Post-COVID Syndrome and Disability Claims

More than a year into pandemic life, we are still subject to many restrictions and dealing with a "new normal" and ongoing variants of concern. While there is hope due to vaccines, there are people who have had COVID-19 and have become "COVID long-haulers" because they have been left with lingering systems after contracting the virus.

Doctors have named this syndrome "Post Acute COVID-19 Syndrome", also referred to as "Post-COVID-19 Syndrome", long-haul COVID or long COVID.

This blog will cover:

• What is Post Acute COVID-19 Syndrome?
• How does it affect my ability to work?
• What do I need to know when making a disability claim?
• Why would my claim be denied?
• Why should I fight the insurance company's denial?
  

What is Post Acute COVID-19 Syndrome

Post Acute COVID-19 Syndrome is the term used to describe the lingering and life-altering symptoms people experience after being infected with COVID-19. These individuals may have recovered from the acute phase of the illness and no longer test positive for the virus but the virus left long-lasting symptoms.

According to the Centers for Disease Control and Prevention, there are also variety of post-COVID conditions including:

• new or ongoing symptoms in people who did not have a severe case of COVID-19 initially
• multi-organ or autoimmune effects of COVID-19
• effects of COVID-19 illness hospitalization such as post-intensive care syndrome including weakness, difficulties thinking and PTSD

Symptoms include:

• mood disorders (anxiety, depression, PTSD)
• severe fatigue
• cognitive impairment ("brain fog")
• neurological symptoms
• respiratory symptoms (shortness of breath)
• sleep disturbances
• joint pain

According to an article from CTV News, a review of several studies published in the journal "Nature Medicine" found that the most common symptoms experienced by COVID long-haulers include fatigue, shortness of breath, anxiety, depression and PTSD. Studies from China, Britain and France demonstrated that 25-30% of patients reported sleep disturbances weeks after recovering from COVID-19.  Of a study of 402 patients in Italy who had been hospitalized it was found that 56% tested positive for at least one psychiatric condition.

A study of 100 patients seeking treatment for long-haul COVID (approx. 3 months post-infection) was conducted by the Mayo Clinic between June 1 and December 31, 2020. The most common symptom was unusual fatigue at 80% and approximately 59% reported respiratory complaints and neurological complaints. More than one third of patients described difficulties performing their basic activities of daily living. One of the study's authors notes that most of the patients had no pre-existing conditions prior to infection and did not have symptoms requiring hospitalization. It is noted that most of the patients had normal/non diagnostic lab and imaging results, despite having debilitating symptoms.

There is not a clear link between typical risk factors and long-haul COVID as people who had mild cases of COVID-19 can develop post-COVID-19 syndrome.

A recent study from Johns Hopkins University indicates that there are biological similarities and symptom similarities in long-haul COVID and chronic fatigue syndrome. As a result, people who experience long-haul COVID will also show signs of chronic fatigue syndrome.

According to researchers, these include:

• signs of oxidative stress
• brain inflammation
• hypometabolic state similar to an underactive thyroid

The research has also shown that many patients with pneumonia or lung inflammation caused by COVID-19 show signs of oxidative stress, similar to chronic fatigue syndrome.

Another study from Oslo University Hospital found that 1 in 10 COVID-19 patients had memory loss more than 8 months after infection. This study, as other studies, found that more than half of these patients continued to suffer from persistent fatigue and approximately 20% found their symptoms limited their daily activities including their ability to work. The study involved more than 2100 adults.

How can Post COVID-19 Syndrome affect my ability to work?

Post COVID-19 syndrome involves physical, psychological and neurological symptoms. These symptoms cause difficulties with activities of daily living, including the ability to attend work regularly and perform employment duties.

Post COVID syndrome can make it difficult to perform a physical or sedentary job. Symptoms such as fatigue, shortness of breath, memory loss and brain fog would make performing a job such as warehouse worker or construction worker difficult and dangerous.

Symptoms such as anxiety, depression, chronic persistent fatigue, memory loss and PTSD would make performing the job duties of an administrative assistant or call centre agent difficult due to difficulties concentrating, focusing and with interpersonal interactions.

What should I know when making a disability claim?

When you apply for short-term or long-term disability benefits, it is important that both you and the doctor completing the forms for you provide as much information as possible.

Post COVID-19 Syndrome may be a new diagnosis, but the symptoms can be very severe and debilitating. You may test negative for COVID-19 or there may not be diagnostic imaging that can confirm your symptoms so providing that type of evidence may be a challenge.

When you complete the Employee Statement/Plan Member Statement you should explain how your symptoms prevent you from performing the duties of your job. It is important to be specific and you may want to give examples. You also will have the opportunity to describe any treatment you have received or will be receiving, any doctors you are seeing/waiting to see and any future testing you are waiting for. This way the insurance company knows that you are actively seeking treatment for your condition.

You should give the Attending Physician Statement to the doctor that is the most familiar with your condition. The doctor will list a diagnosis (or diagnoses) and explain your symptoms, restrictions and limitations. Doctors are also asked to comment on prognosis and duration of disability. It is important that your doctor be very descriptive and provide a clear explanation for your inability to work. If you are waiting to be seen by a specialist and a diagnosis is pending, this can also be indicated on this form. Your doctor can also attach any specialist reports, diagnostic imaging or clinical notes and records that support your case.

The earlier your insurance company receives this information the better.

For more details about the application process, read our helpful blog here.

Why would my claim be denied?

There are a variety of reasons why your insurance company could deny your claim.

Common reasons we see include:

• lack of objective medical evidence
• unclear restrictions or limitations
• you are not attending treatment appropriate for your condition
• you are not under the care of an appropriate physician
• you should still be able to perform your job or modified duties
• you should be able to perform an alternate job that you are qualified for

For more information about reasons for denied claims, check out our Knowledge Centre.

Why should I fight the insurer's decision?

Received a denial letter? This does not mean your claim is over.

You do have the option to fight the insurance company's decision.

Your insurance company has an internal appeal process where you can submit further information to support your claim. There are typically three levels of appeal. However, this process can take many months or longer and you may not be successful with your appeal. This may also be additional stress at a time that is already difficult for you.

You can also fight the insurance company's decision by starting a legal action against them. When you hire an experienced disability lawyer, your lawyer can start the lawsuit against your insurance company as soon as possible so your insurance company knows of your decision to fight the denial. Once you hire a lawyer, you will not longer have to have contact with the insurance company. Your lawyer will communicate with the insurance company/their lawyer and take that stressor away from you.

Hiring a lawyer is an important step in fighting a denial decision.