[Updated May 5, 2020]
COVID-19 has created significant uncertainty surrounding group short and long term disability insurance benefits. Get answers about from NYC's top long term disability attorneys below.
Long Term Disability Insurance Coverage Amid COVID-19
Will my group long term disability coverage continue if my work hours are reduced, I am placed on unpaid leave, or I am furloughed?
It's possible. Here are some questions to ask yourself to see whether you’re still covered by your long term disability coverage if your hours are reduced, you’re placed on unpaid leave, or you’re furloughed:
- Are you still an active employee? Normally, your disability coverage would end when you are no longer an “active employee.” Generally, an “active employee” is defined as an employee being paid to perform the duties of his or her occupation for the minimum number of hours specified in the disability plan (e.g., 30 hours per week). Thus, you generally would not have coverage if your hours are substantially reduced, you are on unpaid leave, or you have been furloughed because you are not an "active employee."
- Does your disability benefit plan contain exceptions to extend your coverage? Even if your benefit plan has an "active employee" requirement, it may include narrow exceptions to potentially extend your coverage. For example, if you are on a temporary “leave of absence,” but the premium is still paid, your benefit plan may provide coverage through the end of the month immediately following the month in which the leave began. Under this exception, you’d need to press that the furlough falls within the scope of a temporary leave.
- Is your insurer instituting internal exceptions to extend coverage not written into the plan? In the wake of COVID-19, some insurers are also instituting internal exceptions to extend coverage for longer periods of time, subject to continued payment of your premiums. For example, your insurer may have instituted an internal exception allowing your coverage to continue through June 2020 if you experienced a reduction in hours or stopped working due to a furlough/unpaid leave as of March 2020. This internal exception would not be found in the plan document but may nonetheless be applied.
An experienced long term disability attorney can review your plan document and advise you whether your coverage has been extended. You or your attorney may need to contact your insurer to determine whether any internal exceptions apply amid coronavirus.
Does my long term disability plan exclude coverage for pandemics like COVID-19?
Most group long term disability plans do not exclude coverage for pandemics like coronavirus. Check your plan document carefully.
What happens if I get laid off and receive a severance package?
You could lose or waive your coverage. Signing a severance agreement can be tempting when you’re uncertain of future income. However, before signing any severance agreements, here are a few things to keep in mind:
- You may lose the chance to file a disability claim now or in the future. Most severance agreements contain a general release of all group employee benefit claims and coverage, including short and long term disability insurance. If you sign the release as-is, you may lose your ability to file any existing or potential disability claims.
- Your long term disability claim likely has more value than payout from a severance agreement. Releasing any claim to file for long term disability could have a devastating impact on your future income. Oftentimes the value of the disability claim far exceeds the value of the severance package, particularly if you are young or a high wage earner. If you have a progressive or permanent medical condition, you may never be capable of securing similar earnings in the future.
How will a work-from-home arrangement affect my long term disability coverage?
If your employer has permitted you to work from home due to COVID-19, there should be no change in your long term disability insurance coverage. This is because you are actively working amid coronavirus.
However, questions may arise as to how your work is generally performed. For example, your insurer will want to see that your medical condition prevents you from performing your duties as they were generally performed before the coronavirus pandemic (e.g., working in an office, traveling to/from clients, etc.). But your insurer may now also question whether your medical condition prevents you from performing that same work from home.
What options do I have if my long term disability coverage ends amid COVID-19?
If your coverage ends amid COVID-19, your benefit plan’s continuation, conversion, and portability options may be triggered. Check the terms of your benefit plan.
Applying for Long Term Disability Amid COVID-19
Can I get long term disability benefits due to depression, anxiety, or other mental illness exacerbated by COVID-19?
Yes. Many people are experiencing increased symptoms of depression, anxiety, bipolar disorder, and other mental illnesses during the COVID-19 pandemic. You may qualify to receive short and/or long term disability benefits if your symptoms are severe and frequent enough to prevent you from working.
You may qualify for short and/or long term disability benefits due to mental illness if you’re struggling to:
- Make work-related decisions;
- Appropriately cope with coworkers, clients, customers, and/or supervisors;
- Tolerate normal work stressors;
- Work your normal work schedule on a consistent and reliable basis;
- Sustain attention and concentration;
- Follow normal work procedures;
- Multitask effectively;
- Begin and complete work tasks;
- Remain reasonably flexible in the workplace; and more.
These difficulties can have a substantial impact on your ability to work, in addition to affecting your personal life. Speak with a qualified long term disability attorney about whether your symptoms may qualify you for long term disability benefits during the coronavirus pandemic.
Can I get short term disability benefits if I am placed on quarantine amid COVID-19?
Maybe. Most short term disability benefit plans require you: (1) to be unable to work (either at your normal place of work or remotely); and (2) to experience an income loss due to a medical condition. Most disability insurers are instituting internal policies for handling short term disability claims for employees under quarantine.
Does a diagnosis of COVID-19 automatically qualify me for long term disability benefits?
No. A diagnosis of COVID-19 will not “automatically” qualify you to receive long term disability insurance benefits. You must still meet the disability plan’s definition of disability and satisfy all other requirements.
Generally, to qualify for long term disability benefits due to a diagnosis of coronavirus, you must:
- Be an active employee (getting paid to perform your regular work);
- Be unable to perform your work duties due to symptoms of COVID-19; and
- Have an inability to work that lasts as long as the benefit plan’s elimination period (also known as a “waiting period”), which is usually at least 90 days.
How will my pre-disability earnings be calculated if I become disabled during a furlough, temporary layoff, or reduction in hours/salary?
An experienced long term disability attorney will argue that your pre-disability earnings should be based on your last day of active work before the furlough, temporary layoff, or reduction in hours/salary. How your insurer will react to this argument will depend heavily on the terms of your long term disability plan and your insurer’s internal coronavirus-related policies.
WATCH OUT: If your monthly premium has been reduced in proportion to your hours, your monthly long term disability benefit may be reduced accordingly. Check your paystub and speak with an attorney to determine whether your monthly premium has been reduced in proportion to your hours.
How can I meet the benefit plan’s medical certification and/or proof of claim requirements during the COVID-19 pandemic?
Most long term disability plans require you to submit medical certification and proof of claim from your doctor. Although the COVID-19 pandemic may make it difficult to satisfy these requirements, the insurers are not waiving them. You must still submit medical certification and/or proof of claim.
However, most insurers are becoming a little more flexible in how these requirements may be satisfied. For example, your insurer may be willing to accept verbal medical certification of disability from your doctor or a telemedicine appointment record.
Current Recipients of Long Term Disability Benefits
How will the COVID-19 pandemic affect me if I'm already receiving long term disability benefits?
Most long term disability insurance companies are still actively processing and reviewing claims, but certain protocols may have changed. For example, your insurance company may be requesting updated medical information less frequently, given your inability to physically see you doctor during COVID-19. Other insurers are still demanding updates -- often suggesting that telemedicine appointments are an option.
Do not ignore your insurance company's requests for updated information amid COVID-19. You may request extensions for additional time to fulfill the request, but outright ignoring it may result it termination of your long term disability benefits.
Will my long term disability benefit payments be delayed because of COVID-19?
Each long term disability insurance company is dealing with COVID-19 differently. However, you can rest easy knowing that the long term disability insurance companies are actively processing benefit checks. We have not witnessed delays in long term disability benefit payments amid COVID-19.
ERISA Deadline Changes Amid COVID-19
Are ERISA deadlines affected by COVID-19?
Many ERISA long term disability deadlines have been suspended amid COVID-19. Recognizing the roadblocks you may face in filing a timely disability claim or appeal, the Department of Labor (DOL) and the Internal Revenue Service (IRS) issued new rules to temporarily suspend certain deadlines associated with ERISA-covered disability plans.
The new rules establish an “Outbreak Period” for which certain ERISA deadlines will be extended. The new rules define the Outbreak Period as starting on March 1, 2020. The Outbreak Period will end 60 days after the end of the COVID-19 National Emergency is declared.
Which ERISA deadlines have been extended due to COVID-19?
The deadlines that the Outbreak Period – the days between March 1, 2020 and 60 days after the announced end of the COVID-19 national emergency – effectively puts on hold are:
- The date within which you may file a benefit claim under your plan’s claims procedure; and
- The date within which you may file an appeal of an adverse benefit determination under the plan’s claims procedure.
For more information regarding how this may affect your short or long term disability claim or appeal, please take a look at Deadlines Suspended for ERISA Long Term Disability Plans Amid COVID-19.
Other COVID-19 Disability Benefits
Will benefits received under the Families First Coronavirus Response Act offset my group short and/or long term disability benefits?
Maybe. If you receive benefits under the Families First Coronavirus Act (FFCRA) for your own medical condition, your insurer may offset your short and/or long term disability benefits based on your particular circumstances and the terms of the benefit plan. If you receive benefits under FFCRA unrelated to your own medical condition (i.e., you take qualified leave time to care for a child or family member), those benefits will not likely create an offset.
What does New York's COVID-19 Paid Leave Provide?
New York has enacted a law that provides job protection and wage replacement benefits for qualifying New York employees who cannot work because they are subject to a mandatory or precautionary order of quarantine or isolation issued by New York State's Department of Health, local board of health, or any other authorized government entity. An employee may also qualify for paid leave to care for a family member diagnosed with COVID-19, or to care for a child.
There’s a lot of uncertainty surrounding COVID-19 right now. Things are changing and developing quickly. If you’re wondering about how your short and/or long term disability benefits may be affected, you should preemptively consult with a long term disability attorney to obtain guidance. An ERISA long term disability attorney can explain your options and guide you out of work protected.
If you’ve already been laid off or fired before filing your long term disability claim, you should consult with a qualified long term disability attorney as soon as possible. Your insurance may still cover you, but the process may be difficult and complicated. A qualified ERISA long term disability attorney can help increase your chances of claim approval.