Chronic Fatigue Syndrome

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Chronic Fatigue Syndrome Disability Claims Will Be Challenged

If you are disabled due to a chronic fatigue syndrome (CFS) diagnosis, prepare for a challenge by your long term disability insurance company. Your LTD insurance company will challenge your claim by arguing there is a lack of evidence to support the diagnosis and/or disability.

Even if you submit all of your medical paperwork as evidence of the disability, your insurer may rely on their in-house doctor, who never met you, to deny your claim.

CFS is also known as chronic fatigue and immune dysfunction syndrome (CFIDS) and myalgic encephalomyelitis (ME).

Chronic fatigue syndrome lack of objective medical tests

CFS is one of several health conditions that rely primarily on your subjective reporting of symptoms. There isn't a test that can objectively show you suffer from constant fatigue.

Insurers rely on this to deny your claim.

They will argue that there is insufficient objective evidence to prove you suffer from this condition. Even though case law prohibits the insurance company from denying your claim based on lack of objective medical evidence, if the condition is one that cannot be proven by objective medical evidence.

The insurance companies don't care and they will argue this anyway. This is what makes chronic fatigue syndrome disability claims so tough. This is why you need the help of a disability insurance lawyer to help you retrieve the benefits you are entitled to.

Primary Symptoms of Chronic Fatigue Syndrome

These are the three primary symptoms required for diagnosis:

  1. Greatly lowered ability to do activities that were usual before the illness. You must experience this drop in activity for at least 6 months or longer. This fatigue can be servere and is different from just being tired.
  2. A Worsening of your symptoms after activity that was not a problem before. Also known as post-exertional malaise (PEM). Often described as a crash, relapse or collapse.
  3. Sleeping problems. You may not feel refreshed or less tired after a full night sleep.

Those are the 3 main symptoms, and one of the following two symptoms is required for a CFS diagnosis:

  1. Problems with thinking and memory.
  2. Worsening of symptoms while standing or sitting upright. Also called orthostatic intolerance.

You may also experience:

Chronic Fatigue Syndrome Disability Claims, Denials and Appeals

If you are diagnosed with CFS and can't work, you will need to apply for long term disability benefits. Be prepared to provide your insurer with a lot of medical reports from your doctors.

Insurers like to deny these claims, and if you get a denial letter do not waste any time. You usually only have 6 months from the date of the denial letter to file an appeal. If you don't file an appeal in time, you may lose your rights to these benefits forever.

The appeal itself must be thorough and complete. Why? If the insurance company denies your appeal, you must file a lawsuit in federal court. You are not allowed to submit anything new other than what's included in the application process and appeal. You can't introduce any new evidence (with some exception).

So why must you act fast if your chronic fatigue syndrome claim was denied?

  1. You usually only have 6 months to file an appeal
  2. Your appeal is your case. You can't introduce any new evidence after your appeal.

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