Link Between COVID and Increase in Insurance Denials

Individuals purchase disability insurance, with the protection for peace of mind and sanity.  They hope that they will never have to use it.  Unfortunately, every day, hundreds of individuals find themselves unable to work due to an illness, sickness, or accident and in need of the disability insurance benefits promised by the insurance company.  

Of course, like it has every other aspect of our lives, the COVID-19 pandemic has upended disability insurance claims.  While the majority of people who test positive for COVID-19 are able to return to work shortly after their symptoms subside, for an unfortunate few – known as “long-haulers” – the symptoms associated with a positive COVID test persist for months.  Many of these symptoms, which can include devastating fatigue, cognitive problems, shortness of breath, joint pain, headaches, chest pain, and cough, are so debilitating that the person cannot return to work.

Unfortunately, these symptoms are all subjective in nature, and insurance companies tend to disbelieve insureds who claim that their disability is caused by subjective symptoms.  Insurers generally understand that someone who is diagnosed with cancer will be unable to work while undergoing chemotherapy, or someone who is on dialysis cannot hold down a full-time job.  However, when an insured tells an insurance company disability claims handler that they are fatigued, have “brain fog” or that lingering pain prevents a return to work, their claims tend to be questioned and often denied.  

Further, given how new COVID “long-haul” claims are to the insurance companies, it is expected that they will be viewed very skeptically and denied for the reasons that insurers deny most claims, because of an alleged lack of objective evidence to support the claim.  

Of course, disability insurers will rarely expressly state they are denying a claim because the insured’s subjective symptoms are not supported by objective evidence.  Instead, they will attempt to minimize the insured’s subjective complaints and assert that the medical records do not support the insured’s claim for benefits.  

When insurance companies deny the claims of obviously sick and disabled individuals, the insureds will need the assistance of experienced long-term disability insurance attorneys, like those at Donahue & Horrow.  Michael Horrow and his team of attorneys have helped hundreds of insureds collect benefits that the insurance companies did not want to pay.  

Recently, the firm secured a settlement of over $1.2 million dollars for a physician whose claim for partial disability benefits (also known as residual disability benefits) was improperly denied.  Our client was determined to continue working, despite the fact that a series of accidents left him with near-constant neck pain and back pain.  Indeed, the pain was such that he would constantly need to ice his neck and back throughout the workday.  Under the terms of his individual disability policy, he was entitled to disability benefits, even though he continued working because he was working fewer hours than before with a corresponding reduction in income.  

After the insurance company obtained our client’s medical records, which supported his claim for disability benefits, the insurer required that he appear for a so-called “independent” medical examination with a doctor that they chose and paid for.  Not surprisingly, that physician issued a report stating that our client could return to work full-time.  

During litigation, Donahue & Horrow was able to neutralize that paid physician’s opinion through deposition testimony and an updated medical examination.  Additionally, Donahue & Horrow demonstrated that the insurance company failed to conduct a financial analysis and comparison of the insured’s pre-and post-disability earnings, which was absolutely necessary to conduct a proper examination of his claim for residual disability benefits.  Donahue & Horrow also secured multiple expert witnesses who confirmed that the insurance company’s decision was not only incorrect but in bad faith.

Ultimately, rather than let a judge and jury decide whether the insurer’s claim decision was proper, the insurance company paid our client a large settlement to end the litigation.

Donahue & Horrow has the experience necessary to help insureds collect the money that they are owed by the insurance companies.  Even if the insured’s disabling symptoms are subjective in nature, like those of COVID long haulers.  If any of your clients are having a problem collecting the disability insurance they are owed, we are happy to talk to them, free of charge.