COVID Long-Haulers Face Hurdles in LTD Benefit Claims: Tips for Applications

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Based on information from the World Health Organization which has been repeated to us time and time again through the media, we have come to understand that 80 percent of those infected with COVID-19 will experience only mild symptoms or be entirely asymptomatic and will recover after only two weeks, while the elderly and those with pre-existing medical conditions are more likely to suffer serious complications and possibly, death.  However, many of these reported statistics fail to consider the growing number of people who are reporting serious, long-lasting and debilitating effects of the virus, weeks and months after infection.  These individuals are now commonly referred to as “long-haulers”.

Unofficially, long-haulers are commonly characterized as those that have been sick with symptoms of COVID-19 for one month or more and continue to experience the impact of the virus in every aspect of their daily functioning.  The number of so-called long-haulers is still unknown, however, in thd negative for the virus (due to waiting too long to be tested or for some other cause for false-negative teste U.S., estimates have been in the tens of thousands.  According to what little is still known about long-haulers, it appears that most are previously fit and healthy women with an average age of 44.  Often they report having experienced only mild symptoms of the infection initially and may not have been tested for COVID-19 (due to not meeting the early criteria or having the symptoms required for testing) or they may have teste results). (Long-Haulers Are Redefining COVID-19, The Atlantic, August 19, 2020)

Long-haulers report symptoms commonly associated with COVID-19, including fever, cough, and shortness of breath.  However, they also report experiencing an ever-growing list of other serious symptoms including gastrointestinal, cardiac and neurological problems (such as hallucinations, delirium, short-term memory loss), as well as vibrating sensations when they touch surfaces and problems with their sympathetic nervous system (which controls unconscious processes like heartbeats and breathing).  They may feel out of breath when their oxygen levels are normal and feel their heart racing when their EKG readings are normal.  They often describe “brain fog” and intense fatigue and anxiety and depression.  Many of their symptoms may come and go and vary in severity over time.  

Based on information from the World Health Organization which has been repeated to us time and time again through the media, we have come to understand that 80 percent of those infected with COVID-19 will experience only mild symptoms or be entirely asymptomatic and will recover after only two weeks, while the elderly and those with pre-existing medical conditions are more likely to suffer serious complications and possibly, death.  However, many of these reported statistics fail to consider the growing number of people who are reporting serious, long-lasting and debilitating effects of the virus, weeks and months after infection.  These individuals are now commonly referred to as “long-haulers”.
Unofficially, long-haulers are commonly characterized as those that have been sick with symptoms of COVID-19 for one month or more and continue to experience the impact of the virus in every aspect of their daily functioning.  The number of so-called long-haulers is still unknown, however, in thd negative for the virus (due to waiting too long to be tested or for some other cause for false-negative teste U.S., estimates have been in the tens of thousands.  According to what little is still known about long-haulers, it appears that most are previously fit and healthy women with an average age of 44.  Often they report having experienced only mild symptoms of the infection initially and may not have been tested for COVID-19 (due to not meeting the early criteria or having the symptoms required for testing) or they may have teste results). (Long-Haulers Are Redefining COVID-19, The Atlantic, August 19, 2020)
Long-haulers report symptoms commonly associated with COVID-19, including fever, cough, and shortness of breath.  However, they also report experiencing an ever-growing list of other serious symptoms including gastrointestinal, cardiac and neurological problems (such as hallucinations, delirium, short-term memory loss), as well as vibrating sensations when they touch surfaces and problems with their sympathetic nervous system (which controls unconscious processes like heartbeats and breathing).  They may feel out of breath when their oxygen levels are normal and feel their heart racing when their EKG readings are normal.  They often describe “brain fog” and intense fatigue and anxiety and depression.  Many of their symptoms may come and go and vary in severity over time.  

If you are suffering the ongoing effects of COVID-19 infection and you are not able to work, we encourage you to consider the following tips for applying for LTD benefits:

The Three Most Important Tips for Applying/Appealing an LTD Claim for Long-Haulers

Functionality is key. 

Always focus your answers and remind your doctor(s) to focus answers to questions on forms and in telephone calls, on your functioning; that is what you can and can not do, as a result of your symptoms.  This is what the insurance company should be most concerned with in assessing your LTD claim.

Many people believe that a diagnosis is necessary to be successful in an LTD claim.  Often with long-haulers it takes a long-time to get a diagnosis and sometimes the cause of your symptoms might never be determined or you might even be misdiagnosed.  Approval for LTD does not hinge on a specific diagnosis; it’s all about whether you meet the definition of disability under the plan/policy.

In terms of meeting the definition of disability, it will help your LTD claims representative to know what the duties of your “own occupation” are and what specifically prevents you from performing those duties.  For example, pain and fatigue may prevent you from standing, walking, sitting, concentrating, remembering, communicating, regulating emotions, etc. These are all functions you might need for your job. Therefore, the insurance company needs to understand that your symptoms prevent you from doing both the physical and cognitive demands of your job on a consistent basis or at all.

Treatment is critical.

While treatment is extremely important for you, medically, it is also important for proving your LTD claim.  This holds true for all LTD claims, but especially so for claims for long-haulers.  The nature and extent of your treatment tells the insurance company a lot about the severity of your condition, about your self-reported restrictions and limitations, and about your credibility.  When all you have to rely on is what you are telling your doctors, you need another means to support your claim.  Treatment is one of the best ways to prove to your insurance company that you are not able to do your job and that you are not malingering or exaggerating your condition.

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