If you have been diagnosed with COVID-19 and are unable to work due to your symptoms, you may be eligible for short-term disability benefits under your disability insurance policy. Because symptoms vary in type and intensity, it will be necessary to establish that your symptoms are disabling. Working with your healthcare providers can mean the difference between a claim approval and a claim denial.
Testing for novel coronavirus is still very limited. Even without a definitive diagnosis of COVID-19, you may still be eligible for short-term disability benefit. Establishing eligibility for benefits will require detailed information from your healthcare provider regarding the severity of your symptoms. Many patients go through the diagnostic process during a telehealth appointment.
Hopefully, most people will eventually recover from COVID-19 and return to work. However, it is not clear what complications or long-term effects some patients may have. If you are unable to work for an extended period of time due to complications from COVID-19, you may be eligible for long-term disability benefits.
The Impact COVID-19 May Have on Your Current Disability Claim
The majority of disability insurance companies remain open and actively engaged in the ongoing administration of disability claims. However, with the COVID-19 limitations put in place by most disability insurance companies, the handling of disability related claims has been impacted. While theoretically these measures should not cause any delay in the review, administration and/or general handling of your claim it is important that you take the steps necessary to hold your insurance company accountable for its obligations to you under the policy and the law and prevent the company from unnecessarily delaying benefit payments, making a determination or timely completing the review of your claim.
New Short-Term and Long-Term Disability Claims to be Filed
If you are thinking about filing a disability insurance claim because you have an illness or injury that prevents your from working, you should not hesitate to file your claim at this time. Your right to benefits under your policy and the obligations and timelines that apply to your insurance company are still relevant even during these challenging times. However, it may be difficult to obtain the medical and other information required to complete the process. At Disability Insurance Law Group, we continue to work closely with our clients, their physicians and their employers to make sure that they are able to timely obtain and submit the information and documentation necessary to submit a successful application for disability benefits and obtain a decision by the carrier without unnecessary delays.
Disability Insurance Claims Under Review And/Or Already Approved
Many individuals are in the midst of waiting for a decision on a claim that was recently filed with their short term disability or long term disability insurance carrier.
Other insureds have been advised that their currently approved claim is being reviewed in order to confirm that the insured remains eligible for ongoing disability benefits.
As noted above, while there are challenges to insurance companies given the current situation, the vast majority are still in operation and their adjusters continue to work full time. As such, they are capable of and required to timely review all insurance claims and reach a determination as quickly as possible. Time is money to most insureds and therefore it is imperative that their insurance company evaluate and pay claims as quickly as possible and without interruption for those already on claim. While obtaining medical support has become a challenge for both the insurance company and the insured, many medical offices remain open at least part time and are willing to provide medical records upon request. The attorneys at Disability Insurance Law Group have had great success in working with our clients’ doctors and their employers to obtain the information, forms, and documents needed to respond to all requests for information and provide the insurance company with the information needed to make a decision.
Some insurance companies are dragging out the review process by requesting updated claimant forms, medical forms (Attending Physician Statements) and even requiring in-person Independent Medical Examinations with a physician of their choosing, despite having ample proof of the insured’s right to benefits. Claim Representatives are fully aware that many physicians like to see their patient prior to completing a form and that medical offices are working with a limited staff and reduced hours to minimize the spread and dangers associated with COVID-19. Given that the guidelines require doctors to primarily see urgent cases only and that many insureds do not want to take the risk of going to a doctor’s office simply to have a form completed or to be examined by a physician they have never seen before, these requests are unreasonable, burdensome, and may possibly be evidence of bad faith. If your insurance company is asking you to see your physician or an independent medical provider you may have the right to say no. While you have an obligation to provide the carrier with proof that you are disabled, you are not required to provide all proof available.
Long-Term Disability Appeals
Of great concern to many of our clients and individuals whose claim has been denied and must submit an Appeal within a specified time frame – usually 180 days from the date of the denial letter, is their ability and the insurance company’s ability to get the evidence required to fully support their claim within that time period. Those whose coverage was provided as part of a group policy or provided by their employer most likely have claims administered under the Employee Retirement Income Security Act of 1972 (ERISA) which provides very strict guidelines as to the handling of group disability claims. Basically, the information provided with the Appeal is the only information a Court of law will review should the denial be upheld and a lawsuit filed. Please visit the ERISA Appeals section of our website for more details.
Getting medical records, physician statements, and the documentation necessary to overturn an ERISA disability insurance denial is normally a challenge, as the insured must provide enough evidence to prove that the insurance company’s denial was not only wrong, but “arbitrary and capricious”. Additionally, most Appeals provide the insured with only one opportunity to appeal the denial of benefits before issuing a Final Denial. At that point, the insured may litigate their case; however, only the information contained within the Administrative Record at the time of the Final Denial will be reviewed by a Court, there is very limited Discovery, and there is no jury. Thus, it is imperative that the claimant submit all evidence to be considered should a lawsuit need to be filed.
In ERISA claims the deadlines are not flexible, although extensions can be granted where appropriate. More importantly, filing the Appeal on time means that the Insured will have the denial reviewed and a determination reached as soon as possible. As such, it is vitally important that the claimant timely file a thorough Appeal and that the insurance company make a determination within the specified deadlines. Our attorneys have been able to successfully obtain the proof required to timely file our clients’ appeals and push the insurance companies to reasonably, fairly and properly review the Appeal and render a decision with little, if any, delay.