How Long-Term COVID-19 Symptoms Are Evaluated for Social Security Disability Benefits And a Long Term Disability Insurance Claim

Do people who are struggling with long-term COVID-19 (or “long COVID”) qualify for disability benefits? The short answer is yes, but it’s a complex question. If you have long COVID symptoms, ask a St. Petersburg disability lawyer to help you apply for disability benefits.

One of the key factors in getting your long COVID Supplemental Security Income (SSI) or  Social Security Disability Insurance (SSDI), is medical documentation of the diagnosis, symptoms and your physical, cognitive and psychiatric functional limitations.

What Medical Evidence Will You Need to Obtain Benefits?

To obtain SSI or SSD  you first must have a medically determinable impairment (MDI). The Social Security Administration (SSA) accepts long COVID as an MDI, but a diagnosis alone is not enough.

You also need objective medical evidence from an acceptable medical source (like an M.D. or D.O.) to establish the MDI. This medical evidence may include:

1. A positive viral test for SARS-CoV-2 (not just an antibody test) or a diagnosis of COVID-19 with consistent signs.
2. Diagnostic tests with findings consistent with COVID-19 effects (such as abnormal chest X-rays or CT scans, pulmonary function tests, cardiac MRIs, or neuropsychological testing).
3. Clinical signs observed by a physician, such as abnormal lung sounds, fever, or observed cardiovascular abnormalities.

What Else is Required to Obtain Benefits?

Your medically determinable impairment must have lasted, or be expected to last, for a continuous period of at least twelve months or result in death. If you recover or are expected to recover swiftly from long COVID with no residual limitations, you will not meet this requirement.

Doctors evaluate long COVID symptoms by looking for these medically determinable impairments:

1. Cardiovascular system impairments (such as a fast heart rate or cardiac damage)
2. Musculoskeletal and immune system disorders (such as chronic muscle or joint pain and fatigue)
3. Neurological impairments (such as dizziness, headaches, the loss of smell or taste or seizures)
4. Cognitive impairment (such as as difficulty with memory or concentration)
5. Psychological impairment (such as  anxiety, or depression)
6. Respiratory system impairments (such as shortness of breath or a chronic cough)

How Are Long COVID-Related Benefit Claims Processed?

If you apply for SSI or SSDI benefits, and your condition matches the criteria for an impairment in the SSA’s Listing of Impairments, the SSA will determine you are disabled.

SSA does not have a listing for Long COVID. As a result, SSA will determine if your symptoms and evidence match the criteria for a related listing (such as a cardiological impairment).

If you don’t meet a Listing, SSA will consider at Step 4 whether you can return to your past work and at Step5 whether you can do other work in the national economy in view of your age, education, transferable skills and your restrictions and limitations. To determine what you can and can’t do, the SSA will assess your “Residual Functional Capacity” (RFC). The SSA considers:

1. Your physical abilities: How much you can lift, walk, stand, and sit, the impact of fatigue, shortness of breath, and muscle pain all of which can significantly limit your physical exertion.
2. Your mental and cognitive abilities: Your capacity to understand, remember, concentrate, and respond appropriately to supervision and work pressures.
3. The credibility of your symptoms: The SSA will compare your subjective complaints (such as severe fatigue and pain) with the objective medical evidence (like test results and physician observations).

To obtain SSI or SSD benefits, you must demonstrate that your limitations prevent you from performing your past work or any other type of work available. At Cavey Law, we pick the right RFC form(s) for your doctor to complete that will help establish your functional abilities..

How Will a Disability Lawyer Help You?

Obtaining disability benefits for a complex condition like long COVID is challenging. Most initial applications for SSI and SSDI are denied. You’ll need to contact a St. Petersburg disability attorney who can explain and guide you through the application process.

Your lawyer will know what records and documentation the SSA requires for your unique medical conditions.. Your lawyer can help document  that you meet the twelve-month duration requirement and your medical records link your symptoms to your inability to perform your past work and other work in the national economy.

A St. Petersburg disability lawyer will also help pick the right  Residual Functional Capacity (RFC) forms so that SSA can properly determine your entitlement to SSI or SSD. These forms may be the most crucial piece of evidence in your favor.

About the Social Security Disability  and SSI Application Process

Your St. Petersburg disability attorney will help you accurately complete the application forms and avoid common mistakes that lead to benefit claim denials.

Denials are common. If the SSA rejects your application for benefits, your lawyer can file appeals, including a “Request for Reconsideration” and a petition for a hearing before an Administrative Law Judge. At a hearing, your attorney will present your case and may:

1. question medical or vocational experts
2. cross-examine the SSA’s experts
3. offer a cohesive, legally sound argument to the Administrative Law Judge

What About Private Long-Term Disability Claims or ERISA Disability Claims?

In addition to a Social Security disability claim, you might have bought a private disability policy or have a disability policy through your employer. If your employer provided you with short or long term disability insurance, your benefits are regulated by the Employee Retirement Income Security Act (ERISA). When a disability insurance company or disability plan rejects a long-term disability claim and unfairly denies benefits, a private individual  disability policy or ERISA attorney can appeal the denial of that claim to recover the benefits. If the appeal is denied, your attorney can file a lawsuit to recover your denied disability insurance benefits.

If you have long-term disability insurance and your insurance company or plan denies your claim, let your disability attorney do all of the talking and negotiating with the company. 

The easiest mistake to avoid when you claim ERISA  benefits is not working from the beginning with a lawyer who has ERISA experience, because ERISA is a complex law with many terms, exemptions, conditions, and deadlines. At the Law Office of Nancy L. Cavey, we can help.

We Advocate for the Disabled

The Law Office of Nancy L. Cavey assists our Florida clients in obtaining Social Security Disability Insurance and helps clients nationwide with their long-term disability insurance claims.

We have more than four decades of experience helping individuals who need long-term disability benefits, and we understand how to resolve the most difficult disputes with insurance companies and the Social Security Administration.

If you need long-term disability benefits, or if your insurance company or the Social Security Administration has rejected your claim, call us at 727-477-3263 and put the Law Office of Nancy L. Cavey to work for you. Your first consultation with our legal team is offered at no cost and with no obligation.