The Six Things That Every Cardiac COVID-19 Long Hauler Needs to Know About Their Disability Insurance Claim
I’m sure that you didn’t think you would ever have to file a claim for long term disability benefits or that you would have to file a claim because of complications of a disease that didn’t exist when you bought your disability policy.
COVID-19 is an RNA virus and, unfortunately, there is no treatment that kills the virus. COVID can cause significant organ system damage, including cardiac system damage. You can be disabled because of just cardiac system damage or a combination of damage to various bodily systems, like a combination of lung and heart system damage.
Some patients with COVID-19 recover and return to work, while others continue to have debilitating symptoms.
There are three commonly seen types of COVID-19 disability:
1. Post ICU Syndrome (PICS), which can persist for months and even years,
2. Post-acute illness lasting greater than three weeks with disability determined by the extent of the organ system damage, or
3. Chronic Long-term COVID lasting greater than 12 weeks, known as long-haul COVID Cardiac COVID 19 Claims
Disability carriers don’t seem to understand the acute or chronic cardiac symptoms or the long-term damage done by COVID to various bodily systems, that can result in disability. Early mortality medical findings showed that COVID caused severe right ventricular dilation and, microscopically, muscle death within the structure of the heart.
The acute cardiac symptoms included:
1. myocarditis with cardiogenic shock,
2. heart failure,
3. arrhythmias, and
Any one of those conditions can be disabling.
The actual mechanism of heart damage and disability varies from patient to patient. Cardiac damage and disability can result from a direct viral myocardial invasion, thrombosis, coronary plaque rupture, an inflammation-related type of injury, or a lung injury that results in oxygen supply demand imbalance. Any one or a combination of these symptoms or mechanisms of injury can easily result in disability.
There are six issues to consider in your COVID-19 disability claim that carriers like to seize on to deny COVID-related claims.
1. The lack of an objective basis for the COVID-19 diagnosis.
The commonly recognized diagnostic studies for COVID-19 are a PCR test, an antigen test, or an antibody test. Unfortunately, there have been problems both with false negatives and with false positives. The false positives play into the hands of the disability carrier who wants to dispute the underlying diagnosis.
Worse yet, many cardiac long-haulers did not have symptoms and were not tested. While that can play into the disability carrier’s hands, the real issue is not necessarily whether you have or have had COVID-19, but what the objective medical evidence is for a disabling cardiac condition.
I suggest that you have testing to include
1. an EKG,
2. an echocardiogram,
3. a Holter Monitor,
4. a cardiac MRI, and/or
5. blood work that includes levels of troponin.
2. The Subjective Nature of the symptoms and the Subjective Medical Condition Limitation
The second problem is the subjective nature of complaints like tachycardia, chest pain, and chronic fatigue that can’t always be objectively measured. There are some disability policies that have subjective medical condition limitations which only pay benefits for a limited period for conditions characterized by the symptoms of COViD-19. It is a common problem in ME/CFS cases, and it will be a common problem with long term COVID-19 cases.
Testing like CPET, FCE testing or pulmonary testing can document objective reasons for restrictions and limitation, while cognitive testing can document issues with cognitive impairment or concentration.
3. The Mental Nervous Condition Limitation
Another common disability policy limitation is the mental nervous limitation that can limit the payment of benefits to just two years if the psychiatric illness is the cause of the disability or, in some polices, contributes to the disability. Unfortunately, it is common for COVID-19 sufferers to have cognitive issues that carriers misclassify as psychiatric in nature, or to have psychological issues.
4. Proving Disability
Your disability policy probably requires that you prove you are unable to perform the material and substantial duties of your own or any other occupation.
I go about this in several ways. The objective cardiac testing may by itself demonstrate the severity of your symptoms and your inability to function. Testing, like an FCE or CPET test, may also demonstrate the impact of your shortness of breath, fatigue or other symptoms that impact your functionality.
Since I am also a Social Security disability attorney, I look to the Social Security Disability Listings for cardiac disability and the Listing for other related conditions such as pulmonary issues, to prove the severity of my client’s condition.
I look at Social Security Listing 4.00, specifically Listing 4.02, Chronic Heart Failure, Listing 4.04, Ischemic Heart Disease, Listing 4.11, Chronic Venous Insufficiency, and Listing 4.12, Peripheral Arterial Disease. These Listings are not binding on the disability carriers, but I use them to illustrate the severity of the symptoms and their impact on your functionality. If appropriate, I will also look to Listings for other conditions such as pulmonary system involvement. I want your disability carrier to consider all your COVID-19 symptoms including cardiac system involvement and the involvement of any other bodily systems, both individually and in combination.
5. Treatment Issues
Many disability policies require that a policy holder have a recognized treatment plan and that a patient comply with the treatment program. However, there is no recognized treatment protocol that addresses COVID’s long term effects or multiple system effects on the heart, lungs, and vascular system. However, the disability carrier will expect you to get the standard treatment for cardiac disorders or any other conditions that you claim are the basis of your disability.
6. Long Term Cardiac Complications
Long term cardiac complications can also be the basis of a disability insurance claim. For example, one of the complications being seen is the onset of chronic heart failure and scarring because of sustained inflammation. The scarring can lead to arrhythmias and heart failure and can turn into fibrosis, which can cause lingering symptoms of fatigue, shortness of breath, chest tightness and even palpations.
I know that you can’t wait to get the disability insurance benefits you purchased, and which are being wrongfully delayed, denied, or even terminated. At Cavey Law we have been helping COVID-19 patients, including those with long-term cardiac COVID-19 symptoms, get their short and long-term disability benefits. We are here for you!
Nancy Cavey, whose father became disabled when she was a teenager, knows first hand the fight with a disability insurance company to get the disability benefits you deserve.
1. specializes in disability law, and has taken on disability insurance carriers across the nation,
2. handles ERISA disability claims from COVID-19 suffers across the nation,
3. has recovered millions in disability benefits for her clients, and
4. can submit your disability insurance claim, appeal a wrongful denial or termination, file a lawsuit in federal court, and negotiate a lump sum settlement.
Call today at 727-894-3188 for a free consultation, and learn more about your rights to your disability insurance benefits for COVID-19.