By Nainesh Kotak
Disabled employees are getting caught in the middle as insurance companies lag the medical community’s growing awareness of the enduring effects COVID-19 infections can have on some patients.
The New York Times newspaper recently reported on a U.S. analysis of nearly 80,000 long-term disability claims for long COVID — the catch-all term for the wide array of debilitating symptoms that linger in some sufferers long after the initial infection has disappeared — that offers new insights on the medical phenomenon.
The U.S. government estimates that between 10 and 30 per cent of infected adults have enduring symptoms. Meanwhile, one-third of the disabled employees with long COVID in the study reported being 100 per cent healthy before contracting long COVID, compared with two-thirds who had some kind of pre-existing health condition.
In addition, the study suggests that there may be a weaker link between the severity of a patient’s initial infection and the impact of their long COVID than some experts expected since less than a quarter of the study participants required treatment in hospital while sick with COVID-19.
“It’s generating a pandemic of people who were not hospitalized, but who ended up with this increased disability,” Dr. Paddy Ssentongo, an infectious disease epidemiologist not involved in the study, told the Times.
Novelty of long COVID used to deny coverage
Studies are harder to come by in Canada, but the findings are in line with what I have seen in my practice – there has been a significant uptick in our office of lasting COVID-related complaints, including continuing shortness of breath and gastric issues, as well as physiological impairments such as heart palpitations and lung damage.
Sadly, disabled employees unlucky enough to be at the cutting edge of medical developments with long COVID should not hold out much hope that their LTD insurer will be any more accommodating because of the emerging nature of their condition if they need to file a claim.
I have written before about how insurers took advantage of pandemic-related delays in mental health care to deny claims, and many LTD providers appear to be following the same pattern with long COVID, using the novelty of the syndrome as a weapon to terminate or deny coverage.
For instance, those with suspected cases of long COVID may find that their LTD insurer raises questions about the diagnosis of their initial COVID-19 infection, depending on when they contracted the disease.
Various shortages of testing kits and evolving public health advice across the course of the pandemic combined to ensure that many people with COVID -19 never actually received a formal diagnosis from a doctor or public health official before going on to display the classic symptoms of long COVID.
Now their insurers may raise the spectre of a denial of LTD benefits on the basis that the individual has provided “insufficient medical evidence,” when in fact they were told at the time that a test was unnecessary because they were already isolating due to a positive close contact, or because they used a rapid test due to the unavailability of PCR tests.
Echoes of fibromyalgia, chronic fatigue
The skepticism of insurers with respect to long COVID reminds me of the emergence of other “invisible” conditions such as chronic fatigue syndrome and fibromyalgia in the 1990s. As research deepened and awareness grew, physicians became better able to identify these conditions and it became harder for insurers to maintain their denials.
Ironically, LTD providers eventually started downplaying the importance of a formal diagnosis in relation to those disorders, claiming that insured workers with confirmed cases needed to do more to convince them that they were unable to work.
Our approach has been to turn these same arguments back on insurers in cases of long COVID, by focussing on the symptoms suffered by injured employees. In the end, it shouldn’t matter whether a diagnosis is suspected or confirmed when the consequence is a debilitating effect on the person’s ability to function in their daily life and at work.
As professionals, researchers and the general public become more familiar with long COVID, I expect the road to LTD benefits to become a little smoother for sufferers. In the meantime, claimants can boost their case by seeking treatment and following the advice of their health providers, including family doctors and specialists.
KOTAK PERSONAL INJURY LAW/DISABILITY LAWYERS CAN HELP YOU
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