A lot of phone calls that I am getting are dealing with COVID and its after-effects. Some callers are seeking assistance on whether they should fill out the disability application forms or how do they deal with application denial.
The first question is usually “I have COVID, can I get disability benefits?”. The answer is “It depends”.
First, some background; disability benefits in this context refers to group disability benefits that one usually obtains through their employment – these are normally called Long-term Disability Benefits.
Most group policy disability benefits have a ‘waiting’ or ‘elimination’ period where the potential claimant will exhaust sick leave or if available, short-term disability benefits. Once the waiting or elimination period is exhausted, then the Long-term Disability benefits would start.
The length of the waiting period varies but for group policies, I find the usual time is 17 weeks (sometimes described in the policy as 119 days) – but be sure to check your Policy because I have seen the periods as short as 1 week or as long as 1 year.
So, the first test to meet when applying for long-term disability benefits is to have the disability exceed the waiting period. Then the issue becomes whether the disability is sufficient to meet the definition of total disability in the disability policy. I have discussed the definition in other blogs so I do not propose to do it today. However, the main point to take away today is the fact that disability is determined by ‘functional limitations’ and not ‘diagnosis’.
What that means in terms of COVID is that you would not automatically get disability benefits because you have COVID; similarly, you would not automatically get disability benefits if you had cancer. Those are diagnostic labels and while important for determining treatment and perhaps long-term residual disabilities, the main issue is whether your functional limitations are such that you meet the definition of total disability.
One of the traits of COVID is ‘long-hauler’ syndrome. According to the World Health Organization, the vast majority of COVID cases only cause mild symptoms or moderate illness. However, about 10-15% progress to severe disease and about 5% become critically ill.
The majority of COVID cases will recover in about 2-6 weeks (i.e. test negative for COVID – be aware this statement is a generality because there are literally hundreds of different methods to determine what ‘recovered’ means. In Alberta, one of the criteria is that you have 2 negative tests 24 hours apart).
However, the problem that ‘long-haulers’ have is that while they will have technically recovered from COVID according to the various medical criteria, they will still suffer from residual symptoms. The symptoms commonly reported include:
Fatigue
Shortness of breath
Cough
Joint pain
Chest pain
Depression
Headaches
Difficulty with concentrating (sometimes referred to as ‘brain fog’).
In the more severe cases, the long-haulers will suffer from inflammation of the heart muscle, lung-function abnormalities, acute kidney injury and even neurological issues such as loss of smell or taste. Now, we get to the point where qualification for disability benefits is considered. Are the above symptoms of such severity as to meet the definition of disability in your disability policy? If the answer is ‘Yes’, then you should obtain benefits; if the answer is ‘No’, then you would not qualify for benefits. The issue comes down to your symptoms and the effect they have on your work ability. We could change the term COVID to ‘Illness ABC’ and the same consideration applies. Many insurance companies like to use diagnoses as part of the requirement for disability benefits, however that is not part of the test – it is not what you have, but rather how it affects you that is important. The next blog will deal with what things you and your doctor can do when filling out your application forms to increase the chances of obtaining disability benefits, either from COVID or other illnesses or injuries. If you are having difficulties with obtaining long-term disability benefits from your insurance provider, please call me at 403-670-0055 (or toll-free 1-877-682-3476) and we can discuss your issues. Until next time, stay safe. James Ludwar Ludwar Law Firm