TORONTO — Many COVID-19 long-haulers, patients who contracted or believed they contracted COVID-19 and suffering long-term symptoms, are stuck in an impasse of being too ill to work and denied coverage by their workplace insurers. These patients must also prove to insurance companies that they are indeed disabled, all the while nursing themselves back to health, CTV News reported.
“Fighting this debilitating illness is really only a small part of a much bigger struggle,” said Chantal Renaud, who did not test positive for the virus but believes, based on her enduring symptoms, that she caught it from her husband, David Lackey, who contracted the virus in early 2020, CTV News reported.
Renaud went on short-term disability leave but tried to return to her job upon a slight recovery — only to make things worse. She found that her body was not as strong as her spirit: one time, Renaud returned home from work with increased breathing difficulties and severe exhaustion.
She tried to apply for long-term disability but did not qualify. After the denial, Renaud and her husband decided to sell their property to subsist.
“The fatigue is really a big part of it. It’s debilitating, and I constantly have to pace myself,” Renaud told the news agency.
Like Renaud, countless Canadians who were infected with the illness and felt crippling symptoms find themselves physically unable to work. However, even as companies are empathetic and cooperative with their workers, the insurance companies have been unyielding, employment and disability lawyers said.
“The amount of claims that are being denied are skyrocketing right now,” Daniel Lubin, partner with employment law firm Whitten & Lublin told CTV. “This is a huge, huge problem where people are unable to get appropriate coverage.”
For some patients, their employers have prohibited them from going to work due to safety concerns. However, they are also denied coverage by the insurer while they are in recovery.
According to the Canadian Life and Health Insurance Association (CLHIA), there currently is no data available to forecast the trends related to COVID-19 claims. Coverage is typically assessed with an individual’s condition and their unique job requirements, an association spokesperson told CTV.
An additional difficulty is that policies differ between insurance companies, meaning there is no definitive answer to why claims are being rejected. Every situation is assessed on a case-by-case basis.
Canada Life, an insurance company, also told CTV News that generally speaking, companies with their disability group coverage provide plan members with some form of income replacement for the period they are unable to work. The caveat is that the employee must fulfill the insurance company’s criteria for “disability.”
“Plan members are eligible for disability benefits if they meet the plan’s definition of disability, including where disability is caused by COVID-19 infection,” Diane Bezdikian from Canada Life said to CTV.
Others, like disability lawyer Mark Yazdani of Yazdani Law Office, believe that a patient’s eligibility should not be contingent on their diagnosis, especially because insurers fixate on the physical symptoms of an ailment and fail to account for the cognitive strain of a job. Disability, Yazdani said, is a “grey-area question.”
“Oftentimes, there’s no proof, there’s no objective way of proving one way or another if somebody is disabled or not,” he told CTV News.
Moreover, like the differing policies between insurance companies, the parameters of what constitutes disability also differs between companies. According to lawyers, insurers consult their own team of medical experts to determine coverage eligibility.
However, the evaluation of disability is often a variation of “do you suffer from either an illness or you suffered an accident that has prevented you from carrying out your job duties,” he told CTV.
“If you have the symptoms and they’re severe enough that they prevent you from being able to do your specific job duties, then you should qualify for disability benefits, even if you don’t have a specific diagnosis.”
Yazdani told the news agency that few patients fight in court despite the rising cases of insurance denial cases because it risks both the insurance companies and plaintiffs. Most of the disability cases are either resolved or settled.
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