Many COVID-19 patients suffer from debilitating long-term symptoms such as difficulty breathing, brain fog, fatigue, and more. These symptoms can make regular routine tasks impossible to perform and even cause some patients to lose their income. Our insurance denial lawyers discuss who is eligible for COVID-19 disability benefits and what to do if your insurer denied your long-term disability claim.
Claiming Disability due to COVID-19
Roughly 80,000 Canadians have “recovered” from COVID-19. However, there are reports that many of these individuals are still suffering from ongoing symptoms. The reported symptoms are anxiety, brain fog, fatigue, shortness of breath, chest pain, coughing and memory problems, among others. These symptoms can last for weeks or months following a bout with COVID-19. The media has begun referring to these individuals as COVID-19 “long-haulers”.
“Long-haulers” are reporting that they are not able to work due to their ongoing symptoms. There are reports that they are being denied long-term disability benefits by their workplace insurance companies.
Who Can Qualify for COVID-19 Disability Benefits?
First, the basics. Long-term disability insurance benefits are wage replacement benefits. They will pay an individual a portion of his or her income during the period that they are unable to work due to illness or injury. During the first two years an individual must be “totally disabled” from his or her own occupation. This is the job that the individual is currently working in. After two years, they must be “totally disabled” from any occupation for which they are reasonably qualify by way of education, training, and experience.
“Total disability” does not require an individual to be physically or mentally incapacitated. Rather, an individual will be totally disabled if a reasonable person would determine that common care and prudence would require them to stop working in his or own occupation to recover or prolong his or her life. In most cases, an individual must simply be unable to reasonably perform the regular functions of his or her job.
What to do if your COVID-19 disability insurance claim is denied?
When an insurance claim is made, the insurance company will determine whether they believe the individual is “totally disabled”. If the insurance company does not believe the individual is “totally disabled”, they may deny coverage. If they deny coverage, an individual is entitled to commence a lawsuit for the payment of long-term disability benefits. If an insurance claim were to end up before a judge in court, the judge will consider the individual’s diagnosis. However, this would not be determinative. Instead, the judge will focus on the individual’s functional capabilities.
For example, say an individual works as an office administrator and contracted COVID-19 in the spring of 2020. This individual may or may not have received a formal diagnosis for COVID-19. However, since the spring of 2020 he or she has been suffering from anxiety, brain fog, fatigue, shortness of breach and memory problems.
This impacts the individual’s ability to perform his or her job. They experience significant anxiety while at work. They are fatigued all the time and continually miss work. The brain fog leads to many errors and the individual’s boss begins to comment on work performance. It becomes very difficult for the individual to stay on task or remember what they were doing due to memory problems.
In this case, even though there may not have been a formal diagnosis of COVID-19, a judge will look at function and the individual’s ability to perform his or her job. Based on what has been described above, there is a reasonable chance that the judge may find the individual “totally disabled” and entitled to benefits.
While there is still a lot of unknowns about COVID-19, it is true that many patients experience persistent symptoms, making them unable to go to work. Individuals who lost their income due to the lingering symptoms of COVID-19 may be eligible to apply for long-term disability benefits through their insurance plans. However, as insurance companies grapple to understand the long-term impacts of the virus, many COVID-19 disability claims get denied. If you have been denied your disability insurance coverage, contact one of our lawyers today for a free initial consultation. You may be concerned about not having money to hire a lawyer, however, we work on contingency fee arrangements so there is no up-front cost to you; and you only pay a legal fee if the insurer pays.