Chronic Fatigue Syndrome and Long-Term Disability Insurance Benefits

Chronic Fatigue Syndrome (CFS) is a debilitating illness that makes performing daily tasks of living difficult and at times, impossible. The typical symptoms include extreme and ongoing fatigue that does not improve with rest. Other symptoms are headaches, muscle pain, and joint pain.

Many people who have CFS find it difficult to get out of bed every day. They have little or no energy, and it is hard to concentrate. Individuals who have been highly functioning throughout their entire lives find themselves frustrated, as they simply don’t have the physical and mental capacity they did before becoming sick with CFS.

Diseases like CFS (sometimes referred to as myalgic encephalomyelitis (ME) or Chronic Fatigue), Immune Dysfunction Syndrome (CFIDS), and fibromyalgia are often challenging because those suffering from these insidious conditions often do not look sick and people have a hard time understanding the severity of the impairments.  We have represented many CEO’s suffering from CFS/ME and often co-workers do not notice a profound physical change, so it is hard to understand why someone is unable to perform complex tasks, or make quick decisions, which as a CEO or other high-level executive, have suddenly become impossible.

Chronic Fatigue Syndrome and the Disability Insurance Claims Process

Like fibromyalgia and other somewhat invisible claims, Chronic Fatigue Syndrome claims are extremely problematic for disability insurance claimants. These types of disorders and related illnesses are often considered “subjective conditions” because a diagnosis is not determined by specific test results. There is no single blood test, x-ray, or MRI result that clearly indicates that a person is suffering from CFS.  Often, policies contain limited benefit periods or special condition limitation clauses contained within the policies, which act to reduce the length of time a claimant suffering from these conditions may stay on claim, despite ongoing impairment.

When working on these claims, we are mindful of the landscape which exists on the insurance company side for how they perceive these types of claims.  For long-term disability insurance companies, seeing Chronic Fatigue Syndrome on a claim form immediately sends up a red flag.  They view these types of claims either as mental health claims or lacking in severity quite often.

The disability insurance company will wrongly and in violation of ERISA take the position that a condition must be supported by “objective evidence,” something virtually impossible to provide with CFS.  Despite the policy not containing such a provision, insurance companies will argue that a claimant still needs to provide objective evidence demonstrating their impairments. We advise claimants that diagnosis alone is not enough to support a disability insurance claim.

The Role of Physicians in a Chronic Fatigue Syndrome Disability Claim

Supporting a claim for CFS can be tricky, but we have developed tools and resources over two decades allowing us to present our clients’ claims with success.  Our relationships with some of the foremost leaders in the CFS field, cultivated from years working with many of them on the Chronic Fatigue Syndrome Advisory Committee (CFSAC).

One issue that Newfield Law Group sees often with CFS claims is the use of physician paper only reviews which most often result in claim denials. Many of the doctors performing these reviews do most of their “Medical“ work for insurance, companies, or third-party vendors.  This is an industry where millions of dollars are paid to these doctors to provide reports to the liking of the disability insurance companies.  Although some courts have been able to appreciate this close relationship, other courts have adopted the argument which the insurance companies put forth that there is independence between the insurance company and the doctor.

Our strategies for these types of cases will focus on developing data and objective evidence to support the impairment of our clients. This may include neurocognitive testing, and at times CPET testing. Then, even their hired guns will be unable to counter the evidence.  For many years, we have worked with some of the leading medical providers in the chronic fatigue sphere, and have developed a strong reputation of advocacy. Many of these providers will send their patients to the firm to advocate their claims, having had success working with us.

If your primary care physician is not up to date on CFS/ME and is not an advocate for you, claim issues or problems will arise. Your medical record may not support your disability claim properly unless the doctor knows what is necessary and how to articulate it properly.  Your doctors must know the importance of having your medical records outline, in specific detail, the restrictions and limitations  that your condition causes. The lack of specific diagnostic tests by the claimant’s treating physician are used to delay and deny claims.

Unless your physician has had other patients who have been represented by experienced disability lawyers, they won’t know how your medical records need to be prepared and what tests need to be included to bolster your claim. We often work with medical providers to develop this support, with specific testing. In the CFS universe, we utilize CPET (Cardiopulmonary Exercise Testing) to seek objective evidence of functional impairment, or Neurocognitive Testing to seek objective evidence of cognitive impairment. Often, these tests can yield support which will help prove a claim.  Our strong relationships with these well recognized providers is a powerful tool for our clients to leverage.

Deep Experience Pursuing Chronic Fatigue Disability Cases

Newfield Law Group has worked with many CFS claimants and their treating physicians. Jason Newfield has many years of experience focusing on this illness, including serving on the Chronic Fatigue Syndrome Advisory Committee, a federal committee that advises the U.S. Department of Health and Human Services about Chronic Fatigue Syndrome and its challenges.  This deep experience has allowed Jason Newfield to completely understand how a CFS claim needs to be prepared, if possible from the very start, before the claim is even filed, to overcome the many obstacles that the disability insurance company presents.  The strategies have been employed successfully for many clients.

The disability insurance company personnel also treat people with CFS and related diseases as if they are malingerers, and cast doubt upon the claim.  As with many disabled, CFS claimants want their old lives and their prior energy levels back. All they can do is try to learn how to live and manage within the severe physical restrictions of this disease, how to develop a pace that might reduce or limit flares and exacerbations. Claimants find fighting back against enormous insurance companies, with their teams of claims managers and lawyers, overwhelming and impossible. That’s where Newfield Law Group comes in to advocate for you and leverage its experience and relationships..

If you have been diagnosed as having CFS, contact Jason Newfield. He is an experienced disability insurance claim lawyer who has successfully represented many CFS patients. The disability insurance process is a complex minefield that is not easily navigated, and claims concerning a subjective condition are even more challenging. Further complicating a disability claim for CFS is that patients often suffer from depression and anxiety, either as part of the disease or because of the disease and how it impacts their ability to enjoy a full and active life.

Be careful not to allow yourself to be put in a mental and nervous claim category by your disability insurance company, as coverage for this group of claims is extremely limited, even in many of the best disability policies. Insurers will often seek to apply a limited pay period to claims for CFS, if they in fact accept liability of the claim at all. Policies that have been issued in the past few years are also likely to contain a provision similar to that of the mental/nervous claim that limits disability insurance payments for more than two years.

Free Consultation for Your Chronic Fatigue Disability Claim

We have developed strong successful strategies to combat the challenges faced with Chronic Fatigue Syndrome claims.  Working with renowned professionals to develop objective evidence of functional deficits, both physical and cognitive, has helped lead to significant success for our client population. At Newfield Law Group, we have a long record of successful representation of CFS patients at all phases of the claim process: before filing, during the process of being denied or delayed, in the appeals process, and in litigation. We understand the special challenges that CFS patients face in the disability claim insurance process.

Call our offices today at (877) 406-7883 to speak with Jason Newfield about your situation or, if you prefer, click here to send us an email.