Chronic fatigue syndrome (“CFS”), also known as myalgic encephalomyelitis, is a complex medical condition characterized by severe and persistent fatigue that is not relieved by rest and is not caused by any underlying medical condition. People with CFS may also experience a range of other symptoms such as muscle and joint pain, headaches, sleep disturbances, and cognitive impairment such as difficulty concentrating, forgetfulness, and slowed thought processes. The exact cause of CFS is not known, but it is thought to be related to a combination of factors including viral infections, immune dysfunction, hormonal imbalances, and psychological stress.
CFS can cause short or long disability by making it difficult or impossible for you to perform your daily activities, including working. The fatigue and other symptoms of CFS can be debilitating, preventing you from staying awake and focused, and cause an inability to perform physical and mental tasks. In addition, CFS can also cause depression, anxiety and other mental illness conditions that can further limit your ability to function.
The severity of CFS varies widely among individuals. Some people with CFS may be able to work and maintain a relatively normal life while others may be completely disabled as a result. If you are considering filing for short or long term disability due to your CFS, you will need to provide your insurance company with sufficient evidence that your CFS prevents you from working.
In this article, we’ll discuss whether you can receive disability benefits for CFS, how disability insurance companies evaluate CFS disability claims, and how The Maddox Firm can help prove your CFS short or long term disability claim.
Can I Receive Short or Long Term Disability Benefits for Chronic Fatigue Syndrome?
Yes, it is possible to receive short or long term disability benefits for CFS. However, the process of applying for and receiving these benefits from your insurance company can be complex and may require the help of a disability attorney. CFS disability claims can be especially difficult to get approved, as insurance companies will often attribute your CFS symptoms to factors such as mental illness or burnout.
To be eligible for short or long term disability benefits due to CFS, you will typically need to provide medical documentation of your diagnosis, evidence of your symptom severity and frequency, and proof of how these symptoms impact your ability to work. The specific requirements and criteria for receiving benefits will vary depending on the type of disability insurance policy you have.
How Do Disability Insurance Companies Evaluate Chronic Fatigue Syndrome Disability Claims?
As mentioned above, disability insurance companies are typically dubious of CFS disability claims. Getting approved for short or long term disability due to CFS can be an uphill battle. One reason insurance companies view CFS disability claims with skepticism is because the main symptom of CFS, severe and persistent fatigue, can be difficult to establish with objective medical evidence. Symptoms such as exhaustion and pain are often self-reported by patients. The presence and extent of these symptoms cannot always be tested in objective measures. As a result, your insurance company may be quick to downplay your CFS symptoms.
Disability insurance companies also scrutinize CFS disability claims more than some other physical conditions because the diagnosis itself can seem nebulous. There is no singular diagnostic test for CFS. Rather, a proper diagnosis of CFS typically requires ruling out other potential causes of fatigue, such as anemia, thyroid disorders, and sleep disorders, through medical examination and testing.
The perception by disability insurance companies can be that those who claim CFS may be malingering. However, CFS has been recognized as a medical condition by several national and international health organizations, including the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) in the United States, the World Health Organization (WHO) and the National Health Service (NHS) in the United Kingdom. Insurance companies do accept CFS as a valid disabling diagnosis with the right evidence.
Ultimately, your insurance company will evaluate your CFS claim to determine that you have a) sufficient medical evidence of your CFS disability and b) sufficient vocational evidence that you cannot work due to your CFS disability.
Sufficient medical evidence may include office visit notes from your treating doctors, diagnostic testing, in-person assessments, imaging, blood work, and other tests or evaluations from your providers. Your doctor will also be requested to complete an attending physician’s statement form from your insurance company that certifies your CFS disability.
Vocational evidence may include your resume, job description, witness statement from your employer/coworkers on how the onset of your CFS impacted your job performance, a personal statement describing your job role and material duties, and a report from a vocational expert that outlines your occupation and how your CFS prevents you from performing your occupational duties.
Your disability insurance company will review this evidence to confirm the diagnosis of CFS and to understand your symptoms and the impact of CFS on your ability to work. In addition, your insurance company may request additional examinations. For example, your insurance company may have you undergo an independent medical evaluation with one of their doctors. They may also have one of their vocational experts conduct an assessment to determine your ability to return to work and your potential for retraining or vocational rehabilitation.
If your insurance company believes your evidence is inadequate, and if their own experts determine your CFS is not disabling, your short or long term disability claim may be denied.
It is always best to speak with an experienced ERISA attorney who can help you navigate the disability claim process and get your CFS short or long term disability claim approved.
How Can The Maddox Firm Help Prove My Chronic Fatigue Syndrome Claim?
An ERISA attorney can help you with your CFS short or long term disability claim by representing you and advocating for your rights throughout the claims process. The experienced team at The Maddox Firm has helped many clients successfully file for short or long term disability benefits due to CFS.
The Maddox Firm can help you with your CFS short or long term disability claim in a variety of ways, including:
Reviewing your disability insurance policy and evidence: The Maddox Firm can review your disability policy, medical records, and vocational evidence to evaluate the strength of your claim. We can then help you understand the process and the potential outcomes of your claim.
Your disability insurance policy will outline the eligibility requirements you must meet to be approved for benefits. Most policies will require you first prove you are disabled from your own occupation, and later down the line (typically 18-24 months), prove you are disabled from any reasonable occupation for your training, experience, and education. However, this definition of disability can vary depending on what kind of policy you have. Therefore, your policy will be key in developing the best strategy to filing your CFS claim.
The Maddox Firm will review your existing medical and vocational evidence. From here, we can assess any inaccuracies, missing information, and determine how you can further develop documentation of your restrictions and limitations due to your CFS.
Helping you gather additional documentation: The Maddox Firm can help you gather additional medical documentation and testimony from your doctors to support your claim. This will ensure that you have presented the strongest possible case for disability benefits.
Additional medical documentation for CFS may include a Functional Capacity Evaluation (“FCE”) or Cardiopulmonary Exercise Testing (“CPET”). The FCE is used to assess your ability to perform activities of daily living, such as dressing, grooming, and bathing, as well as your ability to perform work-related tasks, such as standing, walking, and lifting. Since the FCE uses objective testing of your functional ability, and includes validity testing to substantiate the results, your insurance company will accept this as objective evidence of your CFS disability. The CPET is very helpful for CFS disability claims. The purpose of the CPET is to evaluate your respiratory, cardiovascular, and muscular systems react to exertion. The CPET measures how your body processes oxygen intake during activity. For CFS disability claims, the CPET results can demonstrate objective evidence of your exercise intolerance and resulting fatigue.
The Maddox Firm can also coordinate with your doctors to obtain supplemental letters supporting your disability claim. Your doctor’s office notes are not created with the purpose of supplementing a disability insurance claim, and therefore they may not encompass the scope of your CFS disability. A letter from your doctor outlining your patient history, observations from in-person examinations, elaborations on your symptom severity, and their opinion on your ability to work with your CFS can be submitted to your insurance company as further medical evidence for your claim.
To help develop vocational evidence for your short or long term CFS disability claim, The Maddox Firm can assist you in obtaining witness statements from your coworkers, refer you to a vocational expert for a vocational assessment, and help you provide a personal statement that discusses the onset of your CFS and how your symptoms prevent you from working. This documentation can provide your insurance company with evidence of how your CFS interferes with your ability to perform your job duties in detail.
Communicating your the insurance company: The Maddox Firm will take over all communications with your insurance company on your behalf. We will ensure that all forms and paperwork are completed accurately and in a timely manner, and make sure that your insurance company meets all of their required deadlines. Should your insurance company request an interview, your attorney will prepare you beforehand and attend the meeting to safeguard you from any overstepping or inappropriate questions.
Filing an appeal, litigation, or negotiating a settlement: If your CFS short or long term disability claim is denied, The Maddox Firm can prepare and file an administrative appeal on your behalf. Typically, if a claim is denied or terminated, you must go through the internal appeal process with your insurance company. If your claim is denied on appeal, you can sue your insurance company for the wrongful denial. Your insurance company may also at some point offer a lump sum settlement to buy out your disability claim. The Maddox Firm routinely handles disability insurance appeals, litigation, and negotiations.
We always recommend speaking with a trusted attorney before filing or appealing a chronic fatigue syndrome short or long term disability insurance claim. Whether you are looking for assistance in navigating the claims process, appealing a chronic fatigue syndrome claim denial, or litigating a final adverse decision, The Maddox Firm can help. The team at The Maddox Firm will look over your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim.
Contact us to help you file your claim, appeal, or litigation the right way.