COVID-19 and Disability Claims

COVID-19 has disrupted the lives of millions of Canadians, and will continue to do so. Virtually every industry has been affected. The physical and mental consequences of the virus are expected to result in more short term disability (STD) and long term disability (LTD) claims. Fortunately, most of those infected will experience only mild symptoms, and should be able to return to work after a relatively short recovery. For others, the symptoms of this novel virus will be long lasting. If a return to work is not possible, STD and/or LTD may provide much needed financial relief.

What is COVID-19?

COVID-19 is one of several known strains of coronavirus. Most strains of coronavirus cause only minor symptoms, similar to the common cold. Two other strains, SARS and MERS, can cause serious and life-threatening symptoms. COVID-19 is a third potentially deadly strain of coronavirus. It often causes little to no symptoms, but in severe cases may cause difficulty breathing, pneumonia, and in severe cases death. The elderly and those with underlying medical conditions are particularly vulnerable.

COVID-19 and Short Term Disability

Some employers provide their employees with short term disability benefits to supplement wage losses for a limited number of weeks or months in the event of illness or injury. Most plans provide up to six months of coverage. These STD plans are often administered by an external insurance company, such as Manulife or Sun Life. When a person qualifies for short term disability benefits, they may be paid directly by the employer or by the insurer who administers the plan, depending on the wording of the contract.

Generally an individual must establish total disability to qualify. Total disability is not as onerous a test as it sounds. So long as you are unable to perform the essential tasks of the important duties of your job, due to a physical or mental illness, you should qualify. Most COVID-19 symptoms are mild, and would generally not result in total disability. Imposed quarantine or self isolation may preclude working for a short time, but would probably not be considered a disability. Some cases, however, present with severe symptoms. In those cases, short term disability benefits should be paid until the infected person is able to resume their employment duties, or in the case of prolonged disability, until eligible for LTD.

COVID-19 and Long Term Disability

Employees may also have long term disability coverage through a group plan provided by their employer. Some people, often professionals and the self-employed, have an individual LTD policy. Whether a group or individual plan, these policies generally only pay benefits if the underlying disability persists for a prolonged period. Again, the test of total disability is not as difficult to meet as it sounds.

Most people who become infected with COVID-19 will present with mild symptoms and would generally not be considered disabled as defined in the LTD policy. However, we know that some people will have long term health issues as a result of the infection. Long term disability claims due to COVID-19 may arise in a number of scenarios, including:

Where severe symptoms result in long lasting physical impairments that preclude a return to work;

Moderate to severe cases that result in a complete physical recovery, but psychological symptoms such as depression, anxiety, or post-traumatic stress disorder persist long after the physical recovery; and

An adverse psychological response to seeing family members suffer severe symptoms or death.

In addition, there may be STD and LTD claims that are indirectly related to COVID-19. While most would agree that social distancing, self isolation, and self quarantine are important tools in the fight against this deadly virus, requiring millions of people to stay home, thereby limiting their social interactions, is likely to have a negative impact on mental health. This is a particular concern for those who are already suffering from mental illness, such as depression or anxiety. A large number of Canadians are able to work despite mental illness, but are vulnerable. How many of those already struggling will experience a worsening of symptoms due to increased insolation? For some, deterioration of an underlying condition will result in an inability to return to work.

How Do I Make a Claim?

If you are unable to return to work due to COVID-19, or for any other reason, you must first find out whether you have STD or LTD coverage. Second, you must obtain the appropriate forms from your employer or the insurance company. Your employer may already be overwhelmed responding to other aspects of COVID-19, but it is your right to enquire about short and long term disability benefits. Lastly, these forms should be completed and submitted to the insurance company or other administrator as soon as possible.

How Will Insurance Companies Respond?

We are still in the early days of the outbreak, and it is too soon to predict how short and long term disability insurers will respond to a potential surge in claims.

It is anticipated many STD claims will be approved when there is a confirmed diagnosis and evidence of severe physical impairments. It is also expected, however, that a large number of claims, especially those that include a mental health component, will be denied. Such denials are often weak, and should be challenged with the assistance of a long term disability lawyer.

What If My Claim is Denied?

Short and long term disability claims are complex. There are many legal pitfalls. It may be tempting to appeal, but it is important to consult with a long term disability lawyer first. Michael Jordan is a long term disability lawyer with offices in Toronto, London, and Ottawa serving all of Ontario. Michael offers fast, free, no obligation legal advice.

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