It is true that COVID-19 and the national quarantine have complicated long-term disability claims. But it’s also true that American workers were facing serious economic issues even before COVID-19 shut down the economy. Few had enough savings to survive an economic disaster, loss of work, or injury that prevented work. Fewer still had adequate health insurance or the ability to pay for a serious medical event. And today, employers are paying for long-term disability packages far less frequently than they have in the past.
While the federal government has stepped in to help those who have lost their job due to COVID-19, those protections will run out. Economic insecurity will become a serious problem in the coming months. Employee disability packages are one way that workers can protect themselves, their families, and their incomes against the sickness that prevents work.
If you need to speak to our Atlanta disability attorney about your Long Term Disability Claim, we are here to help.
Why This Matters
A large cross-section of the American population does not have any form of disability coverage provided by their employer. In fact, they have no health insurance either which is why the three most common causes of consumer bankruptcy are: Medical debt (26%), job loss (20%), and illness or injury in the family (15%).
Today, millions of Americans have lost their job and along with it, they’ve lost their health and disability insurance too.
Claims Under Quarantine
Employees who have lost their job due to COVID-19 may still be able to file claims on their employer’s benefits package so long as their employer still exists, continues to pay the premiums, employs the worker, and you’re still eligible under the terms of the policy. However, if your employer is shut down, it may be difficult to figure out how to file a disability claim on your employer’s policy.
In these cases, employers should direct their employees on how to make such claims. An employer is responsible for ensuring their employees have the means to file such claims.
The Impact of COVID on new and existing disability claims
Our disabled clients are finding that the pandemic is creating additional challenges with the claims process, in addition to all the other impacts on their daily lives. New applicants for disability benefits and those already on claim having one thing in common – they need to submit medical proof of their new or continuing disability. As is discussed consistently throughout this website, disability insurers can be very exacting in the forms of proof they require. Most disability insurers place very little weight on the patients complaints. Insurers will not always take you at your word that you have a disabling set of symptoms at a certain level of intensity, frequency and duration. They may not even give you the benefit of the doubt. Disability insurer’s place a great deal more emphasis on “objective findings” like test results and imaging studies that verify and quantify your problems. Objective findings also include notations in your records as to things that your doctor personally observed during a clinical examination. The problem during this pandemic is that you cannot get “objective evidence” without risking an interpersonal encounter. This has created something of a Catch-22.
For most clients, early during the pandemic they could not schedule in-person appointments for anything other than life-saving measures. As of the writing of this article, several months into the pandemic, some of our clients still have not seen a doctor in-person having been limited to telemedicine visits. This has added an extra layer of challenge to keep our longstanding clients on benefits, much less proving new disability claims.
We are also seeing disability insurers making unreasonable demands on our clients, for instance threatening termination of longstanding approved benefits unless our clients subject themselves to sometimes hours-long, in-person testing.
This is a new frontier for everyone concerned. Our Atlanta disability law firm is rapidly gaining experience as we go – just like everyone else in the medical-legal community. So far we have been able to maintain our successful track record assisting disabled clients despite the additional challenges presented by COVID.
COVID-19 Wage Reductions
One of the biggest issues facing employees right now is that their companies are only bringing in a small fraction of what they used to. This has resulted in layoffs for a number of workers, but more still are taking pay cuts that can go as high as 40%-50% of their income.
Since long-term disability plans pay out a specified percentage of your income, it’s creating conflicts under the law. Should the LTD policy payout the disability claim as agreed to before COVID-19 struck? Or should the policy take into account any pay cuts implemented after COVID-19?
In some cases, the top brass may be bringing in no income at all if their income is tied to the profits of the business. This is true for small business owners as well who depend on profits from their business to pay for employee insurance packages.
The term “force majeure” describes unforeseen circumstances that prevent one or both parties from fulfilling the terms of a contract. These unforeseen circumstances include war, riot, Act of God, or even a pandemic. This means that if some calamitous event occurs that makes it impossible for either party to fulfill their end of the contract, then the contract itself would be nullified without any liability by either party.
This, of course, is not what you as an LTD policyholder want to hear when you’re filing a claim against your employer’s LTD insurance policy.
Working from Home
Now that more and more Americans are able and required to work from home, it’s throwing a wrench in the works for several folks who are filing long-term disability claim. Traditionally, it has always been difficult to prove to an LTD provider that you are disabled enough to prevent you from working. Now that everyone is working from home, it will be that much more difficult.
Secondly, this throws another wrench into the 30-hour workweek criteria that policies generally have. Total disability claims generally require that an individual be engaged in no work for profit whatsoever and are seeing doctors on a regular basis.
The Bottom Line
While insurers are required to operate in good faith, they also have a tendency to exploit loopholes in the law, ambiguities in evidential records, and terms of their policies in their own favor. This could mean that millions of Americans who suffer an unforeseen medical event, car accident, or other major trauma have no back-up plan in place to supplement their income.
Further, employees who are still covered by their employer’s disability plan may find themselves suddenly on the exclusion list, be unable to prove that they are totally disabled because they work from home, or find their contract voided based on unforeseen circumstances.
If you’ve experienced a medical issue that prevents you from working, even from home, call the Atlanta disability attorneys at Robinson & Warncke today to learn more about how we can help.