What is Long COVID?
Long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), is when individuals experience persistent symptoms and complications even after recovering from the initial COVID-19 infection, which can worsen with physical or mental activities. While many fully recover within a few weeks, some experience prolonged symptoms that can last for months or even recur later. Referred to as “long-haulers,” these individuals may wonder if long COVID qualifies for long-term disability benefits.
Symptoms of Long COVID
Symptoms commonly associated with long COVID include:
- Persistent Fatigue: One of the most common symptoms of long COVID is continuous and overwhelming fatigue. Individuals may experience extreme tiredness even after minimal physical or mental exertion. This fatigue can significantly impact daily activities and work performance.
- Shortness of Breath: Many long COVID patients have trouble breathing, even after recovering from the initial COVID-19 infection. Breathlessness may persist during physical activities or even at rest, making it challenging to maintain a normal lifestyle.
- Brain Fog and Cognitive Issues: Long COVID can lead to persistent cognitive impairments, often called “brain fog.” Individuals may experience problems with concentration, memory, attention span, and decision-making. These issues can significantly impact work productivity and overall quality of life.
- Muscle and Joint Pain: Ongoing muscle and joint pain are prevalent among long COVID sufferers. These pains can range from mild to severe and may limit physical activities and mobility.
- Cardiovascular Problems: Long COVID can also affect the cardiovascular system, leading to palpitations, chest pain, and an irregular heartbeat. Such symptoms may restrict individuals from engaging in physically demanding tasks.
- Gastrointestinal Issues: Some individuals with long COVID may experience digestive problems such as nausea, diarrhea, and abdominal pain. These issues can further exacerbate the overall discomfort and affect daily functioning.
- Mental Health Challenges: Long COVID can significantly impact mental health, leading to symptoms such as depression, anxiety, mood swings, and irritability. These psychological symptoms can further contribute to the overall disability experienced by individuals.
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However, it’s important to note that the condition can manifest in other ways. Some other potential symptoms to consider include:
- Headaches and migraines
- Sleep disturbances and insomnia
- Loss of taste and smell
- Respiratory difficulties
- Skin rashes and hair loss
- Damage to organs such as the heart, lungs, kidneys, skin, and brain
This list is not exhaustive. It’s crucial to consult with healthcare professionals to diagnose and document your symptoms accurately.
Is Long COVID a Disability Under the ADA?
New guidance indicates that long COVID can be a disabling condition, but this does not automatically mean you will be considered disabled under the ADA.
According to the ADA, you are only considered disabled if you are significantly limited in one or more major life activities. These activities include working, breathing, eating, sleeping, and other essential activities.
As per the July 2021 statement, an individualized assessment is necessary to determine whether a person’s long COVID condition or any of its symptoms substantially limits a major life activity. This assessment will require a doctor to evaluate your symptoms.
What does the new guidance mean for people with long COVID? The new guidance from the federal government offers legal protections for people with long COVID. It prohibits discrimination due to a disability resulting from long COVID in the workplace, schools, healthcare system, and other businesses.
This guidance mandates that employers, schools, healthcare systems, and businesses must provide accommodations for those disabled by long COVID. For instance, a student may have the right to extra time for an assessment if their long COVID makes focusing difficult.
However, the guidance stipulates that any requested accommodation must be reasonable. For example, if you believe you cannot work in your office due to your long COVID, you may request to work from home permanently. Your employer may argue that your job duties require working in the office, making working remotely unreasonable.
If you have a question about whether the ADA protects you, we strongly recommend contacting an experienced employment law attorney.
Does Long COVID Qualify for Long-Term Disability Benefits Under My Policy?
Whether you have a private insurance policy or obtained coverage through an employer-sponsored group benefits plan, you may be eligible for long-term disability benefits for long COVID. You will need strong evidence to prove that your long COVID is disabling.
You will also need to meet specific policy requirements. Claimants need to review their policies to understand their insurance coverage thoroughly. Policy provisions a claimant should review include waiting periods, coverage limits, or exclusions that could impact their eligibility for benefits.
Determining Eligibility for Long-Term Disability Benefits
COVID long haulers will likely have trouble proving that their condition is disabling. We are not trying to be negative. It is just that the symptoms of long-haul COVID are wide-ranging. The diagnosis is typically based largely on subjective complaints, and no singular objective test can be performed to diagnose long COVID.
However, it is still possible to prove that your symptoms and limitations prevent you from returning to work. When evaluating a long-term disability claim related to long COVID, the claims adjuster may consider the following factors.
One of the primary factors considered is your diagnosis and the supporting medical documentation. To be eligible for long-term disability benefits, individuals must provide comprehensive medical records that support their claim.
When evaluating an individual’s eligibility for long-term disability benefits due to long COVID, insurance companies typically consider detailed medical records, including diagnostic tests, physician notes, and specialist consultations. This documentation should demonstrate their condition, including the nature of their illness or injury, its severity, and its impact on their ability to work.
Assessing a claimant’s functional limitations is essential to determine if an individual with long COVID qualifies for long-term disability benefits. This evaluation involves considering the impact of long COVID on their ability to carry out activities of daily living, such as standing, walking, sitting, and concentrating.
In some cases, a vocational assessment may be conducted to evaluate the individual’s ability to engage in gainful employment. This assessment considers the person’s education, work experience, skills, and limitations resulting from their disability. Given their physical or mental limitations, it helps determine whether they can perform any other type of work.
Evaluating the specific demands of the individual’s occupation is necessary to determine the impact of long COVID on their ability to work. This involves considering physical requirements, cognitive skills, and any necessary accommodations.
If you have an “any occupation” policy instead of an “own occupation” policy, or if the terms of your policy changed after benefits were payable for two years, the claims adjuster will consider the requirements of any other occupation with a comparable wage that you may be suited for.
Work with a Long-Term Disability Insurance Attorney
Individuals experiencing long COVID may be eligible for long-term disability benefits. Still, claimants must understand their rights and may need to seek appropriate support to ensure they receive the long-term disability benefits they are entitled to. Long-term disability claims for long COVID are frequently denied.
If you are a COVID long hauler and your disability claim has been denied or terminated, engaging the services of an experienced disability attorney can significantly increase the chances of a successful appeal. These professionals can help gather supporting medical evidence, complete necessary paperwork, and advocate for the individual’s rights during the claims process.
Mr. Ortiz has handled numerous long COVID claims and thus has experience with this particular medical condition in long-term disability claims.
At Ortiz Law Firm, we represent long-term disability claimants across the United States. We offer a free case review to discuss how we can help with your claim, and you only pay a fee if we successfully recover benefits. Call Ortiz Law Firm at (888) 321-8131 to schedule your free case review today.