COVID Long-Haulers Prepare for Wrongly Denied Disability Claims

February 17, 2021, 8:45AM. By Anne Wallace

What we can anticipate from fibromyalgia and chronic pain disability denials

Washington, DCCOVID long-haulers, who suffer from debilitating COVID symptoms long after an initial infection, have had their complaints dismissed as “malingering.” The cruelest cut of all, though, may be the financial blow that lands when long term disability benefit claims are denied. As yet, there are few reported COVID related long term denied disability lawsuits, but long-haulers should anticipate that they are just around the corner.

There are ways to prepare for this, however. LTD plaintiffs and attorneys have long and often successful experience with wrongly denied disability claims that depend on subjective evidence of chronic symptoms.

What is “long COVID”? 

Chantal Renaud likely caught COVID-19 from her husband in March 2020. She continued working until early June, when she came down with a more severe set of symptoms, including debilitating fatigue, shortness of breath and a racing heartbeat. She was bedridden for seven weeks, and when she tried to return to work in the fall, her symptoms came back. Her husband has also been unable to work.

In January 2021, after her LTD claim was denied, the Canadian woman faced the prospect of having to sell her home to pay bills. She filed a wrongly denied disability lawsuit.

Chantal Reynaud’s symptoms are consistent with those being investigated by the CDC, which reports that “[w]hile most persons with COVID-19 recover and return to normal health, some patients can have symptoms that can last for weeks or even months after recovery from acute illness.” Among the long-term symptoms are:

- Fatigue
- Shortness of breath
- Cough
- Joint pain
- Chest pain
- Difficulty with thinking and concentration (sometimes referred to as “brain fog”)
- Depression
- Muscle pain
- Heart palpitations

Many long-haulers start feeling better in their fourth or fifth month, but recovery is tentative, variable, and uncertain.

As yet, few COVID long term denied disability lawsuits seem to have made their way through the U.S. court system, but the symptoms commonly reported are similar to those of fibromyalgia or myalgic encephalomyelitis, also known as chronic fatigue syndrome. These are conditions for which many long-term disability insurers routinely and wrongly deny claims.

Lessons for COVID long-haulers

At the outset, COVID long-haulers should understand that pursuing a long-term disability claim will likely require active and persistent efforts. It may be helpful to think of it as a three-step process that begins with the filing of an LTD claim and may continue through appealing a denial of the claim and ultimately appealing the denial of an appeal.

Step one, the claim, will require extensive documentation, including:

- A personal statement
- An employer statement
- An attending physician’s statement, and  
- Miscellaneous forms and releases

You may have to request these more than once and you should review them carefully to correct any errors. You should also gather and prepare a journal that details your symptoms and medical treatments, statements from co-workers that detail your work ability, and all of your relevant medical records. Be very careful not to exaggerate the severity of your symptoms. You should also assume that you may be under surveillance designed to undermine the credibility of your statements. Be very careful about communicating verbally with the insurance carrier.

Follow your doctor’s orders; do not miss appointments and regularly keep up with recommended or prescribed therapies. You may need the help of outside experts to establish the severity of an “invisible condition,” like chronic fatigue. Assume that, once your claim is filed, you will be asked for further information, documentation and perhaps additional medical examinations. Respond to these promptly.

Remember that you are creating a record on which to base your appeal.

When your covid long-term disability claim is denied 

Most plans have automatic appeals procedures. Plan to file an appeal even though, frustratingly, it may involve repeating some of the same steps that you took in filing the claim, such as requesting your medical records.

If your claim is covered by the Employee Retirement Income Security Act (ERISA), you should have a period of at least 180 days to file an appeal. Pay close attention to deadlines. You must generally follow the prescribed claim and appeal process before filing a long-term disability denied lawsuit.

If your appeal is denied

If you have not already consulted a long-term disability lawyer, now would be the time to do so. You have the right to request the complete file on which the claim and appeal were denied. This will be the basis of any further legal action you choose to take.
COVID long-haulers face multiple challenges, including developing medical science and administrative and court systems that may be operating on reduced schedules. With appropriate assistance, however, it may be possible to succeed in an LTD claim, even after wrongful denial. That, at least, may spare long-haulers some of the financial hardship that comes with debilitating illness.