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Long COVID highlights the ongoing flaws of disability programs

On Behalf of | May 1, 2023 | ERISA

Congress recently voted to end the COVID public health emergency that has been in place for the past three years. While it may seem as if day-to-day life has essentially returned to normal, hundreds of Americans continue to die of COVID complications each week, and the number of people suffering from long COVID continues to rise.

The combination of how little we understand long COVID and the shameful state of this country’s healthcare insurance industry has created a two-fold nightmare for people who cannot work due to long COVID. Their struggle will sound painfully familiar to anyone who has navigated a challenging ERISA claim.

We don’t know what we don’t know

In terms of long COVID, the primary obstacle is how little we know about the condition, and what little we do know, we don’t fully understand. Many doctors don’t even know which tests to administer. Some tests don’t satisfy the criteria for disability benefits, while others come back normal when the patient is clearly suffering.

Though we have been hearing about long COVID for years, and the federal government formally recognized it as a disability, benefits claims are still tough to win because there’s no reliable way to diagnose it.

This lack of documentation ends many disability appeals before they get started. Definitively proving that a cognitive impairment, respiratory or immune system issue is related to long COVID can be nearly impossible when the symptoms are difficult to diagnose conclusively.

When there is sufficient evidence to prove incapacitating long COVID, the familiar sticky cogs of bureaucracy mean that people can go up to two years without income while waiting for approval.

The role of Social Security

Most insurance policies require the claimant to have successfully secured Social Security Disability (SSD) benefits before they will be considered for long-term policy benefits. The ever-present backlog of applications aside, SSD requires that someone suffer from their incapacitating illness for at least a year before they will be considered for benefits. With the waxing and waning, sometimes vague nature of long COVID symptoms, this is a difficult bar to clear.

Mental health has always been an ERISA sticking point

People seeking long-term disability claims due to mental health conditions have never had it easy, and their plight recently worsened. Unlike a physical injury, one cannot objectively prove an incapacitating mental health condition by presenting an MRI or lab results. Evidence is largely based on testimony from mental health professionals, which an insurance company can and will challenge at every opportunity.

Since “brain fog” is one of the main symptoms of long COVID, sufferers face the same uphill battle as people with mental health conditions, who, in a cruel twist, must summon the necessary executive function to prove their claims as high-priced lawyers diligently work to discredit them. Something as simple as filling out a three-page form requires more focus than many claimants can handle.

As time passes, doctors, SSD, and the insurance industry are becoming better versed in long COVID as a disability. However, that familiarity doesn’t necessarily improve the path to securing long-term benefits. Like any ERISA claimant, sufferers will likely need considerable willpower, perseverance, and even legal representation to earn benefits.