As a disability lawyer, I’m not surprised to hear people have been denied long-term disability (LTD) benefits when they are too sick or injured to work.
But I’ve found that when a claim has to do with COVID-19 or any of its long-term effects, the odds of approval become slimmer. And with 60 per cent of people diagnosed with COVID-19 reporting symptoms more than 12 weeks after infection, along with 10 per cent saying they were unable to return to work, according to the Public Health Agency of Canada, more people may need to take long-term disability to recover.
Here’s what to know about making an LTD claim related to COVID-19, and what to do if your claim is denied.
What are COVID-19 long-haulers?
Having symptoms for weeks after initially recovering from an infection is known as post COVID-19 condition, long COVID or long-haul COVID.
The World Health Organization is still determining how to diagnose long COVID. According to Health Canada, however, the most common symptoms of post COVID-19 condition in adults are fatigue, memory problems, trouble sleeping, difficulty concentrating and shortness of breath.
READ MORE: How to get LTD benefits for mental illness during COVID-19
Canada’s Public Health Agency found in a review that 83 per cent of patients with confirmed cases of COVID-19 had symptoms four to 12 weeks after diagnosis, and 56 per cent had symptoms more than 12 weeks later.
Some of my clients have had symptoms for more than 18 months and have seen long-term complications such as lung issues, kidney failure, heart problems and mental health issues.
Why are claims for long COVID denied?
In my experience as a disability lawyer, when faced with a long COVID claim, most LTD insurers usually say that the claimant’s COVID-19 symptoms are not severe enough to render them incapable of working.
As COVID-19 is a new disease, there is very little data on its long-term effects, and there is a lack of consensus on the clinical definition for long-term symptoms. Insurers cite this fact as the basis for denying claims for long COVID.
Insurance companies may also say they’ve denied a claim because a patient has failed to regularly see their doctors and advise them of the symptoms limiting their ability to work, or because many long COVID symptoms are subjective and do not show up on diagnostic testing.
READ MORE: What to know about your LTD rights in the age of COVID-19
How to successfully fight an LTD denial for long COVID
Reframing post COVID-19 condition symptoms as long-term medical issues may make insurers more likely to accept an LTD claim. I recently used this strategy for a client, Jessica (not her real name), who was suffering from difficulty breathing and brain fog, which affected her ability to speak and think.
As a result, Jessica would get extreme anxiety any time she spoke with someone or was in a public place, and was unable to do her job as a customer support representative. But the insurance company denied her LTD claim, so she called me for help.
I appealed the insurer’s decision and framed her disability claim in terms of long-term medical issues, as opposed to only COVID-19.
A number of specialists, including a respirologist, psychiatrist, psychologist and her family doctor, wrote letters that spoke to Jessica’s change in condition and the regular treatment she received from them. Her original claim wasn’t supported by any data; now, it was backed by four medical professionals and made it clear Jessica could not work.
READ MORE: Long-term disability claim denied? This is why you need a disability lawyer
Jessica’s friends and mother gave testimonials about the stark changes they had seen in her. While the insurer really did seem to be compelled by the doctors’ support and the testimonials, the strength of our case meant it would also be more expensive for the insurer to fight it.
When a claimant’s condition is characterized by multiple medical issues, the insurer must decide whether they will hire a specialist to refute each particular medical issue and its effect on the claimant’s functionality. This can cost an insurance company a lot.
By framing the claim in terms of more widely accepted medical issues, we made it more expensive for the insurance company to deny it. The strategy worked in Jessica’s case, and she is now regularly receiving monthly disability benefits.
Has your long-term disability claim for long-hauler COVID-19 issues been denied?
Contact the firm or call 1-855-821-5900 to secure assistance from a long-term disability lawyer in Ontario, British Columbia or Alberta. Get the advice you need — and the compensation you deserve.
Albert Klein is a disability lawyer and partner at Samfiru Tumarkin LLP, Canada’s most positively reviewed law firm specializing in long-term disability claims and employment law. The firm provides free advice as a host of Canada’s only Disability Law Show on TV and radio.