Insurers need to be more accepting of alternative care for long-COVID | Courtney Mulqueen

By Courtney Mulqueen

Law360 Canada (September 22, 2023, 9:40 AM EDT) --
Courtney Mulqueen
Courtney Mulqueen
Clinical trials to test the safety and effectiveness of potential long-COVID treatments have the added bonus of discovering treatments for other “invisible illnesses” with similar symptoms.

However, with no immediate relief in sight for COVID long-haulers or those suffering from other illnesses that are difficult to diagnose and treat, insurance providers need to be more accepting of alternative care.

The National Institutes of Health in the United States recently announced clinical trials for treating long-COVID that will focus on: reducing viral persistence and excessive sleepiness and sleep disturbances; alleviating brain fog, memory loss and other cognitive problems; and treating autonomic nervous system problems, which include heart rate, breathing and the digestive system.

These trials cannot come soon enough. There may also be the positive ripple effect of finding treatments for the same symptoms related to other conditions that are either undiagnosed or are due to immunological conditions including chronic pain and chronic fatigue and other diseases.

Long-term disability (LTD) claimants, regardless of diagnosis, could eventually have appropriate treatment options available to them as a direct result of the research that is being done to treat symptoms of long-COVID. That will not only help in their recovery but also allow them to prove their entitlement to disability benefits.

There is no established definition of long-COVID. Researchers say it presents a problem for both patients and clinicians because more than 200 symptoms can occur. A person typically suffers an average of 60 symptoms in nine different organ systems over nine or more months before recovering, according to a study published in The Lancet.

Research suggests that even those who tested negative for COVID-19 can develop long-COVID.

Long-haulers may feel fine one day and then be unable to get out of bed weeks later. They can also suffer a lower quality of life than those with serious and even life-threatening medical conditions such as Parkinson’s disease or late-stage cancer, studies indicate.

So much is unknown, making it daunting for long-haulers to claim the insurance benefits they need and deserve. Researchers estimate 10 per cent of those infected with the virus suffer from long-COVID. However, many are not going to doctors because they have given up hope, studies show.

I have witnessed an increasing number of inquiries about long-haul LTD claims in the past year. These claims can be difficult to prove because they are based on self-reported symptoms that may not stem from a confirmed diagnosis.

For those with long-COVID, even a diagnosis might not be sufficient to persuade an insurance company of the severity of the impairment because insurers struggle with invisible conditions where it is self-reported.

I often find that when these claims are denied, insurers are not giving the person the benefit of the doubt. There is a concern that these people may be exaggerating or malingering when in fact they are legitimately struggling.

One problem with making a claim is trying to determine what is at the root of the ailment. People may not know why they are suddenly fatigued or why they have strange new symptoms. They may not even associate what they are experiencing with COVID. And because there are so many possible symptoms, it makes it difficult for doctors to definitively say it is long-COVID.

Another hurdle faced by long-haulers is that insurance companies commonly use a redemption arc to assess recovery that may apply to most injuries or illnesses but not all.

The arc is very objective. An insurer will look at the condition to determine the treatment and the expectation for recovery. Unfortunately, long-COVID conditions do not fit neatly within those timelines or within those acceptable or appropriate treatment lists.

Insurers often want to see that the person is receiving appropriate treatment. But with long-COVID, it can be difficult to demonstrate what is appropriate.

Some disability policies insist the claimant undergo traditional medical treatment. However, many experiencing lingering symptoms that are long-COVID related have tried everything with no relief. They may try alternative types of medicine or therapies that they find helpful. It is not necessarily a cure, but enough that it helps them feel better. However, many insurance companies don’t seem to like that. They prefer to see some traditional medicine, which often doesn’t work.

It is not unusual for claims to be terminated or denied because someone opted for alternative therapy when traditional treatment failed to provide relief. However, with long-COVID treatment still in the infancy phase, insurers need to provide people with the financial help they need now, even it means considering those non-traditional approaches.

Many long-haulers are doing everything possible to alleviate their pain. It shows that they are motivated. Often, they are paying thousands of dollars for these non-traditional, alternative medication treatments out of their own pocket. They would not be doing that if it did not help. I am hopeful these attempts will lend credibility to their LTD claims.

The sooner effective treatments become available and accepted by the medical community the clearer the insurance picture will become. People will be then able to prove not only that they suffer from a legitimate disabling condition but also that they are receiving the appropriate treatment required to be eligible for LTD and other disability income benefits.

Courtney Mulqueen, of Mulqueen Disability Law, has over 20 years experience litigating disability claims. Her focus and passion is representing disabled plaintiffs who suffer with complex “invisible conditions” like mental health and chronic conditions that are difficult to prove, diagnose and treat.

The opinions expressed are those of the author and do not reflect the views of the author’s firm, its clients, Law360 Canada, LexisNexis Canada, or any of its or their respective affiliates. This article is for general information purposes and is not intended to be and should not be taken as legal advice.

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