Long COVID and ERISA Disability Claims: Emerging Themes and Guidance for Claimants

Long COVID continues to challenge courts, insurers, and claimants, creating unique complexities in ERISA long-term disability (LTD) claims. With symptoms like fatigue, cognitive dysfunction, post-exertional malaise (PEM), dysautonomia, and neurological issues, claimants often face resistance from insurers demanding “objective” evidence. However, courts are increasingly recognizing the disabling impact of long COVID, even when traditional diagnostic tests fall short.

This guide explores key trends in long COVID LTD cases, provides practical tips for claimants, and explains how to navigate ERISA disability claims.

Key Court Trends in Long COVID ERISA Disability Claims

1. Courts Acknowledge Long COVID’s Impact Without Biomarkers

Federal courts reject insurers’ demands for specific objective tests to validate long COVID claims. Instead, they focus on reliable evidence like treatment records, functional limitations, and physician observations.

Notable Cases:

• Waldron v. Unum (W.D. Wash.)
  The court held that Unum improperly discounted subjective symptoms such as severe fatigue, brain fog, dizziness, and post-exertional declines, finding these well-supported by longitudinal treatment records. The decision emphasized that de novo review permits courts to credit reliable subjective evidence.
• Baltes v. MetLife (C.D. Cal.)
  The court criticized MetLife for dismissing long-COVID and cognitive symptoms due to a perceived lack of objective testing, despite extensive lab work showing abnormal cytokine panels, toxic metal exposure, and consistent provider documentation of fatigue and impaired mental stamina.
• Vartanian v. First Reliance (D.N.J.)
  The claimant’s long-COVID symptoms overlapped with ME/CFS manifestations and were supported by CPET testing and neuropsychological evidence — both of which Reliance overlooked. The court found the insurer’s demand for more objective proof inconsistent with the nature of the conditions.
• Cogdell v. Reliance Standard (E.D. Va.)
  The court rejected Reliance’s emphasis on claimant’s ability to perform basic physical tasks when her job required executive-level cognitive work, noting that the insurer never evaluated the cognitive impact of long COVID on her actual occupational duties.
• Abrams v. Unum (W.D. Wash.)
  A trial lawyer with severe post-viral fatigue, neurological symptoms, and cognitive decline was found disabled despite largely normal neuropsychological test scores — a recognition that normal testing does not equate to normal real-world functioning for cognitively demanding professions.

Key Theme:
Courts understand that long COVID involves fluctuating symptoms, inconsistent test findings, and functional deterioration not always captured by traditional diagnostics. They frequently disapprove of insurers’ reliance on “lack of objective evidence” as a basis for denial.

2. Functional Limitations Take Priority Over Diagnostic Labels

Courts focus on how symptoms affect claimants’ ability to perform actual job duties, especially in cognitively or physically demanding roles.

Examples:

• Waldron: Attempted return-to-work failures, post-exertional crashes, physical therapy records, and treating-provider observations demonstrated functional inability to sustain full-time work.
• Baltes: Fatigue, brain fog, and inability to sustain cognitive tasks, even with rest and stimulants, showed he could not perform the substantial and material acts of a Google software engineer.
• Vartanian: CPET results conclusively showed the claimant lacked the stamina and metabolic capacity to perform sedentary but cognitively demanding work, supporting disability.
• Cogdell: Reliance fixated on her ability to sit, stand, and walk, ignoring the executive-level analytical and managerial duties of her high-level engineering role.
• Abrams: Fluctuating fevers, cognitive fatigue, and post-exertional crashes made sustained legal practice impossible despite outwardly normal exams.

Key Takeaway: Courts prioritize evidence showing how symptoms disrupt real-world work tasks.

3. Insurers Misuse Medical Records, and Courts Take Notice

Many decisions criticize insurers for:

• cherry-picking benign exam findings
• mischaracterizing treating-provider opinions
• ignoring relevant records (e.g., toxicology, CPET results, long-COVID biomarkers)
• relying on non-examining file reviewers who omit critical parts of the record
• adopting post-hoc reasons not raised in the original denial

Illustrations

• Waldron: Unum selectively cited fragments of improvement and ignored symptom recurrence and treating-provider notes confirming disabling limitations.
• Baltes: MetLife’s physician consultant never reviewed entire sets of lab studies, IV treatment records, or job descriptions and relied heavily on assumptions rather than clinical evidence.
• Vartanian & Cogdell: Reliance frequently discounted treating specialists without adequate reasoning while failing accurately to identify the material duties of each claimant’s actual occupation.

Key Theme:
Courts disapprove of insurers’ selective or incomplete review, especially when ignoring significant evidence of functional impairment.

4. Credibility and Consistency Matter

Courts view consistent longitudinal documentation favorably:

• regular treatment
• repeated reports of identical symptoms
• documented attempts to return to work
• evidence of post-exertional malaise
• compliance with treatment recommendations

These patterns strengthened the claimants’ credibility across cases.

5. Risk-Based Disabilities: COVID-19 Exposure Risks Are Legitimate in Specific Circumstances

While distinct from long-COVID claims, Downs v. Unum (N.D. Cal.) demonstrates courts’ willingness to recognize disability where high-risk conditions (age + comorbidities + patient-facing medical work) create a work-preclusive risk of severe infection, even when the claimant is otherwise functionally capable.

This reinforces an important principle: disability under ERISA can arise from inability to safely perform the occupation, not just inability due to functional limitations.

Practical Guidance for Long COVID Claimants

Filing an ERISA disability claim for long COVID? Here’s how to strengthen your case:

1. Document Functional Limitations

Focus on how symptoms impact daily activities or work, such as:

• Cognitive crashes after mental exertion.
• Post-exertional malaise and need for extended rest.
• Failed attempts to return to work.

2. Consider Objective Functional Testing

While not mandatory, these tests can strengthen your claim:

• CPET (Cardiopulmonary Exercise Testing): Documents post-exertional malaise.
• Neuropsychological Evaluations: Illustrates cognitive decline, even if test results appear normal.
• Autonomic Testing: Helps demonstrate dysautonomia or POTS symptoms.

3. Work Closely With Treating Providers

Ensure physicians document:

• Frequency, duration, and severity of symptoms.
• Cognitive and physical limitations.
• Fluctuations and unpredictability of symptoms.

4. Avoid Treatment Gaps

Regular visits to healthcare providers reinforce credibility and prevent insurers from misinterpreting gaps as improvement.

5. Submit a Complete Record Yourself

Don’t rely on insurers to gather all records. Proactively submit medical evidence, test results, and provider statements to ensure your claim is fully supported.

How Roberts Disability Law Can Help

Navigating long COVID disability claims under ERISA can be overwhelming. At Roberts Disability Law, we:

• Build strong medical and functional evidence.
• Collaborate with treating providers to document limitations.
• Manage insurer requests to avoid harmful missteps.
• File strategic appeals and litigate when necessary.

If your long COVID symptoms prevent you from working and you’re facing a denial or delay, contact us for guidance.