Most people infected with COVID-19 recover within a matter of weeks, but some may experience lingering symptoms that persist for months. People infected with the virus may also have new or recurring symptoms after the initial illness. This condition is known as “long COVID.”

Long COVID symptoms can have serious long-term effects and a devastating impact on your daily life and ability to work. Unfortunately, qualifying for long-term disability benefits can be difficult for long COVID patients.

If you’re considering filing a long-term disability claim for long COVID, we highly recommend you consult an experienced lawyer for guidance. The claims process is complicated by design, and even a minor error could lead to significant and permanent consequences.

In this article, we’ll discuss the challenges of getting long-term disability for long COVID and how to improve your chances of receiving benefits.

What we’ll cover:

Common long COVID symptoms

Long COVID symptoms can vary widely and affect people differently. Even those who did not experience a severe initial infection may develop long COVID symptoms and suffer from ongoing health problems.

According to the Centers for Disease Control and Prevention (CDC), “people with long COVID have a range of new or ongoing symptoms that can last weeks or months after they are infected with the virus that causes COVID-19 and that can worsen with physical or mental activity.”

Examples of common symptoms of long COVID include:

  • Persistent fatigue
  • Shortness of breath
  • Difficulty focusing (also called “brain fog”)
  • Dizziness on standing
  • Muscle or joint pain
  • Sleep disturbances like insomnia
  • Chest pain
  • Headaches
  • Loss of smell or taste
  • Mental health conditions, such as anxiety or depression
  • Heart palpitations (fast-beating or pounding heart)
  • Cough

If you’ve experienced any of these ongoing health conditions for more than one year following your initial infection, you may have long COVID and should consult a healthcare professional.

Long COVID is recognized as a disability under the Americans with Disabilities Act (ADA), Section 504, and Section 1557 if it “substantially limits one or more major life activities.” These laws protect people with disabilities from discrimination, but they do not guarantee qualification for benefits.

Can you get disability for long COVID?

You may able to get disability for long COVID if you meet the eligibility requirements outlined in your insurance policy. Qualifying for short-term disability is typically easier than long-term disability.

Learn more about Short-Term vs. Long-Term Disability Plans.

Evidence shows that insurance claims are on the rise due to the impact on long COVID patients’ ability to work. According to the Kaiser Family Foundation, “Surveys show that among adults with long COVID who worked prior to infection, over half are out of work or working fewer hours.”

Graph showing that fewer than half of working age adults with long COVID who working prior to infection work full-time after infection

Source: KFF

How to qualify for long COVID disability benefits

The requirements to receive benefits for long COVID will differ based on your policy, insurance provider, and where you live. It’s important to review your insurance policy carefully and understand the provisions you must meet.

Here are some general criteria your insurance provider may consider when determining eligibility for long COVID disability benefits:

1. Obtain a diagnosis of long COVID

The support of your medical providers is crucial to your long COVID claim. You must have a documented diagnosis of long COVID from a qualified healthcare professional. If your doctor isn’t convinced you’re unable to work due to long COVID, it will be difficult to prove you’re entitled to benefits.

Here are some tips from the Centers for Disease Control and Prevention on preparing for an appointment for post-COVID conditions.

2. Demonstrate duration of disability

Typically, you need to demonstrate that your symptoms have lasted or are expected to last for a specific period to qualify for benefits. The duration requirement can vary, but it’s usually at least several months or more.

Determining the expected duration of symptoms can be particularly difficult with long COVID because it’s a recent medical condition that doctors are still trying to understand. To ensure you’re getting the most accurate and up-to-date information and advice, it’s important to consult with a healthcare professional experienced in treating long COVID.

You need to demonstrate that your symptoms have lasted or are expected to last for a specific period to qualify for benefits.

3. Prove your inability to work

With any disability, you must prove that you are unable to work due to your condition. The terms “any occupation” and “own occupation” are used in disability insurance policies to determine a person’s ability to work.

  • Own occupation: Under the “own occupation” definition, you are considered disabled if you are unable to perform the duties of your specific job or profession.
  • Any occupation: The “any occupation” definition of disability is more stringent and requires that you are unable to engage in “any occupation,” even if it pays less or is not directly related to your previous job. “Any occupation” is the standard set by Social Security Disability Insurance (SSDI).

Be sure to refer to your insurance policy to determine which of these definitions of disability apply in your case.

4. Provide ample medical evidence

You will need to provide comprehensive medical documentation that supports your claim. Helpful evidence may include medical records, test results, treatment history, doctor’s notes, and statements from other healthcare professionals regarding the impact of long COVID on your ability to work.

Consult with healthcare professionals who are knowledgeable about the long-term symptoms of COVID. They should be able to provide thorough medical documentation of your symptoms, treatments, and their impact on your daily life.

5. Demonstrate functional limitations

You must demonstrate the functional limitations imposed by long COVID. This can be supported by medical records, physical or cognitive tests, or statements from healthcare professionals.

Your insurance company may request that you participate in an Independent Medical Examination (IME) or Functional Capacity Evaluation (FCE). These tests typically favor the insurance company, not the claimant, so you should contact a lawyer immediately if you receive such a request.

6. Comply with treatment

Generally, insurance providers expect claimants to undergo appropriate medical treatments and follow recommended therapies for their condition. Failure to comply with treatment without valid reasons may impact your eligibility.

7. Meet waiting period requirements

Disability insurance policies typically have waiting periods, also known as “elimination periods.” These are specific periods of time you must wait after becoming disabled before you are eligible to receive benefits. Check your policy to understand the waiting period requirement.

5 ways to build a stronger case

Proving long COVID can be challenging due to the unique nature of the condition.

In addition to meeting the eligibility requirements we already covered, here are some ways you can build a stronger case:

1. Maintain a symptom journal

Keep a detailed record of your symptoms, their frequency, duration, and how they affect your ability to perform daily activities, work, and engage in social interactions. This journal can serve as a valuable reference and demonstrate the ongoing nature of your condition.

2. Gather objective evidence

If available, include any objective evidence such as test results, imaging studies, pulmonary function tests, or other medical evaluations that confirm the presence and severity of your long COVID symptoms. This can strengthen your case by providing concrete evidence of the physical and physiological impact of the condition.

3. Provide work-related evidence

Collect evidence related to your job requirements and the specific challenges posed by long COVID. Work-related evidence may include job descriptions, performance evaluations, and testimonies from colleagues or supervisors that highlight the impact of your symptoms on your ability to perform essential job duties.

4. Follow the application process

Familiarize yourself with the specific requirements for your insurance policy and provider. Adhere to all deadlines, provide requested documentation promptly, and follow the steps to ensure your claim is processed accurately.

5. Consult a qualified lawyer

Navigating the process of filing a claim or appeal can be incredibly complex and challenging. This is particularly true for policies governed by federal ERISA law, which make up the majority.

It’s important to remember that the insurance company is not advocating for your best interests. Without the guidance and expertise of a legal expert, the likelihood of receiving benefits are slim to none.

For the best possible outcome, you should seek the advice of a long-term disability lawyer who is an expert in federal ERISA law and local laws and regulations.

Get the help you need

If you’re suffering from long COVID, you shouldn’t have the additional worry of having to prove it to your disability insurance company.

Roy Law Group can help you navigate the complex application process by gathering medical evidence, filling out paperwork, and handling all of the intricate details for you. We can take the burden off your shoulders so you can focus on your health and well-being.

Reach out to our team of long-term disability lawyers today for a free consultation.