Navigating Long-Term Disability and Long COVID in Ontario

Though the days of lockdowns, vaccine passports and physical distancing seem to be mostly behind us, the risk of contracting COVID-19 is still great. At the same time, new information about how the disease affects people is coming to light daily. Many studies now confirm that COVID-19 does long term damage to our immune systems not only making it more difficult to fight off other viruses after recovering from an initial COVID infection, but also increasing the likelihood of contracting COVID again— putting everyone at greater risk of experiencing some of the harsher and prolonged symptoms that can occur.

By-and-large, the common symptoms of COVID-19 are expected to resolve themselves within about two weeks, but about 1 in 5 Canadians experience symptoms for a much longer period of time, a condition often referred to as “Long COVID.” A Stats Canada study estimates that somewhere in the realm of 2.1 million Canadians currently live with Long COVID. Living with Long COVID can have a major impact on individuals, causing mental and physical hardship for months or even years.

Though vaccines are improving regularly to meet the shifting demand of the many COVID variants, there are currently no direct healthcare interventions for addressing Long COVID. Should you or someone you know be affected by these longer-term symptoms, it’s important for you to understand how you may be able to access long-term disability benefits for ongoing support.

Understanding Long COVID

There is still a lot to be understood about the causes of Long COVID, and so the definitions of what constitutes the condition vary from country to country. In Canada, Long COVID is considered to occur when any symptoms persist beyond 12 weeks of initial infection. Sometimes people might not even know they had the COVID virus to begin with, or their original symptoms completely subsided, before Long COVID symptoms began to manifest.

The most common of these symptoms in adults are:

• fatigue
• trouble sleeping
• shortness of breath
• general pain and discomfort
• cognitive problems, such as:
  • memory loss
  • difficulty thinking or concentrating
• mental health symptoms, such as:
  • anxiety
  • depression

Overall, scientists have observed a number of neurological, cardiovascular, respiratory and digestive issues among Long COVID patients. Whether these symptoms affect you individually, or one issue in particular arises, Long COVID can have major impacts on one’s work and daily life. Hundreds of thousands of Canadian adults have been unable to return to their normal work or school because of their symptoms.

Long-Term Disability Insurance in Ontario

Long-term disability (LTD) insurance offers protection for income loss in cases where an illness or injury hinders your ability to work. Policy specifics and constraints differ among plans, with certain policies excluding particular illnesses.

Additional considerations to make when evaluating an LTD insurance policy include:

• How the policy defines “disability” and “total disability” concerning coverage eligibility.
• Any waiting periods, indicating the duration between injury occurrence and the initiation of coverage.
• The monthly benefit amount provided.
• The duration for which benefits remain available.
• Your right to appeal if a claim is denied.
• Whether the insurance provider has the authority to reduce benefits during coverage.
• Whether the provider can halt payments at any point during your period of disability.

Take time to carefully assess these factors before finalizing the purchase of an LTD insurance policy.

LTD benefits offer individuals a percentage of their standard income when their illnesses or injuries render them incapable of performing their job responsibilities. Typically, these benefits become accessible after utilizing other available insurance options, such as short-term disability, Canada Pension Plan Disability benefits, and employment insurance (EI).

Long-Term Disability Benefit Eligibility and Long COVID

Under LTD policies, how one qualifies as “disabled” varies depending on the insurer. Because it’s still relatively new and requires far more research and study, Long COVID has a significant impact on one’s ability to meet an insurer’s “total disability” criteria. There are no proven, definitive diagnostic tests, which makes it incredibly difficult for anyone pursuing LTD benefits when they’re living with Long COVID.

Further confounding the issue is the fact that many people who experience Long COVID symptoms experienced other chronic issues prior to their diagnosis.

If your COVID-19 symptoms are lasting beyond 12 weeks, or you begin to show signs of one of the more common expressions of Long COVID, speak to a medical professional. Getting a professional opinion, or opinions, on the matter, along with documenting your symptoms at this stage can play an important role in getting you the disability benefits you deserve.

In Ontario, the assessment process by a provincial health organization will take into account:

• your past medical history.
• the social determinants of your health (i.e. social supports, loss of income).
• physical examination and vitals.
• the date of a positive PCR (polymerase chain reaction) test which will detect the presence of the virus in your system.
• the timing, duration, nature, and severity of your symptoms.
• your vaccination status, including booster doses.

Once you’ve been assessed, do your best to follow through with any recommended treatments, be those medications, therapies, or seeing a specific specialist. At this stage, it’s important that you demonstrate your willingness to address the problem at the root, and documenting your efforts will be a significant help to you when it comes time to make an insurance claim.

Dealing with Denials

Given how murky and misunderstood Long COVID still is, it’s entirely likely that applying for LTD benefits will be met with a denial from your insurance company. Legal representation can aid in this difficult time, helping to shed light on appeals processes, the timelines for submitting a LTD application, as well as advocating on your behalf.

If you or someone you know is suffering from Long COVID, know that there are long-term disability options available. Call Preszler Injury Lawyers for a free consultation. In the face of uncertainty, seeking assistance becomes a proactive step toward securing the support and benefits you rightfully deserve.