Long COVID and Long-Term Disability Claims: Why “Brain Fog” Gets Denied and What You Can Do About It

If you’re a professional whose career depends on a sharp mind – for instance an attorney, a physician, an executive, a teacher, an engineer – long-COVID-19 brain fog and memory lapses  can leave you unable to keep pace with your job demands. You are experiencing a legitimate disability that is largely invisible to everyone except you and the people you used to work alongside.

You also may have discovered something else the hard way. When you filed a long-term disability claim, your insurance company didn’t just accept your word. Instead, it sent you to its doctors, picked apart your cognitive test scores, and eventually sent a letter suggesting you are not disabled at all, or perhaps with “a little more treatment” you’d probably be able to go back to work.

If that sounds familiar, you’re not alone. Long COVID-related cognitive impairment has become one of the most contested categories of long-term disability claims in the country. This is precisely because these problems don’t show up on a normal X-ray. They don’t fit neatly into older definitions of disability. It’s all too simple for an insurance company’s medical consultants to wave away the severity of the problem with a single word: “mild.”

What Long COVID Cognitive Impairment Actually Looks Like

People who develop persistent cognitive symptoms after COVID-19 often describe a strikingly consistent pattern. Emerging research spearheaded by the NIH RECOVER Program has identified a specific cluster of deficits: slowed processing speed, difficulty sustaining attention during long or high-pressure tasks, trouble retrieving information under time pressure, and cognitive endurance that simply runs out far sooner than it used to. This kind of pattern lends inherent credibility to your claim.

Insurance doctors, meanwhile, are often unaware of this newer research – or they simply ignore it in arguing that your claim is not well-documented.

For someone in a demanding, high-stakes profession, the typical pattern of long-COVID deficits isn’t just an inconvenience. It’s the difference between being able to excel within a profession and not being able to survive in it at all.

A trial attorney who can no longer track a fast-moving deposition, integrate testimony with exhibits in real time, and think on her feet under pressure isn’t “a little impaired.” She’s unable to perform. On a good day, in a quiet room with no time pressure, she might still pass a written test, but this does not reflect the essential duties of her occupation.

This the crux of nearly every Long COVID disability dispute involving high functioning professionals.

Why Insurers Downplay These Claims

Long-term disability insurers routinely rely on two arguments to deny or limit Long COVID cognitive claims, and both are worth examining.

“The testing only shows mild impairment.” Standard neuropsychological testing estimates what a person’s cognitive ability used to be (their “premorbid” baseline) using population-based formulas. Then they use terms of art in describing impairment, like “mild” or “moderate.” What is “mild” in neuro-speak can have devastating, disabling consequences in a high-demand profession.

Another critical consideration is that neuropsychological tests come with inherent limitations that almost always underestimate the premorbid ability of people who were exceptionally high-functioning. Many of these tests will cap out a premorbid IQ estimate at 120 or sometimes less.

This upper limit oftentime does not reflect the premorbid functioning of, for instance, a Wharton MBA who is CEO of a fast-growing technology company, an MIT-graduate engineer, a gifted spinal surgeon and professor of medicine, or an attorney who graduated at the top of her law school class, clerked for a federal judge, and ran a demanding practice for two decades.

Neuropsychological tests scoring in the “average” range after an illness can still represent a catastrophic decline for someone whose baseline was in the superior or very superior range. Averaged against the general population, the drop looks small or non-existent. Averaged against the true baseline of high functioning people and what the most demanding professions actually require, these changes are the difference between professional excellence and disability.

“Further treatment will probably fix it.” Insurers frequently argue that a claimant hasn’t reached “maximum medical improvement” because they haven’t tried every available intervention, additional therapy, an experimental supplement, or a low-dose medication being studied for other conditions. The problem is that the medical literature on long COVID cognitive rehabilitation doesn’t support the premise. Newly emerging peer-reviewed research, including large randomized trials, has generally found that there is no cure for long-COVID cognitive impairment once it has existed for a year or more. Available interventions might provide modest symptom relief, but no treatment has been shown to restore the kind of high-speed, high-stakes cognitive performance that professions like trial law, medicine, or executive leadership demand. Denying a claim on the theory that an unproven treatment “might” work, when the evidence doesn’t back that up, is a common and often successful point of legal challenge.

There’s also a subtler tactic: attributing cognitive symptoms to depression or anxiety instead of to the persistent neuroinflammation caused by the COVID virus itself. Mental health claims are almost always treated differently under disability policy language, providing a limited duration of benefits. Moreover most people experiencing a legitimate, organically-based cognitive decline show signs of depression and anxiety caused by the loss of function itself. But here, too, cognitive problems caused by primary depression have a distinct clinical signature, typically involving effortful encoding that improves when a person is given extra time or cues. Long COVID-related impairment often looks different: slowed processing speed, disrupted executive function, and attention difficulties that persist even when mood symptoms are well-controlled or minimal.

Countering the usual insurance doctor tropes requires a serious investment in time, money and energy – a law firm specializing in long-COVID claims knows how to arrange additional specialized objective testing and know where to go to arrange highly qualified long-COVID medical experts to explain the situation.

What Strengthens a Long COVID Disability Claim

Successfully proving a Long COVID cognitive disability claim tends to hinge on a few key elements working together, not any single piece of evidence in isolation.

Serial neuropsychological testing over time matters more than a single evaluation. When two or more independent evaluations, months or years apart, show a stable or worsening pattern rather than improvement, that trajectory itself becomes powerful evidence that the impairment has plateaued rather than being a temporary phase of recovery.

A properly conducted premorbid ability analysis matters too. If your baseline abilities were exceptional, your claim’s strength often depends on an expert being willing to dig past the standard estimation formulas and account for objective evidence of who you actually were before you got sick.  Academic records, professional accomplishments, and specific test measures that are more resistant to the underestimation problem described above.

Advanced neuroimaging is becoming a more important part of the picture. Standard MRI scans frequently come back “normal” in Long COVID patients because the damage caused by persistent neuroinflammation happens at the microscopic level. Insurance doctors disingenuously assert that a “normal” traditional MRI is evidence that nothing is really wrong.

Normal conventional imaging doesn’t mean normal brain function. Quantitative volumetric analysis and diffusion tensor imaging (DTI) can pick up what traditional MRI misses. DTI examines brain structure and white matter integrity in detail that standard imaging can’t capture. Volumetric analysis can show signs of brain atrophy consistent with chronic neuroinflammation. These tests have increasingly been used to provide objective, measurable corroboration of the very deficits identified on cognitive testing.

There is no treatment reason to get this testing done, so it will be up to your attorneys to arrange the testing that can ultimately prove your case. We’ll cover exactly how that works and why it matters for your claim in a companion article on our site.

Finally, a claim benefits enormously from having the right kind of medical experts involved: clinicians and researchers who specifically study post-COVID cognitive impairment and follow these patients long-term are what is needed. General practitioners or generic neuropsychologists usually don’t have sufficient experience to deal with the complexities of this new disease entity. A treating physician who has followed you for years and a specialist with genuine expertise in Long COVID research can speak to your case with an authority that a one-time insurance company consultant simply cannot match.

If Your Long-Term Disability Claim Has Been Denied or Delayed

If you’re dealing with lingering cognitive symptoms after COVID-19 and your disability insurer has denied your claim, questioned your treatment choices, or suggested that you should be able to return to work despite what your doctors say, you don’t have to accept that outcome as final. These claims are winnable, but they require an attorney who understands both the medicine and the insurance law involved, someone who knows how to challenge a flawed premorbid analysis, push back on speculative “you didn’t try hard enough” arguments, and use the specialized medical and legal record to your advantage.

Robinson & Warncke represents individuals across Georgia who have wrongfully had their long-term disability benefits denied, including complex Long COVID and cognitive impairment claims. If your claim has been denied or delayed, or you’re worried it will be, reach out to discuss your situation. Understanding your rights is the first step toward getting the benefits you’re entitled to.