need for lengthy and costly litigation. Contact the NY disability insurance lawyers at Hiller, PC today at (212) 319-4000.