Chronic fatigue syndrome (CFS) is a relatively common condition that can cause debilitating fatigue. It can last for months or even years. CFS not only prevents many sufferers from maintaining full-time employment, but also significantly impacts the quality of their day-to-day lives.
If you currently have a CFS diagnosis and you cannot work, you may be eligible to receive disability benefits under a long-term disability policy from a private insurance company. However, for many reasons, these claims tend to be extremely tough to approve. In this blog post, we’ll explain the challenges that many claimants face when attempting to receive benefits. We’ll also share important tips to increase your chances of getting your claim approved.
If you or someone you love is considering making a long-term disability claim for CFS or recently had a claim denied, contact Bryant Legal Group at 312-626-9316 for a case review and personalized legal advice.
Chronic Fatigue Syndrome: A Quick Overview
Chronic fatigue syndrome, also sometimes known as myalgic encephalomyelitis (ME) or ME/CFS, is a complex and debilitating disorder. The main symptom is persistent, unexplained fatigue that doesn’t get better with rest and doesn’t seem to be caused by any apparent underlying medical conditions.
In addition to chronic fatigue, other symptoms of CFS may include:
- Sleep disturbances (insomnia, prolonged sleeping, etc.)
- Cognitive symptoms, such as problems with memory, concentration, and processing information
- Muscle pain
- Joint pain
- Swollen or tender lymph nodes
- Sore throat (usually without mucous)
- Orthostatic intolerance, which means symptoms tend to worse when maintaining an upright posture but may improve by lying down
- Post-exertional malaise, which is a worsening of symptoms after physical or mental exertion
- Weakened immune system function
- Cardiovascular abnormalities, such as heart palpitations
- Gastrointestinal issues
- Respiratory difficulties
- Visual disturbances, such as photosensitivity or impaired depth perception
There is currently no known cure for CFS. Treatment primarily focuses on managing symptoms and improving quality of life. This may include a combination of lifestyle changes, medication for pain and sleep disturbances, and psychological support, such as cognitive-behavioral therapy or counseling. Since the symptoms and severity of CFS can vary greatly from person to person, treatment plans are often tailored to the individual’s specific needs.
Is Chronic Fatigue Syndrome a Disability According to Your Long-Term Disability Insurance Policy?
The physical and mental limitations experienced by those with CFS can significantly impair daily activities, work, and social life. For this reason, most long-term disability (LTD) insurance policies cover chronic fatigue syndrome—at least in theory.
LTD policies generally define disability in one of two ways:
- A condition or illness that prevents you from performing your current job (“own occupation” disability), or
- A condition or illness that prevents you from performing any job to which you are reasonably suited (“any occupation” disability).
Physically and mentally demanding jobs may be impossible to perform with CFS. However, even many (if not most) jobs require workers to be rested, alert, and available during their scheduled hours. If your CFS symptoms are severe enough, even these might not be feasible.
That being said, disability claims for CFS tend to be difficult to pursue for a number of reasons. Simply having a diagnosis doesn’t necessarily mean your disability claim will be approved.
Chronic Fatigue Syndrome Claims Are Often Denied Due to “Insufficient” Medical Evidence
Unlike most conditions, there is no objective testing for chronic fatigue syndrome. You can’t “prove” that you have it by showing someone a brain scan or blood test. This means disability claims for CFS often involve a lot of extra steps and obstacles to overcome.
Typically, the way you get diagnosed for CFS is by working with a doctor who specializes in the condition. The doctor will provide their clinical opinion that you suffer from CFS based on your reported symptoms and after ruling out other possible medical causes of your fatigue.
However, even if your treating doctor says you have CFS, that might not be “good enough” medical evidence for your insurance company. They may require you to go through an independent medical examination (IME).
Despite the name, an IME is not truly independent or neutral. The doctor, therapist, or other medical professional who evaluates you is someone chosen by the insurance company. They are incentivized to look for any evidence that your symptoms aren’t bad enough to qualify for disability benefits.
Since people with CFS can have “good days” and “bad days,” the precise timing of when you take your IME—as well as examiner bias—can lead to a drastically different judgment than the one made by your regular physician. That said, it’s critically important that you are honest with the examiner and try your best during the exam. If the examiner believes you are able to work and you disagree, you will have an opportunity to counter with your own medical evidence. But if you are dishonest and get caught, your claim may be nearly impossible to salvage.
Your Insurance Policy May Have Restrictions on Conditions With “Self-Reported Symptoms”
Chronic fatigue syndrome is a common example of a “self-reported condition.” Other diagnoses in this category include fibromyalgia, headache disorders, post-concussive syndrome, or a mental disorder (such as anxiety or depression).
Most long-term disability policies acknowledge that conditions with self-reported symptoms can be disabling, even if no objective medical or laboratory tests exist. However, your contract may include a self-reported conditions clause that limits benefits to a certain period—often just one or two years.
Of course, while coverage might stop after two years, there’s no guarantee your CFS will have improved enough for you to return to work by that time. Before filing a long-term disability claim for CFS, we strongly encourage you to read your policy carefully. If you know that benefits are likely to be cut off after a certain period, it’s important that you prepare for it ahead of time.
- RELATED POST: “Self-Reported” Symptoms: How to Fight Back With Medical Evidence – Bryant Legal Group (bryantlg.com)
Tips to Help You With Your CFS Disability Claim
Because there is very little objective testing for CFS, long-term disability providers will be scrutinizing your claim closely. Simply put, you’ll need as much proof as you can get.
It’s not nearly enough to just have a CFS diagnosis. You’ll need to show the insurance company that your symptoms are severe enough to meet the eligibility standard for long-term disability insurance.
Here are some tips that can help you increase your chances of getting your disability claim approved.
Check In With Your Doctors Regularly
It may be hard to find the motivation to keep checking in with your doctor, especially when there doesn’t seem to be any progress in your condition. However, the best way to prove a CFS disability claim is with extensive medical records, and the only way to get them is by making sure your treating physician is updated regularly and documenting your symptoms, as well as your subjective complaints about what you are and are not able to do.
Although no current medical tests can prove someone has CFS, there are some tests which can corroborate symptoms. For example, CFS sufferers who take cardiopulmonary exercise tests (CPET) on consecutive days may reach their ventilatory threshold (i.e., the point at which breathing becomes labored) much sooner and at much lower intensity on the second day. Don’t be afraid to speak with your doctor about any medical testing that might help establish a diagnosis or strengthen your disability claim.
Follow Your Treatment Guidelines
Even though CFS has no known cure, your treating physician may make several recommendations to help you manage your symptoms, including certain medications or behavior modifications. If you ignore your medical advice, the insurance company can use that to argue your symptoms aren’t as bad as you say.
Keep a Detailed Journal
During the time between check-ins with your medical team, keep a daily log of your symptoms and how they are affecting your daily life—for example, when you took medications, pain you experienced, how much activity you were able to perform at a time, and when and how often you had to stop and rest. This not only helps you learn how to pace yourself better, but also serves as key evidence supporting your disability claim.
Prepare for Surveillance
Be aware that some insurance companies might use surveillance tactics to see if you are really disabled. They might follow you on social media or even hire a private investigator. This can cause trouble for chronic fatigue syndrome claimants, since you might have occasional “good days” where you can go out with friends or run errands for a few hours. The insurance company might get a picture or video of you out at the grocery store—but, of course, will conveniently overlook the next two days when you’re totally wiped out.
Again, detailed journaling and regularly communicating with your doctors, particularly on the days after “good” days, can help defend you against these tactics. It’s also important to be completely honest with your doctors about your symptoms and limitations. If, for example, you tell your doctor you can’t stand for more than 20 minutes, but then the insurance company gets video of you walking around a store for an hour, it won’t reflect well on your disability claim.
Chronic Fatigue Syndrome and Social Security Disability Benefits
In addition to a private long-term disability insurance claim for CFS, you might also be eligible to file for Social Security Disability Insurance (SSDI). CFS is considered a “medically determinable impairment” by the Social Security Administration (SSA).
To meet the SSDI guidelines, your CFS must totally prevent you from working any job (i.e., leave you “totally disabled”), and be expected to disable you for at least one year.
Please note that, at Bryant Legal Group, we do not typically handle standalone SSDI claims. If you have a valid disability claim with a long-term disability insurance company, we are happy to handle your SSDI claim as well. If you do not have applicable long-term disability insurance coverage but do qualify for SSDI, we strongly encourage you to reach out to an experienced Social Security Disability attorney.
Contact Chicago’s Premier Long-Term Disability Attorneys Today
The disability lawyers at Bryant Legal Group have helped countless professionals with tough long-term disability claims, including chronic fatigue syndrome and other conditions with self-reported symptoms.
Whether you’re preparing to file an initial claim or wondering what to do next after an unfair denial, we can help. However, if you’ve already gotten a denial letter, it’s important to act quickly. You may only have a limited time to file an appeal. If you don’t provide the necessary medical evidence during that period, you may not get another chance to add more later.
The best way to protect your rights is by working with an experienced disability attorney. We can help you review your policy, gather the evidence you need, and determine your next steps. To schedule your free consultation and get the objective legal advice you deserve, call 312-626-9316 or complete this brief online form.