Navigating a long-term disability claim for COVID

Health impacts from the pandemic continue to linger with ongoing reports of COVID-19 infections.

And some of those who were previously infected with the virus are now suffering from the post-COVID-19 condition known as long COVID.

The World Health Organization expects that between 10 and 20 percent of those infected will have symptoms of long COVID. And a very recent study in Ontario concluded the impacts of long COVID are substantial.

The medical community is continuing to learn about and study the long-term impacts of the SARS-CoV-2 infection and how it will impact society. But it has clearly already insinuated itself into our lives.

The symptoms of long COVID often include brain fog, poor concentration, headaches and fatigue as well as respiratory distress and a variety of other symptoms, preventing some people from completing their tasks at work. This can lead to psychological distress as well, including the anxiety of going back to the physical workplace. As a result, some people are completely unable to work.

Is long COVID a disability?

The question for many who have found the symptoms of long COVID overwhelming and interfering with their ability to do their job is, what can they do and is COVID-19 covered under their disability policy?

Every employer is required to accommodate employees suffering from health impacts. That could include changing the required tasks, different scheduling, offering part-time work or providing more frequent breaks.

Those who can’t be accommodated and simply can’t work because their symptoms are significant may be able to access short- and long-term disability benefits. Those individuals will likely meet the test of disability under the disability policy, which is approved or denied by the insurance company.

Fatigue has been identified as the most common symptom of long COVID, followed by brain fog. But the symptoms can be varied and attaching a label or identifying that the illness is directly tied to COVID-19 could be difficult. The point of short- and long-term disability policies is to provide a safety net in the event that an individual is unable to work because of an illness.

Diagnosis less important than functional ability

The bottom line with a COVID-19-related claim is that it’s no different than any other medical claim related to the inability to work. A label or a specific diagnosis is irrelevant. What matters is that illness is preventing the individual from being able to work. What’s important to consider when making a claim is the symptoms and how that impacts an individual’s ability to do their job.

To obtain disability benefits, it is necessary to collect all the correct documentation. Key is having a doctor complete the attending physician’s statement, supporting the medical claims being made that show the individual is suffering from an illness that prevents them from returning to work. In this statement, the doctor explains what the symptoms are, how long they are expected to last and how they impact the person’s functional ability.

The more detail and documentation made to the insurer to support the claim, the more likely the insurer is to complete a fulsome evaluation for the application.

And like any medical claim, there is a chance that an insurer will deny it. The biggest risk for denial is not having a supportive doctor or not having enough medical information to illustrate the symptomology and how that impacts the individual’s ability to work. The medical complaint, supported by the doctor’s forms, provides a solid framework should the need to challenge an insurer’s denials of coverage arise. The employee statement allows the individual to explain in more detail how the condition makes them unable to do their job.

Government medical benefits

Those who are unable to work because of illness should examine their insurance policy to see what types of benefits are available. Short-term disability benefits for those medically unable to do their job, for example, might provide coverage for 12 or 16 weeks.

But short-term disability isn’t always available. Those who don’t have it can apply for sickness benefits through the federal government’s Employment Insurance which allows for up to 15 weeks of coverage due to medical sickness.

Someone who is too ill to work but has been denied coverage by an insurance company may well have success challenging the insurer by providing more detailed documentation.

Let us be your long-term disability lawyers in Oakville!

If your claim for disability benefits has been denied or terminated and you would like an opinion on your case, call our office at (289) 529-0404 to schedule a consultation.

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