COVID-19 and Long-Term Disability Claims

In March 2020, "normal life" came to a halt due to the COVID-19 pandemic. We are now a year into the pandemic and people are still feeling the effects of the pandemic, both the effects of the virus itself and the increased stress it has caused as well as aggravation of pre-existing conditions like depression and anxiety. 

Our firm assists people whose long-term disability benefits have been denied. We assist clients who have various conditions, both physical and psychological, this includes people who have been adversely affected by COVID-19.

We understand the process of applying for benefits and then being denied for benefits can be stressful and frustrating, especially during a pandemic.

What is Long-Term Disability Insurance?

Long-term disability benefits provide you with income replacement when you are unable to work for a prolonged period of time. You are subject to a waiting period, which is usually 17 to 26 weeks (but can be longer). Waiting periods are specific to the policy, so it is important to check your policy to find out how long this period is. Most policies cover about 55%-67% of your monthly earnings.

The novel coronavirus (COVID-19) had not been seen in humans prior to the first reported cases in late 2019.

Symptoms of COVID-19 (https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/symptoms.html) include:

• new or worsening cough
  
• shortness of breath or difficulty breathing
• high temperature
• feeling feverish 
• chills
• fatigue or weakness
• muscle or body aches
• new loss of smell or taste
• headache
• gastrointestinal symptoms 
  
• feeling very unwell 

Symptoms may take up to 14 days to appear after exposure to the virus.

Who is at Risk?

The novel coronavirus can result in severe illness (https://www.canada.ca/en/public-health/services/publications/diseases-conditions/people-high-risk-for-severe-illness-covid-19.html) for certain groups of people:

• People who have a weakened immune system from a medical condition or due to chemotherapy/medication 
  
• People who have an underlying medical condition such as heart disease, high blood pressure (hypertension), lung disease (COPD/asthma), diabetes, cancer
• People over a certain age (it is felt that people in older age groups i.e. 60+ are most at risk)

Severe cases of COVID-19 can lead to severe complications and hospitalization and prolonged recovery.

Can I Apply for LTD Benefits if my claim is related to COVID-19?

Long-term disability benefits are a type of benefit meant to cover a health-related condition that significantly interferes with your ability to work and complete the essential duties of your job or any job you are qualified to perform.

LTD benefits are meant to cover both physical conditions and mental illnesses, as long as your doctors/treatment providers are able to demonstrate your symptoms are severe enough to prevent you from working.

You may be eligible for LTD benefits as a result of COVID-19 if you contract the virus or complications prevent you from working for a significant period of time. You may also have difficulties performing your duties if your pre-existing mental health condition has been exacerbated or you have a new onset of a mental health condition and are no longer able to function.

There have been an increased number of people experiencing anxiety and depression as a result of their experiences with the pandemic.

The pandemic has also been difficult for people who have autoimmune conditions and are on immunosuppressant medications due to their increased vulnerability to COVID-19. 

Applying for LTD Benefits

When you apply for long-term disability benefits, it is important to submit your application as soon as you can. The application typically consists of 3 forms, the employer statement, the employee statement and the attending physician's statement.

The Employer Statement/Plan Sponsor Statement

Your insurance company requires information from your employer in order to process your claim. This form requests information such as your salary, the length of time you were employed, if modified work is available and the last date you worked.

Since the insurer first assesses your claim based on your ability to perform the duties of your own occupation, the Employer Statement/Plan Sponsor Statement also requests information concerning your job duties including physical/cognitive demands. A job description may also be required.

The Employee Statement/Plan Member Statement

You are responsible for completing this form. This form asks for information such as your date of birth, address, job title, last day worked and a description of your condition. There is where you can provide a detailed account of why you stopped working.

This is an opportunity for you to provide details on how your condition impacts your activities of daily living and functional abilities and how it evolved over time to the point you could no longer work.

Your insurer will also call you while they are adjudicating the claim to conduct a functional telephone interview to obtain further information about your daily activities, restrictions and limitations and how the disability affects your overall daily functioning.

The Attending Physician's Statement

This form should be completed by your treating physician/the doctor who is most familiar with your condition and how it affects your ability to work. Your doctor should include as much supporting information as possible (i.e., test results, diagnostic imaging, specialist reports or consultations if applicable).

This form is where your doctor can provide detailed information about your restrictions and limitations.

For a mental health claim or an invisible illness claim, this is particularly important as there are no "objective" test results for your doctor to submit to the insurance company and it is important for your insurance company to understand what prevents you from working.

Examples of restrictions and limitations can be poor focus and concentration, memory difficulties, fatigue, distraction, mood lability, anger and irritability and panic attacks. Restrictions can also arise from medication side effects (i.e. if medications cause drowsiness). You may be restricted from performing safety sensitive work, work requiring prolonged concentration and focus, customer facing tasks, to give a few examples.

If you have an autoimmune condition that requires an immunosuppressant medication, you may have been advised by your physician that it is unsafe to work at your own occupation if you work a customer facing position/position involving contact with others outside your home. Your physician should outline how your condition/medication compromises your immune system and what limitations and restrictions are associated with that.

Denied Claims

Your claim for LTD benefits can occur at any stage of your claim, be it after the initial application or while you are already on claim or when you reach the end of the own occupation period.

If your claim has been denied, you have the option of going through your insurance company's internal appeal process, which requires you to submit new information for each level appeal and wait for it to be assessed. However, you also have the option of starting a lawsuit against your insurance company.

It is important to consult an experienced disability lawyer as soon as possible so you can make an informed decision on how to proceed as soon as possible and before any limitation period runs out.

Our lawyers have helped many clients to successfully resolve their long-term disability claims. We offer a free initial consultation and do not charge any upfront legal fees.