If you continue to experience symptoms months after recovering from a COVID-19 infection, you are not alone. Nearly 1 in 4 people who were infected with the virus are believed to suffer from so-called Long-Haul Syndrome or Long COVID Syndrome. Symptoms can range from mild to debilitating and, in some cases, can prevent people from performing their jobs. As the pandemic continues and COVD-19 infections exceed the 50 million mark, more long-haulers are applying for long-term disability benefits. Many will face an uphill battle in getting their claims paid, however, as insurance companies seek to poke holes in claims in order to protect their bottom lines.
According to the Centers for Disease Control and Prevention (CDC), people with Long-Haul Syndrome can have a range of new or ongoing symptoms months after recovering from the infection, and these symptoms can worsen with physical or mental activity. Common symptoms include, but are not limited to, fatigue, difficulty thinking or concentrating (called “brain fog”), shortness of breath or difficulty breathing, headache, dizziness when standing, heart palpitations, chest pain, cough, joint or muscle pain, depression or anxiety, fever, and loss of taste and/or smell.
Long-haulers fall into two groups of patients: one group includes those who have sustained some permanent damage to one or more of their organs, such as their lungs, heart, kidneys or brain, that may affect their ability to function. The other group is comprised of patients without detectable damage to an organ, but who continue to experience ongoing symptoms, some of which can be debilitating.
Long-Haul Syndrome can be classified as a disability under the Americans with Disabilities Act and other laws, if an assessment determines the condition substantially limits one or more of the individual’s major life activities, according to guidance published by the Department of Health and Human Services and the Department of Justice.
Different studies have found varying prevalence of Long-Haul Syndrome, in part due to different definitions of the condition. The nonprofit organization FAIR Health released a large-scale study in June 2021 that examined the records of nearly 2 million U.S. COVID-19 patients. The study found that 23.2 percent of the patients sought medical treatment for new or persisting symptoms one month or more after their infection, and defined this group as long-haulers.
While patients who were hospitalized with COVID-19 are more likely to suffer from Long-Haul Syndrome, it also affects people who had mild or even asymptomatic disease. Half of the patients in the FAIR Health study who had been hospitalized with COVID-19 were long-haulers, compared with 27 percent of people with mild to moderate symptoms and 19 percent who were asymptomatic.
Because COVID-19 is a novel disease, there is no information about long-term recovery rates. But the symptoms suffered by many long-haulers are similar to those of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which has prompted numerous studies to investigate the link between COVID-19 and ME/CFS and to determine if, in fact, the coronavirus leads to ME/CFS in some individuals.
ME/CFS has been triggered by other infectious illnesses, including Lyme disease, mononucleosis and severe acute respiratory syndrome (SARS). According to the World Health Organization, about 40 percent of people recovering from SARS still had chronic fatigue symptoms 3.5 years after being diagnosed. A potentially debilitating condition that can linger for decades, ME/CFS is marked by fatigue, problems with thinking and memory, muscle and joint pain, and headaches. Between 1 million and 2 million Americans currently suffer from ME/CFS, according to National Academy of Medicine estimates.
Your Long-Term Disability Claim
With Long-Haul Syndrome potentially having a major impact on long-term disability claim activity, insurance companies will do whatever they can to challenge or deny claims in order to limit their liability.
To successfully file a claim, you will need to prove that you have a disabling condition and that this condition prevents you from performing the material duties of your occupation. You will need a diagnosis from a physician who is qualified to treat that condition. For instance, if you suffered heart damage from COVID-19 and have lingering cardiac symptoms that prevent you from working, the diagnosis must come from a cardiologist, and it should be accompanied by objective evidence, such as results of an echocardiogram, MRI and/or lab tests, to support the diagnosis.
Unfortunately, proving an ME/CFS-like illness is typically challenging because of its varied nature, especially if there is no measurable underlying damage to an organ or body system. Some long-haulers do not even have evidence that they had COVID-19 in the first place, as they may not have gotten a test if they had mild illness, especially in the early months of the pandemic when tests were not widely available.
Further, it is challenging to demonstrate the disabling impact of ME/CFS-like symptoms such as fatigue or muscle aches on your ability to perform the material duties of your job, because there are no objective tests that quantify these symptoms.
Keeping a journal of your symptoms and how they impact various aspects of your life and your work can be helpful in developing supportive evidence. Discuss your journal with your doctor and make sure your doctor keeps thorough notes. Seriously consider trying any treatments that the doctor recommends, and make sure your doctor documents how these interventions impacted your condition. Your medical record should demonstrate that you are collaborating with your doctor to manage your symptoms to the best of your ability.
In addition to your journal and doctor’s statement, functional capacity testing can provide further evidence that certain symptoms impair your ability to perform physical functions, and neuropsychological testing can significantly help document cognitive impairment. Statements from friends, family and co-workers comparing how you functioned before and after developing your symptoms and limitations can provide additional evidence to support your claim.
Consulting with an attorney with expertise in long-term disability insurance law, as early in the process as possible, can go a long way to ensuring that you avoid pitfalls and missteps that could lead to your claim getting denied.
If you are considering filing a long-term disability claim or if your claim is being challenged or has been denied, give us a call. We handle long-term disability claims on a daily basis and have the experience, knowledge and tenacity to make sure insurance companies keep the promises they made to policyholders like you.
Contact us today for a free consultation.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack