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Disability claims for long COVID are still problematic

On Behalf of | May 23, 2024 | Disability Claims, ERISA

While the medical community works to uncover the intricacies and unknowns of long COVID, long-term disability applicants are still struggling to receive benefits for this condition.

The pre-existing condition tactic fails again

Insurance providers, huge fans of pre-existing condition denials, are still tossing out this oldie, even as the medical community coalesces around the conclusion that long COVID is a legitimate, standalone condition.

In Kim v. The Guardian Life Ins. Co. of Am., Guardian swung for the fences, insisting that the plaintiff’s condition—”severe physical, cognitive, and mental health symptoms”—were tied to his previous diagnoses for depression, anxiety and ADHD. Guardian also characterized the plaintiff’s symptoms, including altered cognition and psychosis, eventually leading to hospitalization after an attempted suicide, as minor and non-disabling. Guardian also ignored a neurologist’s post-COVID diagnoses of tardive dyskinesia (uncontrollable facial movements) and tardive akathisia (feelings of jitteriness and a strong compulsion to move the lower extremities).

The court states the obvious

The court pointed out that the plaintiff’s depression, anxiety and ADHD hadn’t been disabling prior to him contracting COVID-19. “The Record contains sufficient evidence to establish that Plaintiff’s condition had subsequently changed from common anxiety and depression to something far more severe and unconnected to his documented prior conditions,” the court added.

With that topic settled, the court concluded that the pre-existing condition exclusion wasn’t applicable. The plaintiff was awarded benefits, plus interest, attorneys’ fees and costs.

Long COVID is a verified disability

The U.S. Department of Health and Human Services has declared long COVID as a legitimate disability when it “substantially limits one or more major life activities.” People with compelling medical documentation pointing to long COVID have federal policy to back up their disability and should therefore challenge any denial of benefits as they cope with their condition.

Alas, even with a doctor’s explicit diagnosis, taking insurance providers to court for benefits can be a stressful and frightening experience. An experienced ERISA attorney should be able to ascertain whether you have a strong case and how to dismantle an insurance provider’s arguments for a denial.