Long Covid patients face battle claiming disability insurance benefits

Mike Yada

Courtesy: Mike Yada

Mike Yada remembers the day in August 2020 when it became clear that his unusual symptoms — which emerged after a mild case of Covid-19 earlier in the year — were worsening.

“I went for an easy hike, but by the end I was so winded that I couldn’t walk back to my car,” said Yada, who, pre-Covid, would have easily traversed the flat terrain near the beach. He had to call an Uber for the one-mile ride back to his parked car.

That was the start of what Yada, 48, calls “crazy symptoms.” He experienced crushing fatigue that left him bedridden, the inability to sit upright for more than five or 10 seconds, blurry vision making it impossible to read. Walking was a challenge, and driving was out of the question.

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He was suffering from “long Covid” — a post-infection condition involving a cluster of symptoms that can be disruptive at best and debilitating at worst. More than two years and many doctor’s appointments later, he is still fighting those symptoms.

Yada, who worked in the tech field, also has had to wage another battle: maintaining income replacement through disability insurance, an employee benefit through his now ex-employer.

While he recently won an appeal to restore those benefits after the insurer suddenly ended them, he’s not sure it will stick.

Many workers get disability coverage via an employer

An estimated 43% of private industry workers have access to short-term disability insurance through their employer, according to the Bureau of Labor Statistics. It typically replaces 60% to 100% of an employee’s income, usually for three or six months, said Alex Henry, a national practice leader at Willis Towers Watson, an insurance advisory firm.

Long-term disability insurance, which is intended to kick in when necessary after short-term disability benefits run out, is available to 35% of workers. It usually pays 50% to 70% of a worker’s income — often through retirement age, depending on the specifics.

Denials are common for long Covid patients

Yet approval isn’t guaranteed. And for long Covid sufferers, denials are common, experts said.

“There are many claims for both short-term and long-term disability insurance that are not approved, specifically for the subjective symptoms,” Henry said. “Insurers tend to handle it like they do with other subjective conditions … there’s no straight-out denial, but they’re looking for objective medical [proof] of disability.”

While most people recover from Covid with no complications, up to 30% of Americans have developed long Covid symptoms, affecting as many as 23 million people, according to the U.S. Department of Health and Human Services. Those symptoms — which often appear after the original Covid infection has cleared — commonly include fatigue and brain fog (an inability to think clearly), both of which can be tricky to measure.

Those are symptoms that are not just disabling but make it difficult to apply for benefits and navigate a stressful situation.

Andrew Wylam

President of Pandemic Patients

“What I’m seeing broadly are cognitive impairment and chronic fatigue,” said Andrew Wylam, an attorney and president of Pandemic Patients, a nonprofit advocacy group that helps long Covid patients get the support and services they need, which can include legal advice.

“Those are symptoms that are not just disabling but make it difficult to apply for benefits and navigate a stressful situation,” Wylam said.

Yada, based in California, had access to both short- and long-term disability insurance at the biotech company where he had worked for 10 years as a senior technical architect.

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In August 2020, when his symptoms became debilitating, Yada filed a claim for — and was approved for — short-term disability insurance benefits, first through the state of California and then through his company. (California is among a handful of states with a short-term disability fund that workers can tap, and insurers expect them to do so.)

Yet when he filed a claim for long-term disability in early 2021, with the hope that it would kick in when his short-term benefits ran out, it was denied.

Facing no income, he tried to work part time instead, which his employer allowed him to do.

It didn’t go well. After 10 weeks of struggling, he filed another short-term disability claim when it was clear he was not improving. 

“My employer was getting ready to write me up for poor performance,” Yada said. “That had never happened.”

Toward the end of 2021, with five doctors agreeing that his condition was disabling, he again filed a long-term disability claim. It was approved.

Approvals can be reversed

Yet a few months ago — in August — Yada received a letter from the insurer stating that his benefits were ending immediately because he had no “objective evidence” of a disability.

This was despite his claim including the results from a “tilt table test” showing that blood flow to his brain was reduced by 33% upon him standing upright. (That’s compared with 7% for a healthy person, according to medical research.) In simple terms, the test involves measuring what happens to a person’s autonomic nervous system — i.e., blood pressure, heart rate and other involuntary functions — when they go from a flat position to an upright one. Yada’s results, he said, help explain why he can’t sit at a desk and cannot think straight.

“You can’t tell me that a [33%] decrease in blood flow isn’t a problem,” Yada said.

He appealed the decision.

What can happen when a claim denial is appealed

Long-term disability insurance is subject to a federal law known as ERISA (Employee Retirement Income Security Act). This means that when a claim is denied, the only immediate recourse is to appeal the decision to see if that results in a reversal.

“If they don’t completely exhaust the administrative appeals with the insurance plan, they cannot file a lawsuit,” Wylam said.

When a claim is denied, you typically get 180 days to appeal the denial. The plan usually must review the appeal within 45 days of receiving it.

If the appeal is unsuccessful, a lawsuit to secure the benefits becomes an option. In fact, cases involving denial of long-term disability benefits for long Covid are cropping up around the country.

“Federal court cases take a while and are expensive, so those claims generally end up settling,” said Mark Boyko, a partner at the law firm of Bailey Glasser who specializes in ERISA cases. The amounts awarded in settlements are confidential, he said.

On the other hand, if the appeal results in a reversal, the benefits generally are retroactive to when they should have started.

That’s what happened with Yada: He recently received a letter stating that appeal of the denial resulted in a reversal, with benefits retroactive to August.

Social Security disability benefits can come into play

However, Yada also was required by the insurer earlier this year to apply for Social Security Disability Insurance, commonly called SSDI.

This requirement is typical, said Henry, of Willis Towers Watson. “If SSDI is awarded, it is typically an offset to the long-term disability benefit,” he said.

For instance, if your workplace disability benefit was paying $3,000 a month and SSDI awarded you $2,000 monthly, the employer-based benefit would be reduced to $1,000.

In other words, you’d still be getting $3,000, but the government would be footing the bill for some of it instead of the insurance company paying all of it.

Yada has no idea whether his SSDI application will be approved. The process is notoriously slow going, and denials are common.

In the meantime, because he lost his employment when the insurer ended his benefits in August, he also lost employer-sponsored health insurance. While he chose to keep his coverage under a federal law known as COBRA, he is responsible for the full premiums instead of having an employer chip in. He’s paying about $800 a month.

He’s also concerned that the insurer paying his benefits will suddenly end them again at some point.

“I’m not confident,” Yada said. “At any time they could just write me a letter and say it’s terminating tomorrow.”

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