Insurance Companies in Denial regarding Long COVID

Santa Clara, CADespite government entities recognizing Long Covid as a disability, attorneys are litigating against health insurance companies that deny disability benefits to COVID long haulers.

According to guidance  by the Justice Department and the Department of Health and Human Services, Covid long haulers  can be protected under the Americans with Disabilities Act. However, Insurance companies have successfully denied COVID long haulers. Like other patients with disabilities such as fibromyalgia and Lyme Disease (where diagnoses are problematic), they are the easiest claimants to deny. Most long-Covid patients don’t have the energy or wherewithal to fight back, and because they are unable to work, they can’t afford an attorney to file an appeal.

The CDC released interim guidelines in June 2021 to help doctors diagnose and treat long Covid. However, the agency also said that “post-COVID conditions are not yet well understood”, which is another Catch-22. The CDC says long Covid is a challenge to define because it is associated “with a spectrum of physical, social, and psychological consequences, as well as functional limitations that can present substantial challenges to patient wellness and quality of life.”

The CDC recently presented data to the SSA on the number of people expected to have myalgic encephalomyelitis/chronic fatigue syndrome as a result of Covid-19. A study published in September 2021 found more than half of people who contracted Covid-19 in 2020 had one or more symptoms of long Covid for six months after they first got sick. A third had one or more symptoms three to six months after their initial infection. It is not yet known how many of those people are or will be disabled. The researchers concluded that “Long -COVID clinical features occurred and co-occurred frequently and showed some specificity to COVID-19, though they were also observed after influenza. Different long-COVID clinical profiles were observed based on demographics and illness severity.”

As a consequence, long Covid patients also struggle to get their medical treatment and mental health support covered by insurance companies. To guarantee that denied insurance attorneys will be busy, a CDC study estimates that one in five adults will experience long COVID.

“Long-patients experience multiple obstacles to obtaining the care they need for this novel condition – poorly understood symptoms, limited treatment options, uncertain prognosis, and potential denial of coverage for the care they need by their insurer,” the Center for Health Insurance Reforms at Georgetown University warned, and reported by the New Hampshire Bulletin. “In the short term, patients with long COVID will need to understand their appeal rights should their health plan refuse to pay for their care.”

Insurance Companies in Denial

Insurance companies typically provide disability coverage for a period expected to last 3 months or longer. Some Covid long-haulers contracted COVID in early 2020 and they have still been denied coverage.  

Private Insurers

Unum Group, one of the leading carriers of long-term disability, told Bloomberg Law that disability and leave claims connected to Covid-19 are primarily a short-term event. Most claimants recover before completing the normal qualification period of 90 or 180 days for long-term disability insurance.

Even if benefits are approved, most insurers can set limits to two years when a person is disabled due to a mental illness and conditions like chronic pain and fatigue. Although Long COVID is not specifically excluded in most current long- or short-term disability insurance policies, some policies are now adding “post-viral syndrome” limitation in benefits.

According to Bloomberg Law, Unum’s practice of limiting benefits to 24 months for self-reported symptoms was recently upheld by the U.S. Court of Appeals for the First Circuit, in a dispute that centered on a woman with chronic fatigue syndrome and fibromyalgia. The court said it was reasonable for Unum to require objective proof of her functional loss in determining whether her disabilities were based primarily on self-reported symptoms.

Social Security

Getting benefits through the Social Security Administration is no easier. The SSA doesn’t include long Covid on its list of disabling medical conditions. The agency’s reasoning is that it doubts Covid causes a long-term disability; Some of long Covid’s most debilitating symptoms are hard to prove and even under routine circumstances, two of every three claims are denied.

The SSA said it’s received 16,000 claims for disability insurance since December 2021, where the person’s medical evidence supports identifying Covid-19 as one of their impairments.  And here is another Catch-22: To qualify for Social Security disability insurance, a condition must meet the agency’s definition of a disability. Under the SSA’s rules, the disabling condition or symptoms also have to have lasted, or be expected to last, for a year or result in death.

In a statement to Bloomberg Law, the SSA said its rules allow it to evaluate Covid-19 cases. A person who has limitations resulting from long Covid, who’s met or is expected to meet the duration requirement, “could be found disabled if their limitations equal a medical listing or if the combination of those limitations and vocational factors prevent them from performing substantial gainful activity,” the agency said.

It can take three to five months on average for SSA to make a decision. Appeals can take more than a year. About 1.2% of disability applicants who filed appeals between 2008 and 2019 died while waiting for the process to play out, and from 2014 to 2019, 1.3% of applicants filed for bankruptcy, the U.S. Government Accountability Office found in a 2020 report.

Covid Long-hauler Lawsuit

A California woman who contracted Covid-19 has been disabled since September 2020. She sued Reliance Standard Life Insurance Co. for denying her disability benefits, telling a federal judge in California that she’s unable to work as a software sales executive because of post-Covid symptoms including asthma, chronic cough, and “brain fog.”

Wendy Haut’s complaint, filed in the U.S. District Court for the Central District of California, is one of the first federal lawsuits seeking disability benefits based solely on post-Covid ailments under the Employee Retirement Income Security. According to the complaint, several doctors wrote letters attesting her disability:

Dr. Maggie Ney: I am encouraging my patient…to stop working and apply for long term disability She has been struggling with profound fatigue and extreme cognitive difficulties that make it impossible for her to do her job.

Neurologist, Marisa Chang, MD and neuropsychologist Martin Stern, Ph.D.: prepared a report regarding Plaintiff’s neuropsychological evaluation. The conclusion was the testing was consistent with mild cognitive dysfunction.

Dr. Eric Mizrahi, Wendy Haut’s primary care physician since she contracted COVID-19: She developed an aggressive course with devastating and rapid deterioration requiring near ICU level care at home. She took nearly three months to recover and wean off oxygen and is still weaning steroids… I am mostly concerned about her relentless asthma and chronic cough that did not exist prior to this illness and her physical and mental decompensation. she experiences constant mental fog and forgetfulness, especially short term memory, and thought processing. • She is literally incapable of assuming her responsibilities of daily living without assistance.

Dr. Sara Ghanderhari regarding Outpatient Pulmonary Rehabilitation: Plaintiff remained symptomatic from her prior COVID-19 infection with cough and tachycardia.

Last December, Reliance Standard denied Haut’s appeal. The case is Haut v. Reliance Standard Life Ins. Co., C.D. Cal., No. 2:22-cv-00237.