Courtesy: Mike Yada
Mike Yada remembers the day in August 2020 when it became clear that his unusual symptoms, which appeared after a mild case of Covid-19 earlier this year, were worsening.
“I went for a quick hike, but it was so windy at the end that I couldn’t get back in the car,” Yada said. He had to call an Uber to travel the 1 mile (1.6 km) to get back to his parked car.
That was the beginning of what 48-year-old Yada calls “the symptoms of madness.” He experienced severe fatigue that made him bedridden, unable to sit upright for more than 5 or 10 seconds, and his vision blurred to the point that he could not read. It was difficult for him to walk, and he could not drive a car.
He was suffering from “long Covid”. It’s a post-infection condition with a series of symptoms that are confusing at best and debilitating at worst. More than two years later and many doctor visits, he is still battling these symptoms.
Yada, who worked in the technology field, faced another battle. Maintaining income replacement through disability insurance and providing benefits through his former employer.
He recently won an appeal to restore those benefits after the insurance company abruptly ended them, but he’s not sure it will last.
Many workers get disability insurance through their employer
According to the Bureau of Labor Statistics, an estimated 43% of private industrial workers have access to short-term disability insurance through their employer. According to Alex Henry, national practice leader at insurance company Willis Towers Watson, he can usually cover 60% to 100% of an employee’s income for three to six months. increase.
Long-term disability insurance, intended to start when needed after short-term disability benefits have run out, is available to 35% of workers. Usually pay her 50% to 70% of the worker’s income. Specifically, often up to retirement age.
Refusal is common in long-term Covid patients
However, approval is not guaranteed. Experts say denial is common for people who have struggled with the novel coronavirus for a long time.
“There are many claims for both short-term and long-term disability insurance that are not approved, especially for subjective conditions,” Henry said. … There is no clear denial, but they seek objective medical care. [proof] of disability. ”
While most people will recover from Covid without complications, up to 30% of Americans will develop prolonged Covid symptoms, affecting as many as 23 million people, according to the U.S. Department of Health and Human Services. Symptoms often appear after the original Covid infection has cleared and commonly include fatigue and brain fog (inability to think clearly), both of which can be difficult to measure.
“What I see broadly is cognitive impairment and chronic fatigue,” says Andrew Wyrum, attorney and Pandemic Patients Representative, a nonprofit advocacy group that helps Covid patients get the support and services they need. said.
“These symptoms not only cause disability, but also make it difficult to apply for benefits and navigate stressful situations,” Wylam said.
Based in California, Mr. Yada spent 10 years as a senior technical architect at a biotech company where he had access to short-term and long-term disability insurance.
In August 2020, when his symptoms were debilitating, Yada filed a claim for short-term disability insurance benefits, first through the state of California and then through his company, which was approved. (California is one of the few states with short-term disability funds that workers can tap into, and insurance companies expect workers to do so.)
But when he filed a long-term disability claim in early 2021, it was denied, hoping it would start when his short-term benefits ran out.
Since I had no income, I tried to get a part-time job instead, but my employer allowed it.
It didn’t work. After struggling for 10 weeks, he filed another short-term disability claim when it became clear that he had not recovered.
“My employer was preparing to report that I was underperforming,” Yada said. “It never happened.”
Towards the end of 2021, five doctors agreed his condition was a disability, and he again filed a long-term disability claim. Approved.
Authorization can be revoked
But a few months ago, in August, Yada received a letter from his insurance company stating that his benefits were immediately terminated due to lack of “objective evidence” of disability.
This was despite his claims, including results from the “tilted table test,” which showed that blood flow to the brain decreased by 33% when he stood upright. From the flat position to the upright position, Yada’s results help explain why he can’t sit at a desk and think straight, he said. rice field.
“You can’t tell me that [33%] Decreased blood flow is not a problem,” Yada said.
he appealed the decision.
What Happens When a Dismissal of a Claim Is Appealed
Long-term disability insurance is subject to federal law known as ERISA (Employee Retirement Income Security Act). This means that if your claim is dismissed, your only immediate recourse is to appeal to see if the decision is reversed.
“You can’t file a lawsuit if you don’t completely exhaust the administrative appeals on the insurance plan,” Wylam said.
If your claim is denied, you usually have 180 days to appeal the denial. Plans generally require him to review the appeal within 45 days of receiving it.
If the appeal is not upheld, litigation to protect the interests is an option. In fact, there have been cases across the country involving the denial of long-term disability benefits due to the prolonged novel coronavirus.
“Federal court litigation is time-consuming and costly, so typically these claims are ultimately resolved,” said Mark Boyko, a partner at Baillie Glasser and an expert in ERISA cases. The amount awarded in the settlement is confidential, he said.
On the other hand, if the outcome of the appeal is reversed, the benefits are usually backdated to the point at which they should have started.
That’s what happened to Yada: He recently received a letter saying that the appeal of the refusal was reversed and the profits were backdated to August.
Social Security Disability Benefits May Work
But Yada was also asked earlier this year by his insurer to apply for Social Security Disability Insurance, commonly referred to as SSDI.
This requirement is typical of Willis Towers Watson, said Henry. “When SSDI is awarded, it usually offsets long-term disability benefits,” he said.
For example, if your workplace disability benefit is $3,000 per month and your SSDI provides $2,000 per month, your employer-based benefit will be reduced to $1,000.
That means you get $3,000, but the government pays part of it instead of the insurance company paying all of it.
Mr. Yada does not know whether his SSDI application will be approved. This process is notoriously slow and rejection is common.
Meanwhile, he also lost his employer-provided health insurance because he was unemployed when his insurance company ended his benefits in August. I did, but I am responsible for paying the premium in full instead of having my employer tip in. He pays about $800 a month.
He is also concerned that the insurance company paying his benefits will suddenly end the benefits again at some point.
“I’m not sure,” Yada said. “They could write to me at any time and say it would end tomorrow.”