Our client, an accomplished Attorney, contracted COVID-19 on two occasions approximately six months apart. Unfortunately, she never fully recovered following her second COVID-19 infection. Even after she cleared the active infection, she continued to experience symptoms such as severe fatigue, post-exertional malaise, exercise intolerance, cognitive problems, dizziness, joint pain throughout her body, cardiac problems (such as shortness of breath and heart palpitations), recurrent sore throat, gastrointestinal issues, and vision problems. Despite these symptoms, our client pushed herself to continue working for approximately six months before she was forced to stop and apply for short term disability benefits. By the time she stopped working, our client was virtually bedridden, and could barely take care of her basic activities of daily living, let alone return to work. 
We were hired to assist the client with her short term disability (“STD”) claim. Around the time she applied for STD benefits, the client underwent a two-day cardiopulmonary exercise test (“CPET”) and neuropsychological testing – both of which overwhelmingly supported her disability claim. For example, the CPET documented, among other things, our client’s fatigue, post exertional malaise, exercise intolerance, and dysautonomia, and the neuropsychological testing documented deficits in attention, memory, processing speed, and executive functioning. The insurer initially approved her STD claim, and paid her the benefits to which she was entitled for about five (5) months. Then, without any improvement in her symptoms, the insurance companyterminated her STD Benefits with less than three weeks remaining in the STD benefit period. Notably, the insurer stopped our client’s STD benefits despite that a few days prior to the denial, her treating physician recommended that she use a wheel chair both inside and outside her home. Rather than truly consider the evidence submitted, in terminating our client’s STD benefits, the insurer – consistent with insurance company tactics – relied on the opinions of a mere file review physician who cherry-picked the medical evidence, ignored the objective test results (i.e., the CPET and neuropsychological testing), and failed to consider the opinions of the insured’s treating physicians.
We immediately began to process the administrative appeal of the insurer’s adverse determination and file her application for Long Term Disability (“LTD”) benefits. We not only obtained updated medical records, but we also secured rebuttal reports from our client’s treating physician, the CPET evaluator, and the neuropsychologist. Hiller, PC then prepared a detailed administrative appeal letter. We described the significance of the insured’s Long COVID symptoms, and demonstrated how those symptoms devastated not only her professional life, but also her personal/home life. We then explained to the insurance company exactly why the opinions of its file reviewer were not only incorrect, but arbitrary and capricious.
We are happy to report that not long after the submission of the administrative appeal, the insurer realized its error. It not only re-approved the our client’s STD claim, but it also approved her LTD Claim. Our client is currently receiving LTD benefits, and Hiller, PC is monitoring her claim.
This type of factual scenario is unfortunately all too common in the Short Term Disability and Long Term Disability arena. Insurance companies routinely deny disability benefit claims despite being presented with irrefutable objective evidence of a claimant’s inability to work in his/her/their own occupation or any other occupation. Hiller, PC can assist at all stages of the disability claims process – from filing an application for STD or LTD benefits, to appealing a denied claim, to suing the insurance company in state or federal court.
