During COVID-19 infection and after recovery from acute illness, patients may develop one or more disabling symptoms that interrupt or diminish their ability to maintain employment. Some patients experience disabling symptoms of COVID-19 immediately during their initial infection and continuously afterward, while others recover from their initial COVID-19 infection and develop disabling symptoms following their recovery. Long-term symptoms associated with COVID-19 may improve or worsen over time and they may fluctuate between improving and worsening. The long-term symptoms of COVID-19 are commonly referred to “long COVID,” “post-COVID,” and “Post-Acute Sequelae of SARS-CoV-2 infection” or “PASC.” Depending on their individual circumstances, patients with long-term disabling symptoms associated with COVID-19 may have access to disability benefits, which can provide a source of income while they are unable to work.
WHAT ARE SOME EXAMPLES OF DISABLING COVID-19 SYMPTOMS?
Long-term symptoms of COVID-19 typically result from damage to the heart, lung, kidneys, circulatory system, and brain. Symptoms of damage to these organs that can interfere with a person’s ability to work can include:
This is not an exhaustive list of the debilitating long-term symptoms of COVID-19 that can interfere with a person’s ability to work. Also, how these symptoms affect your ability to perform your job will depend on your specific job function. Symptoms that interrupt a person’s ability to perform physically demanding manual labor will differ from those that interrupt a person’s ability to perform mentally taxing skilled labor. If your long-term symptoms of COVID-19 are creating workplace challenges for you, Pandemic Patients recommends consulting with your health care provider and a disability specialist to determine whether you should apply for disability benefits.
WHAT DISABILITY BENEFITS ARE AVAILABLE TO PATIENTS AND SURVIVORS OF COVID-19?
Several states have laws that permit individual workers to receive workers’ compensation benefits if they become infected with communicable diseases like COVID-19 in the course and scope of their employment. Workers’ compensation coverage will provide a monetary benefit and may also cover medical treatment costs associated with COVID-19. If a worker recovers from COVID-19 and continues to experience long-term symptoms that interfere with their ability to work, they may be eligible for extending their workers’ compensation claim, accruing additional benefits. Eligibility for workers’ compensation requires the claimant to prove that they were infected with COVID-19 at work, which may be difficult due to how infectious the virus is and the possibility that the claimant could have been exposed to COVID-19 elsewhere. An individual’s eligibility for workers’ compensation benefits will depend on their individual circumstances and the state they live in. The application process for workers’ compensation will vary between states.
The Family and Medical Leave Act (FMLA) requires covered employers to provide job-protected unpaid leave to employees who are incapacitated with a serious health condition and those who are providing care for sick family members. FMLA guarantees employees 12 weeks of unpaid leave during any 12-month period. Employees must work for their employer for at least 12 months before they are eligible for FMLA leave. Some employers may choose to voluntarily provide pay for employees when they utilize FMLA leave. Some disability insurance policies may require the claimant to exhaust all available FMLA leave before becoming eligible for benefits. Even though FMLA leave is typically unpaid, employers are required to continue offering health insurance benefits to employees during FMLA leave.
In the context of COVID-19 and long COVID, FMLA leave can be useful to provide unpaid time off for employees who require an overnight stay in a hospital and employees with chronic conditions that cause occasional periods of incapacity. To obtain FMLA leave, an employee must work with their health care provider to complete an FMLA certification form. Once the certification form is complete, it must be returned to the employer or their claims administrator. If the employee does not provide certification of their medical condition, their employer can deny an employee FMLA leave.
Short-term and long-term disability insurance policies are often offered by employers as a benefit of employment. Short-term and long-term disability insurance policies replace a percentage of the beneficiary’s income for the duration of coverage. Short-term disability benefits typically last up to twelve months and long-term disability benefits can last for several years or for life. These group disability insurance policies are not usually individually underwritten, which means they typically do not exclude pre-existing conditions from coverage. Employer-sponsored disability insurance plans commonly exclude from coverage injuries and illnesses that arise from an individual’s employment because those situations are covered by workers’ compensation programs. If an individual becomes eligible for short-term or long-term disability insurance benefits and their symptoms later improve, their coverage may end. Employers commonly delegate the administration of their disability insurance plans to third-party claims administrators who oversee benefits eligibility and payment.
To become eligible for short-term disability insurance coverage, an individual must experience a “qualifying event,” in the form of an illness or injury, that prevents them from doing their job. Having COVID-19 can make you eligible for short-term disability insurance coverage if your symptoms are severe enough to prevent you from doing your job. If your symptoms last longer than one or two weeks, you should consider applying for short-term disability insurance benefits.
To become eligible for long-term disability insurance coverage, plans typically require the beneficiary to first exhaust their short-term disability insurance benefits and to be disabled for at least 26 weeks. A long-term disability insurance policy may have a definition of “disability” that is narrower than a short-term policy, making it more difficult to secure eligibility for benefits. Additionally, some long-term disability insurance policies will require the beneficiary to concurrently apply for Social Security Disability Insurance (SSDI) benefits and the benefit amount will be reduced by any amount that SSDI provides. Some long-term symptoms of COVID-19 are severe enough to qualify for long-term disability insurance benefits. If you continue to experience debilitating long-term symptoms of COVID-19 and you have exhausted your short-term disability insurance benefits, you should consider applying for long-term disability insurance coverage and SSDI.
Five states and Puerto Rico currently require employers to offer their employees disability insurance coverage through a state disability insurance program. This includes California, Hawaii, New Jersey, New York, and Rhode Island. If you are experiencing debilitating symptoms of COVID-19 and are covered by a state disability insurance program, consult with your state’s disability program to determine whether you are eligible for disability benefits.
Private disability insurance is typically an individual policy that is purchased directly from a disability insurance company. These policies are individually underwritten, which means they can exclude certain conditions from coverage, including pre-existing conditions. Coverage with private disability insurance is less common than disability insurance obtained through employment, but these policies may provide benefits for COVID-related disability. Private disability insurance coverage replaces a percentage of the beneficiary’s income and typically lasts from the date of disability until the beneficiary reaches the age of retirement. The terms of these policies can vary greatly. If you are experiencing disabling symptoms of COVID-19 and you are not currently covered by a disability insurance policy, you will probably not be able to acquire a private disability policy that covers those symptoms because disability related to COVID-19 will be excluded as a pre-existing condition.
Social Security Disability Insurance (SSDI) is a federal disability insurance program that provides benefits to disabled Americans. SSDI is administered by the Social Security Administration (SSA) and the program exists as a safety net for disabled Americans who are unable to work by providing monthly income. To be eligible for SSDI benefits, an individual must be unable to work or engage in substantial gainful activity because of their medical condition, they must be unable to perform work they have historically performed because of their medical condition, and their condition must be expected to last at least one year or until their death. Additionally, an individual must have earned a certain amount in wages from employment in the ten years preceding their disability.
Applying for SSDI is a more challenging process than applying for disability benefits under an individual or group disability insurance policy. Additionally, the eligibility criteria are more difficult to satisfy. SSDI does not provide coverage for partial or temporary disability. Individuals who are currently working are generally ineligible for SSDI, with limited exceptions. Before an individual can begin receiving SSDI benefits, they must complete a five-month waiting period. If an individual is eligible for both Medicare and SSDI benefits, they must complete a 24-month waiting period before they can begin receiving SSDI benefits.
For SSA to consider long-term symptoms of COVID-19 a “disabling impairment,” an individual must have a record of a positive viral test for SARS-CoV-2, a diagnostic test that establishes the presence of COVID-19, such as a chest x-ray, or a record of diagnosis of COVID-19 with accompanying symptoms. SSA currently does not accept antibody tests as evidence of a prior COVID-19 infection.
SSA maintains a list of disabling medical conditions the agency considers severe enough to prevent an individual from engaging in substantial gainful activity for at least one year. Unfortunately, SSA’s list currently does not include COVID-19 or long COVID, which complicates the process of applying for SSDI for patients and survivors of COVID-19. To determine eligibility, SSA will assess the individual’s medical condition and measure it against other listed medical conditions. If an individual’s medical condition has symptoms that are equivalent to another condition that is listed by the SSA and it prevents them from engaging in substantial gainful activity, SSA is more likely to consider their condition disabling. For an individual to prove to SSA that their long-term symptoms of COVID-19 should qualify them for SSDI, it may require extensive documentation of their symptoms over the course of several months. If an individual develops a Post-COVID Condition following their initial infection, that can help satisfy SSDI eligibility requirements. For example, if an individual develops diabetes following their recovery from an acute COVID-19 infection, that will help them secure eligibility for SSDI.
Supplemental Security Income (SSI) is a federal program administered by the Social Security Administration (SSA) that provides monthly payments to eligible individuals who have limited income and assets. To be eligible for SSI, an individual must be a U.S. citizen who is at least 65 years of age, blind, or disabled, have limited income, and have limited assets (less than $2,000 for individuals, less than $3,000 for married couples). Eligibility for SSI requires individuals to meet the same disability requirements as the SSDI program.
WHAT IS THE PROCESS FOR FILING A DISABILITY BENEFITS CLAIM UNDER AN INDIVIDUAL OR GROUP POLICY?
The first step of filing for disability benefits is to find the insurance policy document that governs the policy you are covered under, which is commonly known as the “Summary Plan Description.” If you are covered by a workplace disability policy, you may need to reach out to your Human Resources department to obtain a copy of your policy. Once you have obtained a copy of your policy, you will need to familiarize yourself with its terms of coverage, the benefits it provides, how to file a claim for benefits, and any limitations of the policy. Before filing a claim for disability benefits, locate your policy’s definition of “disability” to determine whether your symptoms will qualify for coverage. You should also check to determine whether you satisfy your plan’s requirements on when you must file a claim to become eligible for benefits. Pay close attention to your plan’s adjudication timelines and the process for appealing an adverse determination.
Most disability insurance policies contain an “elimination period,” which is a waiting period that you must complete before you are eligible for benefits under the policy. The elimination period could be days, weeks, or months, depending on your policy. While benefits are not payable during the elimination period, you do not need to wait to complete the elimination period before you file a claim for benefits under your policy.
To qualify for disability benefits under a disability insurance policy, you will need to substantiate the details of your disability in consultation with your health care provider to ensure that your condition satisfies your insurance policy’s definition of disability, which can vary between policies. To improve your ability to become eligible for disability benefits, you should make certain that your medical documentation is detailed, specific, and supported by objective information, such as results from diagnostic tests and medical examinations. Some disabling symptoms of COVID-19 can be difficult to objectively document, which can make this process challenging.
Once you open your claim for disability insurance benefits, your plan will adjudicate the claim and communicate the outcome to you within a certain timeframe. Most disability insurance plans provided by an employer are governed by the Employee Retirement Income Security Act (ERISA). ERISA requires disability insurance plans to evaluate a claim for benefits within 45 days of receiving the claim, though they may request extensions under certain circumstances. These extensions can lengthen the time of review for up to 150 days. Private disability insurance policies are governed either by their own terms of coverage or state law, which can result in a lengthier adjudication process.
WHEN SHOULD I GET HELP FILING A DISABILITY BENEFITS CLAIM?
The short-term and long-term health consequences of COVID-19 continue to develop unpredictably. Symptoms vary greatly between individuals and some patients continue to experience symptoms long after recovering from an acute COVID-19 infection while others make a quick recovery. The uncertainty around COVID-19 can lead some disability insurance plans to initially deny coverage for disability associated with COVID-19. However, an initial adverse determination denying disability benefits can be overturned on appeal. It is common for an individual to be initially denied disability benefits and subsequently secure eligibility on appeal, but your plan may limit the number of times you can appeal an adverse determination. If you have received an initial adverse determination for disability benefits, you should consult with an experienced disability attorney to ensure that your appeal is successful.
The process of applying for Social Security Disability Insurance (SSDI) is more rigorous compared to other types of disability insurance. If you are applying for SSDI, you will benefit most from the assistance of a disability attorney for the entire application process.
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