LTD Insurance Companies Denying Long COVID Claims

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LTD Insurance Companies Denying Long COVID Claims

Written By: Steve Rastin, Senior Counsel & Lawyer

As vaccines slowly return some normalcy to a world living under a cloud of coronavirus, long COVID threatens to be the next healthcare crisis, and it could have a profound effect on long-term disability claims.

Long COVID could very well be the fibromyalgia of the next decade. We are starting to see instances where people who have been trying to get benefits for several months seek legal advice because their insurance companies refuse to look at their claims. I anticipate that this is going to be a massive battleground as people fight for their rights.

Many have been functioning on the assumption that if COVID-19 does not kill you, you will eventually get better, but that is not always the case. There is a tendency to view COVID as the bad flu. It is not. It is a different disease with another mechanism. After more than a year of dealing with the COVID crisis, there is growing evidence of the after-effects still suffered by so-called “long-haulers.”

People suffering months after a positive test

Researchers at the British Medical Journal found that about 10 percent of those tested positive for the coronavirus continue to suffer months later. They state post-acute COVID-19 symptoms vary widely, and even a mild case may be associated with long-term symptoms, such as low-grade fever, cough and fatigue.

About 1.4 million Canadians have tested positive for COVID, which means if researchers are correct, there may be 140,000 long-haulers still suffering from the disease. The numbers could be much higher since it only includes people who have tested positive for the virus. Many others may have caught a mild case of COVID but were not tested. And even though they may have seemingly recovered, there could still be lingering long-term effects. What is even more frightening is that others are dragging themselves through their lives and suffering. But because this cluster of symptoms is so ill-defined, they do not realize that they are long-haulers.

More long COVID cases may come to light when people return to the job from a remote workplace environment. People go back to the active workforce with commuting and all the stresses associated with an office. If you are functioning at less than maximum efficiency while working from home every day, it might take longer for some of these deficiencies to become evident.

Three categories of COVID patients

There are three categories of COVID: asymptomatic people, those who have had minor symptoms, and hospitalized. From anecdotal evidence, it appears that many long-haulers may be young and in previously good health.

Science has learned much about the virus, but many questions remain. For some, it does permanent damage. It could do permanent damage, but some might not even realize it.

Some people who have been dealing with health issues due to the coronavirus have been able to rely on emergency government funding. But what is happening now is that things such as Employment Insurance have run out, and people are hitting the long-term disability (LTD) wall. Most LTD policies have a four- to a six-month waiting period before they kick in. We are now starting to see more cases where claims are being denied. It is going to be a big fight.

Insurance companies expect a claimant to document the history of their claim, which is one of the problems with the virus. An insurer will ask for a positive COVID test, but not everyone who caught the virus got one. Insurers also demand medical paperwork to back up a claim.

Establishing a good paper trail

Establishing a good paper trail with your family physician is essential. But many family physicians have not seen patients in a year and a half. You may have long COVID, but you have not seen your doctor during the lockdown, and the insurance company will use that against you if you have not documented it.

Another hurdle is a lack of a clinical definition for long COVID. The underlying problem is that many of these symptoms do not show up on diagnostic testing. There is no test to find something abnormal. Doctors have not gotten together to come up with a clinical definition for long COVID. It has not reached the attention that it deserves. We need to get a clinical definition of long COVID, and we need to educate the medical community to start making a diagnosis.

Insurance companies have a responsibility to the long-haulers they insure

You buy insurance to save yourself from precisely this type of stress. You have been paying into this policy religiously so that you have peace of mind knowing that your family will not be financially ruined if the worst happens. Then the worst happens, and the insurance company says, ‘Prove it.’

It is fair to say that this is new enough that lawyers are feeling their way too. However, the problem is too big to be dismissed because there is insufficient medical evidence to support a claim. It is essential that people facing this reach out to a lawyer who has experience representing people with disability claims—someone with the skills to deal with chronic pain cases and invisible disabilities.