Hiller, PC Wins Long Term Disability Benefits for Emergency Medicine Physician with Long COVID

Our client, a highly accomplished Emergency Medicine Physician who worked on the front lines during the height of the COVID-19 pandemic, contracted a form of Long COVID following receipt of her second COVID-19 vaccination. Almost immediately following her second dose of the COVID-19 vaccine, the client began experiencing cognitive deficits, severe fatigue, fogginess, dizziness, and crippling insomnia. Notwithstanding these symptoms, our client pushed herself to continue working for a few months before she was forced to stop and apply for long term disability benefits (“LTD Benefits”). By the time she stopped working, our client was experiencing, among other things: severe fatigue, easy fatiguability with normal activities, post-exertional malaise (“PEM”), exertion intolerance, dizziness, lightheadedness, imbalance, postural orthostatic tachycardia syndrome, palpitations, tachycardia, brain fog, memory problems, poor concentration and attention, delayed processing of information; word-finding difficulties, gastrointestinal problems, and sleep problems (including ongoing insomnia).

Following her application, the insurance company immediately approved our client’s LTD claim and paid her the LTD Benefits to which she was entitled for approximately two and half years. During that time, our client did experience some improvement in her symptoms and, with her doctors’ blessings, was able to return to work in a different occupation on a part-time basis. Nonetheless, the insurance company continued to find that she was Disabled under the LTD plan and pay her LTD Benefits without any issues. The insurer first began giving our client a hard time when the definition of Disability changed from being unable to perform the duties of her regular occupation (i.e., as an Emergency Medicine Physician) to being unable to perform the duties of any occupation for which she was suited by reason of her age, education, and experience. Unfortunately, following an internal review by its in-house doctors, the insurance company terminated our client’s LTD Benefits despite her continued inability to perform the duties of any occupation on a full time basis. As is typical in LTD cases, the insurer’s file review physicians cherry-picked the medical evidence, failed to consider the opinions of our client’s treating physicians, and ignored the objective medical evidence of her ongoing Disability.

Our client hired us to prepare an administrative appeal shortly after her LTD Benefits were terminated. We worked with our client to obtain additional objective medical evidence, including without limitation, a two-day cardiopulmonary exercise test (which is considered the gold standard for evaluating patients with fatigue and PEM), neuropsychological testing, and an updated tilt table test. Hiller, PC also secured detailed narrative reports from our clients neurologist, cardiologist, and infectious disease specialist along with a vocational assessment confirming the fact that her restrictions and limitations prevent her from returning to work in any occupation on a full time basis. We then prepared a detailed administrative appeal letter describing the significance of our client’s Long COVID symptoms, and explained how those symptoms devastated not only her professional life, but also her personal/home life. We then explained the inaccuracies and shortcomings of the arbitrary opinions of the insurance company’s file reviewers.

Not long after the submission of the administrative appeal, the insurer overturned its denial, re-approved our client’s claim, and paid her the LTD benefits to which she was rightfully entitled. Our client is currently receiving LTD benefits, and Hiller, PC is monitoring her claim.

This type of factual scenario is unfortunately all too common. We routinely see LTD claims denied when the definition of Disability changes despite the presence of overwhelming medical and vocational evidence of a claimant’s inability to work in any other occupation. If your LTD claim is denied, we recommend that you contact an experienced attorney to help you with the administrative appeal. Hiller, PC provides free consultations, and we are happy to evaluate and discuss the merits of your claim.