Disability Claims Resulting from Exposure to COVID-19 Coronavirus and Other Environmental Threats

The category of disability claims described as “environmental exposure” are not the same as disabilities that result from exposure to toxins in the workplace. This includes disabilities that result from being physically present in a work location. COVID-19 presents many different situations of environmental exposure risks that can lead to a disability. Here are a few scenarios:

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Individuals with underlying conditions at a high risk of complications from COVID-19 may determine that the risk of returning to the workplace is too great. Treating physicians will likely advise patients not to return to the workplace. Disability insurance companies are likely to push back against these claims; we anticipate that the corporate line will be that the person has chosen not to work and therefore has violated the terms of their disability policy, despite their doctor’s recommendation.

COVID-19-Related PTSD – Hundreds of thousands of healthcare workers in hospitals, EMTs, nursing homes and related services have experienced conditions that can best be described as combat zones. The mental stress is a just beginning to be reflected in disability claims. How will these claims be treated, and how well supported will claimants prepare their claims are important issues that will be significant.

Addiction Exacerbated by Environmental Exposure – Addictions to pharmaceutical medications are a risk for healthcare professionals. Frankel & Newfield has represented physicians who were able to get their addictions under control, but found that being in their workplace – hospitals, clinics, medical practices – make it next to impossible to manage their addiction.

It should be noted that the number of prescriptions for anti-anxiety and antidepression medications have surged with the pandemic. A recent article in The Wall Street Journal reported that prescriptions for these medications increased dramatically in March and April. The combined stresses that the coronavirus has created, including general fear, uncertainty, unemployment, and social isolation are having a significant impact on American’s well-being. Doctors are concerned that the use of medication may lead to addictions that remain after the pandemic has ended.

Representative Case of Environmental Exposure Disability Claims

A dentist suffers from severe bronchial asthma, and her treating physician establishes that her disability is a result of long-standing exposure to respiratory irritants in the workplace, notably formaldehyde and common dental specific irritants (grinding silica, ceramic and porcelain crowns, acrylic and amalgam). She had scarring on a pulmonary CAT scan as well as poor results from Methacholine inhalation tests and pulmonary function tests. The disability insurance company did not argue against the fact that when she was treated with high-dose steroids, she did receive short-term, incomplete relief. But the insurer’s paper medical reviews failed to take into account the simple fact that when she was not treating patients, the doctor was asymptomatic. Frankel & Newfield overturned the claim determination and our client is receiving her benefits on a monthly basis – satisfying the proof of loss for her environmental disability.

FAQs

Dental offices have had to change how they practice dentistry. Patient management now involves limiting the number of patients in the office, the use of thermometers before patients are permitted into the office, investing in personal protective equipment (PPE), cleaning products, masks, face shields, and plexiglass shields in reception areas and in clinics, if patients are seen in a large open space.

Even with all the right precautions, it is still possible that the dentist may be exposed to COVID-19. Dentists with underlying conditions must be extremely cautious. Some may decide to file a disability claim for their underlying issue, rather than put their life at risk.

Will Nurses Disability Claims From Covid-19 Be Paid?

The risk that nurses face every time they go to work has never been recognized more than during the current coronavirus pandemic. Shortages of personal protective equipment and hospitals that were unprepared and overwhelmed by the number of cases left many nurses exposed and at risk in the workplace.

The question of how or if nurses’ disability claims resulting from coronavirus is not yet known, as the claims are so new. One of the tactics we believe the disability insurance companies will attempt will be to claim that the illness is the result of an injury suffered at work and try to pass the claim off as a Workers Compensation claim.

Workers Compensation coverage is for medical costs, lost wages and ongoing care costs. But if the nurse has paid for disability insurance policy, they should be eligible for monthly benefits from their disability insurance policy also. However, even if eligible, there may be an offset (reduction) of the benefits paid due to the payment of Workers Compensation benefits.

Will Nurses Disability Insurance Claims be Limited?

Another tactic that we expect nurses to see when they file disability claims will be requests for extensive medical records. The nature of nursing to be exposed to illness and stressful situations will lead the disability insurance company to look for any hint of a mental/nervous condition in an attempt to limit the company’s exposure to a 24 month limited payment period. Many group policies obtained through work contain such limitations.

“Own occupation” is another provision that nurses must be watchful for when filing a disability claim. Many disability policies have an “own occupation” provision that is limited to a set number of months. After that, they convert to an “any occupation” policy. The disability insurance company may terminate the claim after a number of months, stating that the nurse can work in another capacity, either as a nurse in a less stressful environment or in a private practice, where compensation is considerably lower.

Can I file for long-term disability because I am immune-compromised and work in a high risk environment?

A person whose immune system is compromised, whether because of medical treatment or illness, is eligible to file for short or long-term disability. The same environment that may have been acceptable to immune-compromised people before COVID-19 could be life-threatening today. This include front line workers and anyone who worked or had to travel in crowded conditions where potential airborne spread could occur.

In the experience of the attorneys at Frankel & Newfield, the disability insurance companies will likely attempt to deny claims based on the theory that a person who was able to work before COVID-19 in a particular environment is still capable of performing the material tasks and duties of their occupation. The coronavirus pandemic is still relatively new and disability insurance companies are working through their policies and tactics. The best recommendation is to work with an experienced disability insurance attorney to strategically prepare a claim in advance, anticipating delays, denials and eventual terminations.

What if I can still perform the tasks of my job, but my life is at risk by being in a front line position?

You need an attorney whose practice focuses on disability insurance. Many workers are finding that despite the good will and intentions of their employer, the disability insurance companies are not providing any flexibility in their claim coverage requirements. Someone who is on short-term disability because of an illness and was unable to return to work because their risk factor is too high may not be deemed eligible for disability benefits.

The issue may hinge on the support of the treating physician, and whether they would prevent or restrict the claimant from their work as part of their treatment. We have represented many individuals who were suffering from post- illness disabilities where environmental exposure posed a significant risk to their well-being. The coronavirus is new, but the scenario is not. Some employers may consider an at-risk person to have made a decision not to work, and denied their short or long-term disability claim. The insurance company may point to a provision that defines the difference between not working because of a disability and not working because of a threat in the immediate work environment.

Jason A. Newfield

Written By:

Jason A. Newfield

Disability Insurance Attorney