ERISA LAW BLOG

Our country is facing a new and very significant disease.  While the implications of it are far reaching, I expect that there will be a vast number of short term and long term disability claims related to Coronavirus (COVID-19).  Since the pandemic has hit the United States, I have been asked many questions about it, but I am just now beginning to see the cases of denied claims begin to come in.  First, if you are out of work for any significant period of time and you have short term and long term disability benefits through your employer or through a private policy (individual disability income or IDI policy), I would encourage you to file a claim.  The first wave of questions that I faced was simply whether or not folks could file a claim. That answer is “Yes, you should file a claim if you are out of work for any medical condition.” 

However, the denied claims that I have begun to see involve individuals who are vulnerable to Coronavirus and to whom the potential contraction of COVID-19 would likely have dire circumstances.  In other words, people of a vulnerable population (individuals over a certain age and/or have pre-existing medical conditions such as heart disease, diabetes, etc.) who are advised by a doctor to not return to work.  So far, I have not seen any denials of individuals who have actually contracted Coronavirus.  I am hopeful that I do not see any of those denials, but you certainly never know.  Instead, the question that I am currently pursuing in several cases is whether an individual who is vulnerable to the disease, is entitled to short term or long term disability benefits.  These cases are brand new so I do not yet have any rulings to indicate how these cases are going to turn out.  The insurance companies seem to be claiming that even if you are at risk of contracting Coronavirus and those risks could be dire, if not fatal, you still are medically able to do your job, despite the danger that it poses.  They are looking at the question of do you have any physical restrictions which make you unable to do your job.  I believe that they are asking the wrong question in determining those disability claims and, instead, should be asking, “Is there a medical reason which makes you unable to return to your job?”  I believe that the answer to this is clearly “yes.”  I would equate it to a case where an individual has a heart attack and they are told not to return to their job because either the physical demands or the stress of that job would likely cause another heart attack, potentially killing them.  Is that person physically capable of returning to their job?  Sometimes the answer is “yes.”  However, if that individual was to return to that job and perform it, it could kill them.  Because of this, they have a medical condition which prevents them from returning to work.  I believe that susceptible populations face the same situation with Coronavirus.  I will continue to update this Blog as I have more case results come in. 

I am anticipating a third wave of cases.  I have not yet faced this situation, but I suspect that I will see them within the next year.  I believe that I will begin to see cases of medical workers or other essential workers filing disability claims for post traumatic stress disorder and anxiety disorders.  I believe that COVID-19 has put such a strain on our healthcare workers and medical providers and other essential workers, that once this is all completed many of them may have difficulties continuing their work.  If you are facing a denied short term or long term disability claim, or any denied insurance claim related to Coronavirus or COVID-19, please do not hesitate to contact me.  I would be happy to help if you are faced with such a terrible situation.  I look forward to helping you.  Nathaniel W. Bax, Foster Law Firm, LLC.