Doctors Rebuffed by Courts in Long Covid and Disability Fights

Eneida DelValle was sick and running out of options.

It was October 2021, and DelValle was suffering a barrage of symptoms from the Covid-19 she contracted in late 2020: gastroparesis, fibromyalgia, short-term memory loss, and chronic fatigue.

She was forced to quit her dream job and was burning through her retirement, racking up credit card debt as her short-term disability payments dwindled.

Returning home from yet another doctor’s appointment, DelValle opened a letter from Unum, the company providing long-term disability insurance through her employer.

Her application was denied.

Unum Group, the nation’s largest private disability insurance provider, concluded—without examining DelValle in person—that her long Covid wasn’t severe enough to be disabling.

DelValle broke down in the elevator, crying.

“I don’t have anything else,” she thought. “What am I going to do for rent? What am I going to do for food? How am I going to survive?”

DelValle’s fight for long-term disability is one of dozens of court battles by workers with long Covid, a new test of a system that lawyers and academics say is stacked against them. The complex, yearslong process passes judgment on enrollees from afar and is filled with conflicts of interest that benefit the insurer, according to court opinions, plaintiffs’ complaints, and interviews with lawyers and academics.

A quarter of long Covid denials later challenged in federal court—including DelValle’s—were evaluated by insurance company doctors and nurses admonished by judges for their conclusions in disability claims, according to a Bloomberg Law analysis.

The analysis focuses on doctors and insurers whose long Covid disability rejections were challenged in court. It represents a fraction of the long- and short-term disability claims filed with private insurers, but offers a look into a largely hidden system. Few obtain a lawyer to navigate insurers’ murky, bureaucratic internal appeals process—where the majority of cases are won or lost. And fewer still opt to sue when the company upholds the initial denial.

Many of the insurers, which provide little information on denials, continued employing the same doctors after courts determined they made false statements and ignored critical evidence.

Disability denials make up a major portion of lawsuits under the Employee Retirement Income Security Act, which governs employee benefits. People using such insurance usually must exhaust administrative appeals before challenging a denial in court.

Data on private disability claims, unlike those for Social Security, is hard to find. But a 2017 survey from the American Council of Life Insurers found that roughly a third of initial long-term disability claims are denied, and 62% of appealed claims are rejected. Initial denials for private health insurance claims, by contrast, averaged 14% in 2023, with 40% of appeals ultimately rejected.

Disability insurance industry profits outpace health insurance profits. Disability insurance profit margins are expected to average 10% in 2026, according to data firm IBISWorld, compared to 5% for health insurers. The $20 billion industry is projected to keep growing in the next few years.

Under ERISA, insurers face limited penalties for unlawful denials beyond paying benefits and sometimes legal fees. Because just a fraction of denied applicants sue and the bar for a judge to overturn the insurer’s decision is high, there is little incentive for insurers to change.

The US Supreme Court ruled that judges must consider the conflict of interest when insurance companies both review claims and pay out benefits under ERISA. But plaintiffs attorneys struggle to convince courts that structural bias is a problem, in part because judges generally prohibit attorneys from subpoenaing documents or deposing company executives.

“I think doctors sometimes bring their own values and opinions into this,” said Marcus Dillender, assistant economics professor at Vanderbilt University, who co-authored a study on doctors’ decisions in state workers’ comp cases. “And it’s certainly not surprising that some doctors just will systematically reject these types of claims even though they’re not supposed to.”

Insurers win or settle most lawsuits, and doctors can review hundreds of claims a year. Still, Unum staff physician Scott Norris, who court documents show rejected DelValle’s claim, has been reprimanded at least 29 times over the past decade in cases where Unum denied disability claims. Federal judges have called his reasoning “troubling,” “questionable,” and “not persuasive.”

Norris didn’t respond to requests for comment. Unum didn’t answer Bloomberg Law’s questions about Norris or the review process.

Unum spokesperson Emily Downing-Baer said the insurer approves the “vast majority” of disability applications. She declined to provide approval numbers, including how many were related to maternity leave, which is often processed as a disability. The company paid about $3.5 billion in disability benefits in 2024, she said.

Downing-Baer noted that doctors supply medical opinions but the insurer ultimately renders benefit decisions.

“Of the small subset of claims denied, only a fraction were resolved in litigation,” she wrote in a statement. “And of the claims that were resolved in litigation, courts affirmed Unum’s decision in the majority of those cases since 2020.”

Bloomberg Law’s analysis shows that federal judges regularly rebuke the insurers themselves. They’ve accused insurers of omitting records sent to reviewers and moving the goalposts on what applicants need to submit for approval. In other cases, the insurers changed their minds without any reason or hired doctors with the wrong specialties.

Betsy Keller, a former professor of exercise science at Ithaca College who has conducted exercise tests on chronic fatigue patients for 23 years, said disability denials seem to be increasing since the pandemic.

“The big fat rubber stamp ‘no’ from the insurance companies has been used more liberally,” she said. “They’re getting denials very quickly. Very quickly.”

Stacked in Favor

Getting approved for long-term disability is often a yearslong process both through private insurance and Social Security. Approval for something like long Covid—characterized by symptoms like fatigue that are tough to measure objectively—is even harder, said Sean Anderson, a law professor at the University of Illinois Urbana-Champaign and former ERISA litigator.

The law is “stacked in favor of the plan,” he said.

Only 35% of nonunion workers have access to long-term disability insurance through private employers, according to the Department of Labor. Private plans fill a crucial gap before Social Security.

Research shows that disability fraud is rare. While little data is available on private plans, the Social Security Administration estimates that improper payments make up less than 1% of its total paid benefits.

Social Security Disability Income payments, based on a worker’s earnings history, average about $18,000 a year.

Private short-term disability plans, which can last six months to a year, can initially pay the full salary, but decrease over time to as low as 40% of the claimant’s paycheck. Long-term plans can pay between 60% to 80%, with benefits lasting to retirement.

Changes and Struggles

DelValle said she made $140,000 a year at CBS as an investigative news producer. She was approved for Social Security disability payments, which total around $30,000. Her long-term disability benefit through Unum was supposed to help make up the gap.

DelValle, 50, used up her savings fighting the denial, cashing in her 401(k), and going on New York City’s public assistance. Her Social Security disability application was approved just in time to save her from eviction.

She never wanted to give up her job. Growing up in Puerto Rico and a rough New York City neighborhood, DelValle put herself through night school and took pride in producing stories about women and racial minorities. Her job let her pay off her school loans.

After Covid, she went from lugging video equipment across mountains and jungles to struggling to walk a city block.

“I loved being a journalist,” she said, tearing up. “I was going to be a journalist until I was in the grave.”

After the letter denying her application, DelValle got a lawyer and appealed.

Even then, records from her primary care doctor, gastroenterologist, cardiologist, neuro-ophthalmologist and physical therapist didn’t sway Unum. Her appeal was rejected.

Waiting for a Ruling

DelValle claims in court filings that Unum’s final denial hinged in large part on Norris. Unum argues that Norris is fully qualified and his opinions are supported by the record.

Certified in family and occupational medicine, Norris was tasked with giving his opinion on whether DelValle could work. He concluded her long Covid treatment had been of a “modest intensity” that was not consistent with her symptoms.

A federal judge in the US District Court for the Southern District of New York recently rejected both her and Unum’s motions for summary judgement, sending the case to a court mediation program. She doesn’t know what she’ll do if she loses.

DelValle’s experience with Unum and Norris is far from unique.

Doctors who reviewed long Covid claims were named more than 150 times in court opinions involving Unum in the past two decades. Courts admonished them in 59 of those instances, with judges usually overturning the disability benefit denials or remanding claims back to Unum. Norris was criticized by judges at least 29 times.

In March 2025, a Pennsylvania federal judge overturned Unum’s denial of a disability claim from a physician with a traumatic brain injury, saying Norris “unreasonably ignored critical evidence.” That included Norris’ conclusion that she showed “limited participation” in a stress test, while the examiner reported she was physically incapable of completing it.

In 2023, a federal judge in Illinois called out Norris for a “plainly incorrect” reading of the medical records of an attorney with chronic pain from a car crash.

And in July 2021, a federal judge in Pennsylvania blasted Unum and Norris for denying benefits to the manager of a manufacturing company who had both legs amputated below the knee. The patient also had Ménière’s disease—which causes sudden bouts of dizziness and vertigo—as well as depression and PTSD stemming from the amputation.

Critical Reviews

Beyond Unum, judges have repeatedly found fault with other major disability insurance companies and their doctors.

In 2024, a California federal judge overturned Aetna’s denial of a fibromyalgia patient’s application after the insurer included surveillance videos of the wrong person. Frank Polanco, an occupational physician, had noted the individuals had “different appearances” because one person was bald, but still concluded the disability applicant was capable of working.

In another case involving Life Insurance Company of North America (LINA), Polanco misread the medical opinions in two reports, prompting the company to reject benefits to a woman suffering complications from a serious fall. A California federal judge reversed the decision in 2019.

Judges have overturned or remanded at least six cases that name Polanco, who stopped responding to Bloomberg Law’s requests for comment. Aetna said it sold its disability business in 2017. New York Life Insurance Co., the parent company of LINA, didn’t return a request for comment.

Courts have overturned or ordered insurers to revisit at least 10 benefit denials since 2016 that mention Howard Grattan, an independent physician in rehabilitation and physical medicine, who regularly reviews internal appeals for Unum, LINA, and Sedgwick Claims Management Services, Inc.

In 2023, a California federal judge overturned Sedgwick’s disability denial in part because an analysis of Grattan’s reports revealed he recommended denials in 82% of the cases he reviewed for one insurer over a three-year period. A Massachusetts federal judge ordered Unum to reexamine the claim of a marketing employee in 2024 after Grattan mislabeled a report from her physician as an appeal from her attorney.

Grattan didn’t return requests for comment. Sedgwick said doctors are independent and board-certified.

“The claims process is clinically informed, structured, and subject to multiple levels of review and oversight,” the company said in a statement.

Insurers often don’t request in-person exams, which judges have repeatedly pointed out. Medical reviewers who spoke to Bloomberg Law say that relying on paper records creates headaches. Doctor’s notes and records can be jumbled, tough to decipher, or not include important information, and physicians can be hard to reach or reticent to answer questions.

“The health care system is so wrought with doctors being overworked,” said Swati Shah, an OB-GYN and former reviewer who founded medical networking and career coaching startup PlansConnect, LLC. “Then how can it be adequately documented such that a disability claim can be approved for someone who legitimately needs it?”

Conflicts of Interest

Insurers often rely on staff physicians, and internal financial metrics found in court records suggest that doctors are incentivized to reject claims.

Unum bases employee bonuses in part on the company’s profitability, according to a 2022 deposition from Unum’s Lead Medical Director Freeman Broadwell.

Those annual bonuses add up to between $58,000 and $74,000, according to DelValle’s court filing, which cites Broadwell’s deposition. That’s between 31% and 39% of a staff doctor’s salary, according to the filing. In early 2025, a judge rejected another plaintiff’s argument that this bonus structure was unlawful, saying she didn’t show that the conflict of interest clearly impacted the insurer’s decision.

Unum denied in court records that its doctors are incentivized to reject claims and has said that financial guidance and performance metrics given to its employees are simply general management tools.

Courts do recognize a conflict sometimes. In 2019, the US Court of Appeals for the First Circuit chastised Aetna for overruling its reviewers in denying a claim to a melanoma patient, saying the record didn’t look like you would expect it to look “were Aetna proceeding without regard to its own interest.”

Court records show that some specialists can make a lot of money reviewing claims in a short time frame.

Hartford Life and Accident Insurance Company paid an independent neurologist roughly $255,000 to review 331 claims in 2020, court documents show, amounting to nearly a case per day.

When workers file an administrative appeal, the case is often sent to outside physicians to review. Many are contracted by third-party recruiters to act as a buffer against the insurer’s conflict of interest. But it’s insurers—not patients—who pay for the reviews.

“They purely review medical claims for the insurance companies,” said disability plaintiffs attorney Amar Raval. “They won’t take on a claim for an individual.”

That means they have a strong financial interest to keep insurers happy, said Anderson, of the University of Illinois Urbana-Champaign.

“It doesn’t take a rocket scientist to figure out the incentives,” he said.

Accidental Standard

Insurers are entitled to a significant amount of deference under ERISA case law if the plan’s terms grant them control in determining eligibility for benefits instead of the employer. Denials are only overturned if the judge concludes the insurer made critical errors or intentional oversights.

Plaintiff’s lawyers point to this as the most significant hurdle in overcoming unfair denials, arguing Congress should follow the lead of states like California and Texas, where insurers aren’t entitled to deference from the courts.

“ERISA is a mess,” said John Jacobi, a law professor at Seton Hall University, adding that federal courts, including the US Supreme Court, have asked Congress repeatedly for better guidance on how the law should be enforced.

“We’re sort of stuck with courts trying to make the best out of an accidental standard,” he said. “I don’t think Congress ever intended for this crazy system to take over.”

Sara Whitehouse, 47, experienced these hurdles herself after she was diagnosed in March 2020 with presumptive Covid-19 while working as a doctor in a hospital treating Covid patients.

Three weeks later, her symptoms intensified. She couldn’t speak without feeling winded, and brain fog clouded her thoughts. She used the wrong words without realizing it, and struggled to process what people were saying. She would get up to refill a glass of water and forget what she was doing.

Her coronavirus tests came back negative, but she was eventually diagnosed with presumptive Covid-19 because of the scarcity and unreliability of early tests.

Unum approved Whitehouse’s short-term disability in May 2020 but later denied her application for long-term disability.

She eventually sued and court documents show that a federal judge awarded her nearly $72,000 in back benefits in March 2024, long after she’d returned to work as a family medicine physician. The court found that Norris, who analyzed her claim for Unum, ignored and dismissed critical evidence.

Whitehouse ultimately reached a settlement with Unum, and is barred from discussing the details. She said her family relied on savings and her spouse’s income as she recovered.

“At some point the money matters,” she said, “when you can’t support your family and you’re thinking, we’re going to lose our home.”

Methodology

To examine how long Covid patients are treated in employer-sponsored disability plans, Bloomberg Law reporters searched through federal Employee Retirement Income Security Act (ERISA) lawsuits through July 2025 and found 130 disability cases involving long Covid. Such cases are a challenge that has emerged in the past six years for patients, the insurance industry, and the courts.

In those lawsuits, reporters identified 51 doctors and nurses who reviewed and rejected disability claims from long Covid patients. The reporters then searched for those reviewers in judicial opinions to find other disability benefits lawsuits where they were named, and confirmed their identities.

A large language model, GPT-4o, was used to read about 1,400 opinions naming reviewers and identify how a judge discussed both the reviewers’ and insurance companies’ actions. Journalists then verified the LLM’s answers.