Since COVID-19 first appeared in the United States in early 2020, the disability insurance industry has had to make several adjustments, including accounting for a rise in the number of complex claims and the move to remote work in support of “safer from home” policies. What started as a burst of short-term disability (STD) claims with a COVID-19 diagnosis gradually leveled out with some claims transitioning to long-term disability (LTD) or death benefits and some claims closing as claimants recuperated. Despite the drop in the initial and subsequent surges of cases, COVID-19 and the emergence of post-COVID conditions – or long-haul COVID – have disrupted the industry unlike anything before.
As much as COVID-19 has impacted the industry thus far, we do expect that it will be here to stay, at least for the time being. As we continue to listen to experts, we remain hopeful that the transition from a pandemic to an endemic state is in our future. Claims continue to come in with some form of COVID-19 diagnosis at a steady pace, and as the number of milder cases increases, this transition becomes more of a reality. While we must continue to monitor acute COVID-19 claims, we cannot ignore the increasingly more difficult to manage long-haul COVID claims.
Preparing ourselves for the unexpected – or recognizing that we may never be as fully prepared as we would like – has provided the space for self-reflection on how our industry, alongside the Social Security Administration (SSA), has reacted to the challenges COVID-19 has presented. We share our thoughts of reflection as well as our insights regarding what we expect the impact long-haul COVID will have on the industry as we continue to navigate this season.
The importance of filing a claim at the right time
Research shows that most diagnoses of COVID-19 have a recovery time between two to six weeks, even for the most severe cases. An STD claim with a COVID-19 diagnosis may even be considered a “simple” claim that will generally resolve itself within the expected timeframe of about thirty to forty-five days. These STD benefits can provide important financial stability for individuals unable to work because of a COVID-19 diagnosis. But what about longer-term benefits?
Depending on the policy, STD benefits typically last three to six months. From there, claimants may have options, particularly if they remain unable to work and experience long-haul COVID symptoms. Options may include:
- Transitioning to LTD benefits,
- Filing for Social Security Disability Insurance (SSDI) benefits,
- Participating in vocational rehabilitation,
- Utilizing physical, occupational, or speech therapies; or
- Returning to work, if able.
To qualify for longer-term benefits, claimants must prove the existence of ongoing limitations caused by their condition. For claimants transitioning to LTD benefits, a qualification period of up to six-month is typical and may even be covered by previous STD benefits. In contrast, to qualify for SSDI benefits, claimants must prove they have a condition that will last at least twelve months or end in death. Given the uncertainty surrounding long-haul COVID, it is impossible to determine how long symptoms are expected to last. While the unpredictability of duration and ongoing severity in long-haul COVID cases may not hinder an initial LTD approval, the same cannot be said for an SSDI application. This then brings us to the question, “When is the right time to file for SSDI benefits with a COVID-19 and/or long-haul COVID diagnosis?”
SSDI applicants may file for benefits and make a return-to-work attempt if their condition improves throughout the application process. They can even withdraw the application if the work attempt is successful. Applicants must be cautious, however, as Social Security guidelines may prevent the withdrawal of multiple applications, particularly within a twelve-month period. What may have been the typical timeframe for transitioning from STD benefits to filing for longer-term support through SSDI may not always be the best course of action for a COVID claim. Adjudicators and examiners may consider allowing additional time to monitor the severity and duration of the illness to ensure Social Security’s stringent guidelines are met. Failure to adhere may result in a baseless denial or revocation of a premature approval. This should be to considered when moving claims forward, particularly if policy requirements state the claimant must file for other possible benefits.
The Social Security Administration and COVID-19
SSA has not released any specific data confirming the number of SSDI and Supplemental Security Income (SSI) applications with a COVID-19 diagnosis they have received. With the prevalence of transmission, especially among the most physically and mentally vulnerable, it is fair to assume that many cases will list a supplementary diagnosis of COVID-19 if it is not the primary condition. In July 2021, long-haul COVID was added as a disabling condition under the Americans with Disabilities Act (ADA), with additional guidance provided by the U.S. Equal Employment Opportunity Commission in December 2021. Despite being afforded the protection of being added to the ADA, the only COVID-19 SSDI and SSI claim adjudication guidance provided to SSA employees occurred through an Emergency Message, last updated over one year ago, in April 2021.
Neither COVID-19 nor long-haul COVID fall under any of Social Security’s Blue Book Listing of Impairments, which are conditions considered severe enough to prevent substantially gainful work activity. If a condition – or combination of conditions – does not meet a listing, the associated claim moves to the remaining two steps of the sequential evaluation process SSA uses to adjudicate SSDI claims. In doing so, the burden of proof increases for both the applicant and Social Security. At these steps, where most claim decisions are rendered, SSA considers an applicant’s residual functional capacity, age, education, and work experience to see what work can be performed, if any. When assessing the transferability of skills attained through prior work activity, SSA considers the last fifteen years of the applicant’s employment history. These steps require a significant amount of additional information to support the claim and secure an approval. This information must be gathered by the applicant, reviewed by the disability examiner, and processed by the claim adjudicator – steps that only add to the steadily increasing backlog of pending SSDI claims.
The difficulty of obtaining a long-haul diagnosis
Chronic conditions can prove difficult to diagnose and subsequently approve benefits for; long-haul COVID is no exception. While individuals can obtain a definite test result for an initial COVID-19 infection, there is no diagnostic test for long-haul COVID and there is no universally accepted definition of the condition either.
Individuals who have tested positive for COVID-19 can continue to do so for several months after symptoms subside. However, continuing to test positive does not necessarily mean an individual has long-haul COVID. For those who may be experiencing long-haul COVID, symptoms range from physical to mental and can include:
- Heart palpitations,
- Brain fog,
- Damage to vital organs, including the heart, lungs, and kidneys; and
- Damage to the circulatory and neurological systems.
Many long-haul symptoms mimic other diseases or conditions, so a diagnosis is often obtained through a process of elimination. As symptoms may expand across different parts of the body, treatment may be sought from various specialists, and if there is a lack of coordination between the physicians, it may be difficult to obtain the correct diagnosis. Even without the proper diagnosis, a claim may still be approved, but an incorrect diagnosis may lead to incorrect categorization of the claim, or a denial may be issued if there is no clear medically substantiated condition.
Where does this leave the disability insurance industry?
According to a study done by FAIR Health, a majority of those diagnosed with long-haul COVID were not hospitalized during their bought of acute COVID-19. The existence of co-morbid conditions accompanying the acute COVID-19 diagnosis is most likely to lead to long-haul COVID. As additional research becomes available and questions are answered, one thing is certain: we are not out of the woods as it pertains to COVID-19 – acute or long-haul.
The industry should once again be prepared for shifting dynamics as “long-haulers” continue to file claims and navigate their health complexities. It is up to us as industry professionals to provide the support and tools needed for a claim to be successful, with success being measured differently in each case. We anticipate the potential for additional courses of action from the federal government as it pertains to benefits, particularly in light of protections granted under the ADA. Most support thus far has come through reactive measures, and we expect additional guidance to be issued as proactive support for policy and guidelines that are developed to handle COVID-19 for the foreseeable future. Any changes or announcements of adjudication support may very well impact decisions on your claims, so it is important to be aware of and understand any measures put into place, particularly as the average claim level increase in complexity.
The increase in the number and severity of complex claims may very well be one of the longest-lasting effects of the COVID-19 pandemic. We have already seen a fair number of instances where acute or long-haul COVID had a slight impact on a claimant’s ability to work, but the impact of the subsequently developed complex conditions was far greater. It is these conditions, such as mental, behavioral, and neurocognitive conditions, in addition to chronic pain disorders and lingering respiratory illnesses, that will continue to drive case numbers. We expect that these cases may be difficult to manage, particularly as the levels of complexity vary.
To our current partners, as well as prospective new customers – we are prepared for the opportunity to customize solutions that meet your unique needs. We will continue to follow changes closely, provide updates accordingly, and work to develop and implement strategies to support your business.
National Institutes of Health
Nothing in this post is intended as advice or a suggestion to elect or not elect to claim benefits of any kind, including Social Security benefits, nor is it intended as financial advice in any way. The decision to claim benefits is a personal one that is contingent upon each individual’s unique circumstances. Nothing herein is considered medical advice, diagnosis or treatment.