Long COVID, a condition where individuals endure persistent symptoms long after their initial recovery from the acute phase of COVID-19, has revolutionized the fields of health, employment, and disability insurance. Professionals from all walks of life—executives, healthcare workers, educators, and others—have found themselves facing debilitating symptoms like chronic fatigue, brain fog, shortness of breath, and more. These symptoms can make it nearly impossible to perform the duties of their jobs effectively.

Long Covid Disability AttorneyDespite the clear impact of long COVID on a professional’s ability to work, insurance companies often deny long-term disability (LTD) claims related to this condition. For professionals, this denial can be devastating, as it puts both their financial stability and future careers at risk. Below, we’ll explore why insurance companies deny these claims and why hiring an experienced attorney is vital for navigating this complex process.

Understanding Long COVID and Its Impact on Professionals

Long COVID, also known as Post-Acute Sequelae of SARS-CoV-2 (PASC), is characterized by a range of symptoms that can last weeks, months, or even years after the initial infection. Common symptoms include:

  • Chronic fatigue
  • Cognitive impairments (“brain fog”)
  • Joint and muscle pain
  • Difficulty breathing
  • Heart palpitations
  • Anxiety or depression

For professionals in high-demand careers, even mild symptoms of long COVID can have a profound impact. Brain fog, for example, may prevent an executive from making critical decisions, while chronic fatigue may render a healthcare worker unable to endure long shifts.

Unfortunately, these symptoms are often subjective and difficult to measure with standard diagnostic tools. This makes proving the severity of long COVID to insurance companies particularly challenging.

Why Insurance Companies Deny Long-Term Disability Claims for Long COVID

Insurance companies often deny LTD claims for long COVID due to a combination of medical, procedural, and financial reasons. Here are the key factors:

  1. Lack of Objective Evidence

One of the most common reasons for denial is the lack of objective medical evidence. Insurance companies often require measurable proof, such as imaging scans, blood tests, or functional capacity evaluations, to confirm the severity of a condition. Long COVID, however, does not always present with identifiable markers. Symptoms like fatigue or brain fog cannot be easily quantified, giving insurers an opportunity to argue that the condition is insufficiently documented.

  1. Subjective Symptoms

Long COVID primarily manifests through subjective symptoms, which are often dismissed by insurance adjusters. For example, fatigue or cognitive impairment may be labeled as “self-reported” symptoms, and insurers may claim that these are not disabling enough to warrant LTD benefits.

  1. Pre-Existing Condition Exclusions

Insurance companies may try to argue that the claimant’s symptoms existed before contracting COVID-19, labeling them as pre-existing conditions. For example, an insurer might claim that anxiety or depression was present before the onset of long COVID, thereby denying coverage under a policy’s pre-existing condition clause.

  1. Failure to Meet Policy Definitions

LTD insurance policies often have specific definitions of what constitutes a “disability.” For instance, some policies require claimants to prove they cannot perform the duties of their “own occupation,” while others require them to demonstrate they are unable to work in “any occupation.” The subjective and episodic nature of long COVID symptoms can make it difficult for professionals to meet these stringent definitions.

  1. Incomplete or Inconsistent Medical Records

Insurance companies scrutinize medical records for inconsistencies or gaps in treatment. If a professional suffering from long COVID has not sought consistent medical care or has conflicting notes in their medical files, the insurer may deny the claim.

  1. Financial Incentives

Ultimately, insurance companies are profit-driven entities. Paying out long-term disability claims is costly, and they have a vested interest in denying as many claims as possible. Professionals with high salaries represent particularly significant financial liabilities, which may make insurers more inclined to challenge their claims.

Why Hiring an Attorney Is Essential

The long-term disability claims process can be daunting, particularly for professionals grappling with the physical and emotional toll of long COVID. An experienced attorney can provide critical support and increase the likelihood of a successful claim. Here’s how:

  1. Navigating Complex Insurance Policies

Disability insurance policies are often filled with complex language and fine print designed to benefit the insurer. Attorneys specializing in LTD claims can decipher these policies, ensuring that professionals understand their rights and obligations. They can also identify potential loopholes or unreasonable exclusions that insurers might exploit.

  1. Gathering and Presenting Medical Evidence

As mentioned earlier, one of the biggest challenges for long COVID claimants is the lack of objective evidence. Attorneys work closely with medical professionals to compile comprehensive evidence, including detailed physician statements, test results, and expert opinions. They know how to present subjective symptoms, like fatigue and brain fog, in a way that meets the insurer’s requirements.

  1. Managing the Appeals Process

If an insurance company denies a claim, the claimant has the right to appeal. However, the appeals process is often highly technical and governed by strict deadlines. An attorney can handle the appeals process on behalf of the claimant, ensuring that all necessary documentation is submitted and deadlines are met.

  1. Preventing Common Mistakes

Many LTD claims are denied due to errors made by claimants, such as incomplete forms, missed deadlines, or contradictory statements. An attorney ensures that all paperwork is accurate and complete, minimizing the risk of denial due to procedural issues.

  1. Representing Claimants in Litigation

If the appeals process is unsuccessful, litigation may be necessary. Attorneys with experience in disability law can represent claimants in court, advocating for their rights and presenting a compelling case to a judge.

  1. Leveling the Playing Field

Insurance companies have teams of attorneys and claims adjusters working to protect their interests. Hiring an attorney levels the playing field, giving professionals the legal expertise they need to counter the insurer’s tactics.

Tips for Professionals Filing a Long-Term Disability Claim for Long COVID

While hiring an attorney is crucial, there are steps professionals can take to strengthen their LTD claims:

  1. Seek Consistent Medical Treatment: Regular visits to healthcare providers help establish a clear medical record, which is essential for proving disability.
  2. Document Symptoms Thoroughly: Keeping a daily journal of symptoms, their severity, and their impact on work can serve as valuable evidence.
  3. Communicate Openly with Your Doctor: Ensure that your healthcare provider understands the demands of your job and can clearly explain why your symptoms prevent you from performing those duties.
  4. Avoid Social Media Pitfalls: Insurance companies often monitor claimants’ social media accounts for evidence that contradicts their claims. Be mindful of what you post online.
  5. Consult an Attorney Early: The earlier you involve an attorney in the claims process, the better your chances of success.

 

For professionals suffering from long COVID, long-term disability benefits can be a lifeline. Unfortunately, insurance companies often deny these claims due to subjective symptoms, a lack of objective evidence, and other reasons. Navigating this process alone can be overwhelming, especially when battling the debilitating effects of long COVID.

Hiring an experienced long-term disability attorney can significantly impact the outcome. From interpreting complex policy language to gathering compelling medical evidence and representing clients in appeals or litigation, attorneys provide the expertise and advocacy needed to secure the benefits professionals deserve.

If you’re a professional struggling with long COVID and facing a denied LTD claim, don’t navigate this journey alone. Reach out to Uscher, Quiat, Usher & Russo, P.C. today; they will fight for you.