By Nainesh Kotak
We’re still learning about the long-term effects of contracting COVID-19, but a recent report from an Ontario science advisory group estimates that between 57,000 and 78,000 people in the province had or are currently experiencing long-haul COVID symptoms. What constitutes long COVID varies, but it’s essentially when someone’s symptoms extend beyond the initial expected acute infection period.
Of the more than 200 different symptoms reported by COVID long-haulers, the most common include fatigue, shortness of breath, general pain or discomfort, anxiety and depression. I have clients dealing with continued shortness of breath, memory issues or brain fog and sleeping difficulties months later. And, of course, these symptoms can compound depression and anxiety because of the tremendous lifestyle change. It’s similar to chronic fatigue syndrome or fibromyalgia, where it can have such debilitating effects on people that they’re no longer able to work.
Although long COVID has been studied more extensively in the United Kingdom and the United States, research in Canada is lagging. One major hurdle Canadians face is that people were not encouraged to get tested at the beginning of the pandemic. For example, if one family member was diagnosed with COVID-19, it was suggested that no one else in the household needs to be tested and instead should quarantine for two weeks. So, you may now be exhibiting long-haul symptoms but never had an initial diagnosis of COVID.
If you’re someone who is experiencing prolonged COVID symptoms and applying for a long-term disability (LTD) insurance claim — or your LTD claim has been denied — there are some steps you can take to strengthen your claim.
Seek medical allies
First and foremost, you need a medical practitioner in your corner. In most cases, that person is your family doctor. They can recognize the changes to your health and make the appropriate referrals to specialists. Depending on the symptoms exhibited, your GP could refer you to a psychologist, rheumatologist, cardiologist or neurologist. It’s crucial to have an effective interdisciplinary approach, although the ability to seek out medical attention has been compromised due to backlogs and shutdowns. That said, it’s essential to pursue medical attention to effectively manage and document your symptoms.
When it comes to LTD claims, there are two provisions for total disability. With most policies, for the first 24 months, your insurer will determine whether if you are disabled from performing the essential tasks of your job. After two years, the insurer determines if you’re able to perform any gainful occupation suitable by way of education, training or experience.
Insurance companies don’t just look at your diagnosis. They will also consider your ability to function and whether you can succeed in proving that you established total disability under either test. Mitigation — seeking treatment for your condition — is a significant factor in fulfilling the definition of total disability in the provision of the policy.
Write it down
It’s important to document your symptoms and moods because long COVID can change over time. Keep a journal to track your experiences and how things have changed. Long COVID can take an emotional and mental toll, so document your moods and how you are feeling. You can also jot down the activities you can no longer do and how your ability to function has changed. Because long COVID can cause brain fog and memory issues, your notes will help you recall problems later.
Avoid internal appeals
Insurance companies have been dismissive of LTD claims for long COVID, so it’s not surprising that your claim may be denied due to “insufficient medical evidence.” Although the insurance company may offer you the chance to appeal the decision, I strongly suggest avoiding their internal process because you’re likely to get the same result. It’s one hand judging the other hand within the same company. The appeals process will also delay the resolution of your case. Appealing creates an added expense where you have to get new medical records, and odds are you will inevitably get the same result — denial of your claim.
Particularly with a novel illness like long COVID, insurers are not going to be receptive to overturning their initial decision. So, my recommendation is to seek legal counsel so that the insurer can be sued, and then it’s out of the hands of the various case managers involved with the claim. Instead, it goes up the chain to a litigation specialist, a lawyer who can look at the claim with fresh eyes and hopefully less bias.
History repeating itself
Many years ago, chronic fatigue syndrome and fibromyalgia were not recognized the way they are now. Over time, these disabilities have been established, diagnosed by medical professions and accepted by insurance companies.
I suspect long COVID will go through the same process. Because it’s new, insurers will find ways to deny claims based on insufficient medical evidence — until there’s more research and case law behind long COVID.
That said, there’s a growing body of evidence to support that long COVID exists and can have debilitating symptoms, so anything you can do to bolster your claim will help you receive the compensation to which you are entitled.
KOTAK PERSONAL INJURY LAW/DISABILITY LAWYERS CAN HELP YOU
We understand that being denied short-term disability or long-term disability benefits can be devastating. Your time to fight your disability insurance company is limited. Please do not delay in calling a short- and long-term disability claim lawyer at Kotak Personal Injury Law. We have successfully sued numerous disability insurance companies including Manulife, Sunlife, Desjardins, Cigna, Great-West Life, Equitable Life, Empire Life, London Life, Blue Cross, AIG, SSQ, RBC, Industrial Alliance, Canada Life, Fenchurch, OTIP, Teachers Life and more.
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