COVID-19 Update: Impact on Long Term Disability/ERISA Claims

How Does COVID Impact Disability Claims= The Big Picture

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Disability insurance should cover individual claims for loss of income due to contracting COVID-19 and its after effects on medical health.  What about our medical providers who were exposed to the horrors of the illness in hospital settings for example, and develop mental health impairments.  Are they required to continue working, suffering in silence?  No. ,Disability insurance policies provide for coverage for conditions of mental health, but unfortunately, many policies, especially group policies limit the duration of these claims to 24 months. The Parity Health Parity and Addition Equity Act enacted in 2008 bars health insurers from offering different benefits for the treatment of chronic physical conditions and mental health conditions. This act does not apply to disability claims. It is a travesty that  disability insurers can limit their benefits based on the type of illness, whether related to mental health or physical health.  Millions of Americans are struck with symptoms of anxiety, panic, depression, and turn to their disability policies only to learn that their illness is limited in coverage.  With the increase of these claims as related to COVID-19, the insurers will tighten their purse strings, and try their best to limit their financial exposure and continue to discriminate against those with psychiatric conditions.  This is a disheartening failure of our congress and the judicial system.

Even with the safety equipment provided by employers, must all employees return to the workplace?  Would disability cover the class of workers who are at high risk of contracting the COVID? Individuals with conditions that place them in a risk of severe medical illness from COVID may qualify for disability insurance since they need to remain sequestered until the risk of the virus passes.  The Centers for Disease Control and Prevention have identified certain conditions that warrant such restrictions, such as severe asthma, lung conditions, heart disease, people who are immuno-compromised, and several others.  These claims have not been litigated yet, and you can be sure that the disability insurance companies are deep in discussions on how to limit these claims.  There is some precedential decisions in this area of the law, mostly related to individuals with a high risk of severe medical complications such as a person with severe cardiac disease who risks heart damage including a heart attack, if exposed to high work stress.

Medical practitioners will be facing new challenges as their patients seek their support for seeking disability benefits.   What patients will be eligible to continued disability benefits because their medical health does not warrant them returning to the workforce?  We have helped many offices address this issue, and come up with a viable strategy when facing their dual roles as treating physician supporting and as a specialist advocate for their patient remaining out of the workforce.

Medical personnel who are treating the sick, have significantly increased risks of exposure to someone who has COVID-19 and if their underlying condition warrants extra precautions, they deserve protection and may be able to make a viable claim for disability benefits.

There is a large category of doctors who are paid partial disability benefits due to their inability to work full time or to perform some of the material duties of their occupation.  These claims are paid on a monthly basis depending on the amount of income earned by the doctor each month.  A doctor whose monthly income has been reduced because his/her office is closed, or opens on a reduced basis, will suffer a much higher income loss.  Will the insurer pay this claim or counter a defense alleging the closure of the office or reduction in hours is due to a “legal” cause, not a medical cause?

Our firm specializes in handling disability claims continues to represent individuals seeking coverage for their illnesses and fighting for the rights of those denied their legitimate claims.  See www.disabilitycounsel.com

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