Weiss v. Lincoln National – Vermont Federal Court Sides with Insurer in a Long COVID Disability Claim

Carl Weiss claimed that long COVID left him unable to work and sought both short-term and long-term disability benefits. The District of Vermont ruled against him on every issue, finding that the medical record did not support a disability during the relevant period and that key evidence in his favor was unreliable.

Who Was the Claimant and What Condition Did He Claim?

Carl Weiss was a software engineer at Verista, Inc. who worked remotely from home on a computer until his employment ended on February 18, 2022. He claimed he developed long COVID while employed and that the resulting brain fog, cognitive decline, chronic fatigue, nerve pain, and vision loss made him unable to work.

The record appeared to show a different picture. Verista terminated Weiss because his engagement with a client ended, not for performance or health reasons. He never missed a day of work, never used any of his accrued sick leave, never requested an accommodation, and never told his employer he was ill. He did not file a disability claim until April 11, 2023 — well over a year after the date he later alleged as his disability onset.

Why Did Lincoln and Verista Deny the Benefits?

The insurers denied the claims because the medical evidence purportedly did not document a disabling impairment during the period that mattered. Verista denied short-term disability benefits because Weiss’s claimed disability date (February 19, 2022) fell one day after his termination, and because the records did not show he was unable to perform his job before that date.

Lincoln denied the long-term disability claim on three grounds:

1. There was purportedly insufficient evidence that Weiss was disabled before his termination.
2. His records purportedly lacked the exam findings, test results, or documentation needed to show he could not work throughout the policy’s elimination period.
3. His pre-employment treatment for anxiety, depression, and ADHD potentially triggered the plan’s pre-existing condition exclusion.

The court ultimately did not need to reach the pre-existing condition issue, resolving the case on the first two grounds instead.

What Standard of Review Did the Court Apply to Each Plan?

The court reviewed the two plans under different standards because only one contained a discretionary clause. This standard of review question often decides ERISA cases, because it controls how much deference a court gives the insurer.

For the short-term plan, the court applied de novo review (no deference to the insurer) because the summary plan description contained no discretionary clause. Verista argued that a separate Administrative Services Agreement granted it discretion, but the court declined to resolve that dispute as the claim failed even under the more claimant-favorable de novo standard.

For the long-term disability plan, the court applied the more deferential arbitrary and capricious standard because the policy expressly gave Lincoln discretion to construe terms and decide eligibility. Weiss argued that Indiana’s Insurance Department Bulletin 103 bars discretionary clauses, but the court noted the bulletin is non-binding and that Indiana courts routinely enforce such clauses.

Did the Court Find the Claimant Disabled Under the Short-Term Plan?

No. The court held that Weiss was not disabled as of his February 18, 2022 termination date, and that he could not satisfy the plan’s elimination period. To qualify, his disability had to begin while he was still employed and continue for seven consecutive days.

The only evidence Weiss pointed to was a February 15, 2022 visit with his physician, Dr. Park. At that visit, Weiss reported that he “overall feels well,” denied virtually every COVID-like symptom, and was found to be healthy-appearing, alert, and oriented with normal mood, affect, and memory. Dr. Park attributed Weiss’s fatigue to a change in his cannabis use rather than illness and ended the visit by telling Weiss to enjoy skiing. Because Weiss kept working, used no sick leave, and saw no provider again until more than a month later, the court found no rational basis to call him disabled, and no way to establish seven consecutive disabled days.

Did the Court Find the Claimant Disabled Under the Long-Term Plan?

No. Applying the deferential standard, the court held it was reasonable for Lincoln to conclude Weiss was not disabled as of February 28, 2022 or throughout the 180-day elimination period. The central problem was the near-total absence of objective support for the claimed conditions.

The two plans used different elimination periods — the consecutive days a claimant must stay disabled before benefits begin — and Weiss could not satisfy either:

Plan	Elimination period
Short-term disability (STD)	7 consecutive days
Long-term disability (LTD)	180 consecutive days

There was no verified COVID infection anywhere in the record — only Weiss’s self-reports, which gave inconsistent infection dates. Dartmouth-Hitchcock’s long COVID clinic repeatedly denied his referrals precisely because there was no evidence he had ever contracted COVID. During the elimination period, a cognitive screening (MoCA) scored 29 out of 30, a neurologist found normal memory, and an ophthalmologist found normal eyesight. His blood work and imaging were repeatedly described as normal and reassuring, and no treating physician said these issues prevented him from working.

Why Did the Court Doubt the Claimant’s Credibility?

The court found Weiss to be an unreliable historian, though it did not find him intentionally dishonest. It pointed to a pattern of inconsistent and unsupported statements that undermined his self-reported symptoms.

The court pointed to a pattern of inconsistent and unsupported statements that undermined his self-reported symptoms:

• He gave at least five different dates for his supposed COVID infection.
• He reported “hundreds of seizures” with no medical evidence that any seizure ever occurred.
• He told a provider he could not sit upright while visibly sitting upright on video.
• He claimed he had been hospitalized for long COVID when he had not been.

The court also weighed Weiss’s acknowledged poor memory and years-long history of heavy daily cannabis use, which several of his own providers linked to his brain fog, fatigue, and other symptoms.

Why Did the Court Give Little Weight to the Treating Nurse Practitioner’s Opinion?

The court discounted Nurse Practitioner Gabriella Neacsu-Katz’s disability opinions because she did not treat Weiss during the relevant period and appeared to accept his self-reports at face value. In an ERISA case reviewed de novo, courts are not required to defer to a treating provider, and may weigh reliability against the rest of the record.

Neacsu-Katz did not begin treating Weiss until November 9, 2022 — long after his alleged onset — and saw him almost entirely by video without taking vital signs. She diagnosed long COVID without any verified infection, adopted diagnoses like dysautonomia without reviewing the underlying records, and never addressed his heavy cannabis use. Her disability statement also ignored her own recent notes showing his symptoms were improving and that he was walking three miles per day.

Why Didn’t the Social Security Disability Award Help the Claimant?

The court gave the Social Security award little weight because the federal disability standard differs from the ERISA plan’s disability standard, and because the SSA reviewers overlooked critical evidence. Insurers and courts are not bound by an SSA determination.

The SSA’s reviewing physicians found “no evidence of any substance abuse disorder,” a conclusion the court called flatly contradicted by the record, including Weiss’s own statements that he used cannabis multiple times a day and “needed it to get [his] brain to work.” The SSA reviewers also appeared not to account for the fact that Weiss was working full-time, without sick leave, just eight days before his SSA disability onset date.

What Did the Court Ultimately Decide?

The court denied Weiss’s motion and granted judgment to both Lincoln and Verista. It held that Weiss failed to carry his burden of proving disability under either plan, even applying the claimant-friendly de novo standard to the short-term claim.

The court also addressed Lincoln’s structural conflict of interest — it both decides claims and pays them — but gave that conflict no weight here. Lincoln had decided the claim on the merits, hired two independent physician reviewers and a nurse consultant, repeatedly invited Weiss to supplement the record, and tried to confer with his treating provider. With no evidence the conflict affected the outcome, it did not tip the balance.

What Can Disability Claimants Take Away From This Decision?

This case illustrates how heavily ERISA outcomes turn on objective evidence, consistent reporting, and the timing of a claim. A diagnosis alone does not win benefits; the record must document functional limitations during the specific period the policy covers.

The decision is a reminder to report symptoms to your employer and providers contemporaneously, to seek treatment that creates a consistent paper trail, and to understand that conditions diagnosed long after you stop working can be difficult to tie back to your last day on the job.

If your benefits have been denied, an experienced long-term disability attorney can evaluate whether the administrative record actually supports your claim before you appeal. Contact the Ortiz Law Firm for a free case evaluation, or call (888) 321-8131 today.

Frequently Asked Questions

Here is a PDF copy of the decision: Weiss v. Lincoln National