By now we have all heard of “long-COVID,” but the condition remains relatively poorly understood. Medical research is racing to catch up. For as many as 4 million formerly working Americans, it has presented a major life challenge, leaving them feeling exhausted and sickly. Many of them have now been out of work for months or years, not because they want to be, but because they simply cannot perform at the level that their work requires. As is so often the case, a medical disaster then turns into a financial disaster. Our long COVID clients are too sick to work, facing mounting medical bills, and worrying about whether their disability insurance is going to financially protect them as promised.
The attorneys at Robinson Warncke are committed to ensuring that your long COVID disability claim is accepted. Call or click here for a free consultation.
So what is long COVID? How does it affect people? And why is it harder than other disabilities to prove? This article will address these and other questions.
What is long COVID?
The Centers for Disease Control uses the term “post-COVID conditions” as “an umbrella term for the wide range of physical and mental health consequences experienced by some patients that are present four or more weeks after SARS-CoV-2 infection.”[1] These conditions are referred to by a variety of names, including: long-COVID, post-acute COVID-19, long-term effects of COVID, chronic COVID, long-haul COVID, post-acute COVID syndrome, and post-acute sequelae of SARS-COV-2 infection (PASC).
In the broadest sense, these conditions can be considered “a lack of return to a usual state of health following acute COVID-19 illness.”[2] There is currently no standardized definition or diagnostic criteria for long-COVID and any individual patient labeled with long-COVID or post-COVID syndrome may really have one of many different possible presentations.
Interestingly, the likelihood of developing long-COVID seems to have nothing to do with how severe the initial infection was. Peer-reviewed medical research now confirms that the majority of long-COVID patients had only mild initial infections.[1]
[1] Wulf Hanson S, et al., A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021. medRxiv [Preprint]. 2022 May 27:2022.05.26.22275532. doi: 10.1101/2022.05.26. 22275532. PMID: 35664995 (Of the 144.7 million long-COVID sufferers considered in the study, more than ninety percent (approximately 130 million) had experienced only a mild to moderate acute COVID infection as the triggering event. Less than ten percent (11.5 million) had been hospitalized for COVID and only 3 million developed long-COVID after needing ICU care.)
As the image below demonstrates, there are a wide range of possible long-term effects from COVID:
Source: Lopez-Leon, S., Wegman-Ostrosky, T., Perelman, C. et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep 11, 16144 (2021). https://doi.org/10.1038/s41598-021-95565-8
One of the most common forms of long-COVID presents very similarly to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), postural orthostatic tachycardia syndrome (POTS) and other forms of dysautonomia, or mast cell activation syndrome (MCAS). This generally means “brain fog” and crushing chronic fatigue, where the patient has a greatly diminished capacity for any physical or mental output.
Many long-COVID patients were formerly active professionals excelling in highly demanding occupations while also leading rich, fulfilling lives outside of work. Now they find themselves sleeping 12+ hours per night. They might be able to run a local errand or two, at most, before crashing completely and having to rest. Even concentrating on a mentally challenging task for an hour or two can completely deplete their energy stores for the rest of the day.
The “brain fog” element is reported widely with long COVID. Patients who used to be superstar physicians, attorneys, or high level executives report they have a hard time even balancing their checkbooks or paying bills.
Some specialists who have been studying post-viral syndromes and ME/CFS since before the pandemic believe long-COVID could be exactly the same condition. For example, David M. Systrom, M.D., a professor at Harvard Medicine School, states: “This for all the world looks like ME/CFS. We think they are frighteningly similar, if not identical.”[1]
For now, we do not need to prove whether long-COVID might turn out to be ME/CFS with a different triggering mechanism. What matters is that a massive and still-growing number of post-COVID patients worldwide report persistent and prolonged symptoms of chronic fatigue and post-exertional malaise,[2] often accompanied by dysautonomia.[3]
The exact prevalence of this type of long-COVID is difficult to ascertain because there is significant overlap of symptoms with other conditions, there are no established diagnostic tests, COVID testing was limited in many places at the start of the pandemic, and because many people around the world with long-COVID may struggle to access care.
However, in May 2022, the largest study of its kind was released to assess the prevalence, severity, and recovery path of long-COVID. The study reviewed detailed information from tens of thousands of COVID infections and hospitalizations as well as medical record data from over one million more.[4] The study estimated that 144.7 million people worldwide suffered from long-COVID in 2020 and 2021.
The study collated the information on long-COVID symptoms into three common clusters of symptoms – fatigue, respiratory issues, and cognitive symptoms. These three clusters of symptoms were present in approximately 51%, 60%, and 35% of long-COVID cases, respectively.
The study estimated that 6.17% of all COVID patients would develop long-COVID and found no correlation between severity of the COVID event itself and the likelihood of developing of long-COVID. Of the 144.7 million long-COVID sufferers, more than ninety percent (approximately 130 million) had experienced only a mild to moderate acute COVID infection as the triggering event. Notably, less than ten percent (11.5 million) had been hospitalized for COVID and only 3 million developed long-COVID after needing ICU care.
63% of long-COVID sufferers were female and 15% continued to have symptoms 12 months after acute infection. Notably, 12 months was the longest follow-up time available at the time of the study. Only time and additional study will reveal the true long-term pattern of recovery for the minority of long-COVID sufferers who continue to be impacted beyond 12 months.
The study also estimated the level of disability among long-COVID sufferers as equivalent to “severe neck pain, Crohn’s disease, or long-term consequences of moderately severe traumatic brain injury.” Other studies have similarly recognized the symptoms of long-COVID, particularly severe fatigue and post-exertional malaise, as “severely disabling.”[5]
One international study of patients with COVID symptoms lasting more than 28 days found 45% of respondents required a reduced work schedule, and another 23% had left the workforce completely because of long-COVID.[6] In the United States, a study by the Brookings Institution found that long-COVID was responsible for 1.6 million unfilled jobs at any given time during the first 20 months of the pandemic.[7]
What does long COVID mean to Unum and the disability insurance industry, generally?
In short, long-COVID could be an unexpected financial disaster for disability insurers. Like every other form of insurance, disability insurance is priced based on actuarial data and expected outcomes for already-known rates of diseases or injuries. The insurers expect to collect enough premiums in the aggregate to pay out expected claims and still turn a profit.
Before 2020 the disability insurance industry had no reason to expect that as many as 4 million Americans would be leaving the workforce and claiming disability benefits due to a completely new disease entity. But that is now where they find themselves. It is likely that if every insurer paid every long-COVID claim, at best their profits would erode markedly. More likely this would be a crushing, unexpected liability.
How will Unum and other insurers handle my long-COVID claim?
It is impossible to know exactly what the disability industry is saying behind closed doors about long-COVID. But we have a past precedent with Unum, the single largest insurer of disability income benefits for decades. History may provide some insights.
In the 1980’s and 1990’s Unum and others got into an arms race to insure doctors and other professionals for disability protection. They began dropping the price of premiums and enhancing the coverage features, in some cases offering lifetime benefits and greatly improved definitions of disability. For instance, a surgeon could buy “own speciality” coverage that would pay the full total disability benefit if the surgeon could not operate. This was true even if he or she could work in a different, less demanding medical specialty. Full benefits would be payable even if he or she could make more money than before in a replacement occupation.
These feature-rich policies sold well. However, other market factors later resulted in Unum and others experiencing a much higher-than-expected number of claims. They found they were hemorrhaging money. Subsequent litigation and multi-state Market Conduct investigations revealed that Unum tried to restore its profitability via the only thing it could still control, which was aggressive “claims management,” i.e., inventing reasons to deny claims. Reported cases and the Market Conduct report concluded Unum had crossed the line, and by the early 2000’s, Unum wound up paying multi-million dollar fines and entering into a regulatory agreement that required it to re-open (and in many cases pay) thousands of previously closed/denied claims.
Whether long-COVID could yield a similar reaction remains to be seen, but we know this is an unexpected liability with massive potential financial exposure for Unum and its competitors.
How do I win a long-COVID disability claim with Unum?
The biggest challenge with any disability claim is how to satisfy a demanding insurance company and its doctors that your proof of disability is adequate.
Our long-COVID clients seem to be finding their way to doctors who have become de facto experts in long COVID. Since 2020 these treating physicians have become intimately familiar with the myriad of ways that long- COVID can manifest and affect people over time. The treater/specialists are very good at ferreting out the genuine from the fake. even if you and your treating specialist are highly credible, and even if the doctors confirm in medical notes and disability forms that your long-COVID symptoms prevent you from working, you should not expect Unum, MetLife, Guardian, Hartford, New York Life or any other disability insurer to give you the benefit of the doubt.
Unum employs teams of physicians to review disability claims, which it calls “On Site Physicians:” (OSP’s) and “Designated Medical Officers” (DMOs). In the Unum cases we have reviewed so far, we have yet to see an OSP or DMO who has any experience or training in long-COVID. Many of them retired from seeing patients years before COVID even came into being. This does not stop them from disagreeing with COVID experts, however.
The OSPs and DMOs at Unum routinely demand “objective evidence” to confirm a disability. Objective evidence is anything that cannot be faked and which goes beyond the patient’s report of symptoms. It would include:
- abnormal test results verifying long-COVID or its related conditions like POTS (a tilt table test is common for verifying POTS);
- abnormal test results verifying your limitations (e.g., with cognitive problems this might include a full neuropsychological battery of tests)
- Abnormal physical examination findings noted in your doctor’s notes;
- Abnormal scans and imaging studies.
Long-COVID and its most disabling symptoms are less susceptible to objective verification than many other disabling conditions. Still, there is hope for those willing to go the extra mile to prove their claims.
If crushing fatigue is your biggest problem, there is an objective test that might confirm it, called a two-day Cardiopulmonary Exercise Test (CPET). In the most simplistic terms, this test measures the exchange of blood gasses from your breathing while you increasingly exert yourself on an exercise bike. The results tend to show how much physical output you can muster on both a peak and sustained basis. The two-day version also measures whether the patient recovers normally from the first day’s output.
The blood gas measurements cannot be faked and they do not lie. The CPET measurements for both days are compared to statistical normative data. Many long-COVID patients objectively demonstrate a much lower-than-expected tolerance for physical work even on day one. By day two they often test only slightly better than an older person who is homebound and totally sedentary. We can compare these objective measurements with the physical demands of work duties, including things as common and mundane as sitting, walking down the hall, and talking.
The objective comparison between the patient’s numerical sustainable CPET output and the numerical output of these work tasks should make for a straightforward analysis, but don’t expect Unum or other insurers to agree. In our experience, even armed with every type of objective evidence that modern medical science can muster, the path of a long-COVID disability claim can still be very challenging. We have recently seen Unum (and other insurers) deny some extraordinarily well-documented long COVID claims, forcing the claimant into litigation.
Outcomes in litigation are notoriously hard to predict, but Unum will likely win some and lose some. Those claimants will fare best who: (1) go the extra mile to prove their claims; and (2) are represented by attorneys who Unum knows to be competent and tenacious litigators.
Why You Should Hire a Disability Lawyer as Early as Possible
We advise consulting with a disability specialty attorney like those at Robinson Warncke as early as possible. A specialist attorney can do things proactively to improve your chances of recovering benefits without a dispute. If a dispute arises, your attorney should know what to do procedurally and substantively to maximize your chances of success.
If a lawsuit becomes necessary, you will not want to be represented by a large “settlement mill” that routinely settles claims on the cheap. You also won’t want to be represented by someone who only “dabbles” in disability claims. This is a specialized world, and your opponent is sophisticated and well-financed.
You only have one claim, and you deserve to have it handled by a law firm willing to go the distance if necessary. Your attorneys must also be willing to spend the time and money necessary to complete all intermediate steps to maximize the case value. The lawyers at Robinson Warncke have been committed to exactly those things for over three decades. We believe you kept your part of the deal by paying premiums to Unum, so it should keep its part of the deal when you become too sick to work. Call or click today for a free consultation.
[1] Miriam E. Tucker, Long COVID Mimics Other Post-Viral Conditions, WebMD: https://www.webmd.com/ lung/news/20220824/long-covid-mimics-other-post-viral-conditions
[2] Twomey R, DeMars J, Franklin K, Culos-Reed SN, Weatherald J, Wrightson JG. Chronic Fatigue and Postexertional Malaise in People Living With Long COVID: An Observational Study. Phys Ther. 2022 Apr 1;102(4):pzac005. doi: 10.1093/ptj/pzac005.
[3] Romero-Sanchez CM, Diaz-Maroto I, Fernandez-Diaz E, Sanchez-Larsen A, Layos-Romero A, Garcia-Garcia J, et al. Neurologic manifestations in hospitalized patients with COVID-19: the ALBACOVID registry. Neurology. (2020).
[4] Wulf Hanson S, et al., A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021. medRxiv [Preprint]. 2022 May 27:2022.05.26.22275532. doi: 10.1101/2022.05.26. 22275532. PMID: 35664995.
[5] Rajan S, Khunti K, Alwan N. In the wake of the pandemic: preparing for long COVID: policy brief 39, 2021. Available: https://apps.who.int/iris/bitstream/handle/10665/339629/Policy-brief-39-1997-8073-eng.pdf
[6] Davis HE, Assaf GS, McCorkell L, etal. Characterizing long covid in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine 2021;38:101019. doi: 10.1016/j.eclinm.2021.101019 pmid: 34308300
[7] Brookings, Is ‘long Covid’ worsening the labor shortage?, available at https://www.brookings.edu/research/is-long-covid-worsening-the-labor-shortage/
[1] https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-conditions.html