Why are Chronic Fatigue Syndrome LTD Disability Claims Denied on a Regular Basis?
Disability insurance claims for Chronic Fatigue Syndrome (CFS), also referred to as Myalgic Encephalomyelitis (ME/CFS), are frequently denied and face numerous challenges. Despite the significant impairments caused by CFS, the lack of strong objective medical evidence makes these claims difficult to prove. An experienced long-term disability attorney with deep knowledge of CFS can help overcome these challenges and counter the tactics used by insurance companies to deny these claims.
Chronic Fatigue Syndrome from an Insurance Company’s Perspective
Even claims with clear diagnostic tests can be denied, so it should come as no surprise that claims without objective evidence, like those for ME/CFS, face an uphill battle. ME/CFS diagnosis is based on five core symptoms, but no single test exists to definitively diagnose the condition, making it difficult to validate for disability insurance companies.
Fatigue and Post-Exertional Malaise are Primary Symptoms of ME/CFS
The unpredictable nature of ME/CFS symptoms, including fatigue and Post-Exertional Malaise (PEM), complicates claims further. PEM causes a severe worsening of symptoms after minimal physical or mental exertion, leading to a cycle of activity followed by extended periods of debilitating fatigue. This makes consistent work or daily activities nearly impossible for sufferers.
Cognitive Issues Lead to an Inability to Perform at Work
Brain fog and cognitive impairments are hallmark symptoms of ME/CFS, making it challenging for sufferers to focus, make decisions, or handle tasks requiring high-level executive functioning. Jobs requiring precision, such as surgeons or anesthesiologists, or roles involving complex decision-making, like financial traders or logistics managers, are particularly affected.
Why Claimants Should Speak with Disability Attorney Jason Newfield
Jason Newfield brings over two decades of experience representing ME/CFS claimants and has served on the Chronic Fatigue Syndrome Advisory Committee, advising the U.S. Department of Health and Human Services. His expertise includes advocating for ME/CFS claimants, collaborating with medical professionals, and educating physicians about the condition.
How Can a Chronic Fatigue Syndrome Disability Claim Succeed?
ME/CFS claims require a strong defensive posture from the outset. Critical factors include:
– A detailed diagnosis from a qualified physician, such as a rheumatologist or neurologist.
– Objective evidence, including neurocognitive testing and Cardiopulmonary Exercise Testing (CPET), to demonstrate the impact of the condition on the claimant’s performance.
Newfield Law Group works with leading medical experts and employs testing and documentation to tilt the scale in favor of claim approval.
Who Reviews the Medical Records for ME/CFS Claims?
Medical records are often reviewed by individuals without expertise in ME/CFS. Insurers may cherry-pick records or assign them to professionals unfamiliar with the condition, leading to inaccurate assessments. Newfield Law Group fights these flawed evaluations by ensuring accurate and comprehensive documentation.
Is the Insurance Company Using AI to Review My Claim?
Insurance companies increasingly rely on AI and software to screen disability claims. CFS/ME diagnoses are often flagged and subjected to additional scrutiny by humans who may share the software’s bias. Experienced legal representation is essential to navigate these challenges.
Even a Strong Diagnosis of CFS/ME Isn’t Enough for a Disability Claim to Succeed
A successful claim must address two critical points:
1. Establish the medical condition with detailed, objective evidence.
2. Demonstrate how the condition prevents the claimant from performing their occupational duties.
Newfield Law Group works closely with treating physicians to ensure medical records comprehensively document how ME/CFS impairs the claimant’s ability to work.
What If You’re Also Suffering from Depression or Anxiety as a Result of Having CFS/ME?
Many ME/CFS claimants experience secondary mental health conditions. Unfortunately, insurers often reclassify such claims as Mental/Nervous disorders, which are typically limited to 24 months of benefits. Newfield Law Group has extensive experience countering these tactics to ensure claimants receive the full benefits they are entitled to.
Newfield Law Group Offers a Free Consultation for Chronic Fatigue Disability Claims
Jason Newfield has decades of experience representing ME/CFS claimants through every stage of the disability claim process, from application to federal litigation. His in-depth knowledge and dedication make him uniquely equipped to handle these complex cases.