Our client was a 60 year old professional, working as senior accounting manager at a busy New York City law firm, overseeing employees and handling a full workload of high level support functions, including handling payroll for close to 200 employees, end of year tax related information and all financial activities for the firm, including developing budgets, managing cash flow, adhering to accounting standards, and more. Prior to her illness, she had a full personal life as well, raising a successful daughter and enjoying family and friends. Then she became sick in 2022 with COVID, and her life was never the same. That illness triggered a cascade of medical problems that she continues to suffer to this day.
After struggling to work for more than five years, including working ten-hour days from home when she could no longer manage a commute, she applied to Guardian for short-term disability benefits, and then long-term benefits through her ERISA policy. Her disability insurance claim denial was outrageous, given the extent of her disability.
She contacted Newfield Law Group and we set about developing a strategy and preparing an appeal on her behalf. We identified leading medical experts in the field of both cognitive health and medical health to assist in supporting her claim and developing the necessary proof to overcome the claim decision.
We interviewed her, her daughter, other family members, colleagues from the law firm where she worked, and the picture that emerged was of an active, independent, and healthy woman who, in a matter of years, became unable to manage the basic daily tasks of living. She has been reduced by COVID and Myalgic Encephalomyelitis/Chronic Fatigue (ME/CF) to a dependent person who can barely manage to live alone.
How could Guardian deny her claim?
Clearly Guardian failed to understand or appreciate the complexities of her condition and failed to recognize the level of cognitive skills needed to perform the duties of her occupation.
She was in charge of managing an accounting department, overseeing employees, and handling the complex financial demands of a sophisticated professional organization. She was also an active mother, friend, and member of her community.
Then she became seriously ill following COVID-19 infection.
Over time, what began as a struggle with fatigue, cognitive problems, and other symptoms developed into a complex post-infectious illness involving Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Despite extensive efforts to continue working, her health deteriorated to the point that she could no longer reliably perform the essential duties of her occupation.
When Guardian denied her disability claim, Newfield Law Group undertook a comprehensive review of the medical and vocational evidence. The resulting appeal presented a detailed picture of a woman whose ability to function had changed dramatically and whose medical evidence supported substantial restrictions and limitations.
From a Successful Career to Severe Functional Limitations
Before becoming ill, our client was independent, energetic, and highly accomplished. Her work required sustained attention, organization, judgment, memory, multitasking, and the ability to manage significant responsibility over the course of a full workday.
She had built a successful career and maintained an active personal life. She raised a successful daughter, maintained close relationships with friends and family, and participated fully in her community.
After contracting COVID-19 and later experiencing another COVID-19 infection in December 2022, she began experiencing persistent fatigue, cognitive difficulties, migraines, and other symptoms. She initially continued working because she was determined to maintain her career and because she believed she could compensate for her limitations.
For a significant period, she worked extraordinarily long hours from home after she could no longer tolerate the demands of commuting. Working remotely allowed her to conserve some of the energy required to get through the workday, but it did not eliminate the underlying illness.
By 2025, her fatigue had become overwhelming. Her migraines and cognitive symptoms interfered with her ability to function consistently. Activities that had once been routine became difficult or impossible. She required assistance from family members with ordinary household responsibilities and ultimately moved into a setting where she could receive additional support.
This progression was critical to understanding the disability claim.
Why Long COVID and ME/CFS Can Be Difficult to Evaluate
Long COVID and ME/CFS can present unusual challenges in disability claims because the severity of a person’s limitations may not be apparent from a brief conversation or office examination.
The Centers for Disease Control and Prevention describes ME/CFS as a serious, often long-lasting illness that can interfere substantially with ordinary physical and mental activities. Symptoms can include severe fatigue, cognitive difficulties, sleep problems, pain, and post-exertional malaise, or PEM.
PEM is particularly important in evaluating functional capacity. According to the CDC, symptoms can worsen after physical, cognitive, or emotional exertion that previously would not have caused a problem. Symptoms may become worse 12 to 48 hours after the activity and can persist for days or weeks.
That delayed response can create a significant problem when someone is being evaluated solely on what she can accomplish during a short examination.
A person may be able to speak clearly for an hour, complete an isolated task, or appear composed during an appointment and still be incapable of sustaining the concentration, pace, attendance, and energy required for full-time employment. Our client’s experience illustrated this distinction.
Her ability to communicate intelligently and advocate for herself did not mean she retained the ability to perform a demanding accounting position on a predictable and sustained basis.
Building a Comprehensive Disability Appeal
Newfield Law Group approached the appeal by examining the claim from multiple angles.
We obtained and analyzed medical records, functional testing, neurocognitive evidence, physician opinions, the client’s personal account, and corroborating statements from people who knew her before and after the onset of her illness.
We also interviewed individuals who could describe the dramatic change in her functioning, including family members, colleagues, and her daughter, who is herself a licensed psychologist.
The woman who had once managed a demanding professional position and maintained an active personal life had become substantially limited by fatigue, post-exertional symptoms, migraines, and cognitive impairment.
There was no question she could no longer reliably perform the essential duties of her occupation for a full workday and workweek, without experiencing symptoms that would prevent sustained employment.
Objective Testing Helped Document Functional Impairment
A central part of the appeal involved objective testing of physical and cognitive functioning.
One important evaluation involved cardiopulmonary exercise testing, or CPET. CPET measures the body’s response to exercise and can provide information about exercise capacity and physiological function. Researchers have studied two day CPET protocols in connection with post-exertional malaise and functional impairment in people with ME/CFS.
The client’s testing documented significant functional abnormalities, including an impaired performance and recovery response.
The testing provided additional objective evidence that could be considered alongside her medical history, symptoms, clinical examinations, treatment history, and real-world functioning.
The medical literature also recognizes the complexity surrounding CPET and ME/CFS. Research findings regarding the use of two day CPET to define disability are not uniform, which makes it important to interpret testing within the complete clinical record rather than treating any single result as conclusive.
For this client, the CPET results formed one component of a much broader evidentiary record.
Neuropsychological Testing Documented Cognitive Problems
The appeal also addressed the cognitive demands of our client’s occupation. A neuropsychological evaluation included a clinical interview and an extensive battery of more than 20 cognitive tests. The evaluation examined areas including executive functioning, visual memory, spatial attention, processing speed, cognitive flexibility, intellectual functioning, and other cognitive abilities.
Her job required sustained concentration, accuracy, organization, judgment, memory, multitasking, and the ability to manage significant responsibilities without prolonged recovery periods.
Cognitive impairment can be particularly difficult to appreciate when an individual remains articulate and capable of explaining her circumstances. The CDC recognizes cognitive impairment, including problems with thinking, memory, executive function, and information processing, as an important feature of ME/CFS.
Our client’s neuropsychological evidence helped demonstrate that her difficulties were not limited to subjective complaints of being tired. They affected specific cognitive functions relevant to the requirements of her occupation.
Looking at the Whole Person, Not an Isolated Diagnosis
Another important part of the appeal was the need to consider the combined effect of her medical conditions. She was not experiencing one isolated symptom but was dealing with a complex combination of fatigue, post-exertional malaise, cognitive impairment, migraines, pain, sleep disruption, and other symptoms associated with her post-infectious illness.
These limitations all interact with each other. For example, the ability to concentrate for a short period did not mean she could maintain concentration throughout an eight or ten hour workday. The ability to complete one household task did not establish that she could perform a full-time professional job five days a week.
Similarly, the fact that she had continued working for years after becoming ill did not necessarily demonstrate that she retained the capacity for sustained employment. In fact, her effort to continue working became an important part of understanding the severity of her condition.
She had been using extraordinary effort and compensatory strategies to remain employed. Eventually, those strategies were no longer sufficient.
The Importance of a Meaningful Vocational Analysis
A disability claim also requires careful consideration of the actual demands of the claimant’s occupation.
Our client held a high-level accounting position that required significant cognitive and organizational capacity. The appeal therefore addressed whether her documented restrictions and limitations were compatible with the essential responsibilities of that occupation.
The record included evidence regarding her personal functioning, her work history, her treatment, her cognitive abilities, her physical capacity, and the observations of people who had witnessed the progression of her illness.
We argued that the evidence needed to be considered as a whole rather than through isolated references to individual medical records.
The appeal also challenged the reliance on paper reviews that, in our view, did not adequately account for the complete medical record and the claimant’s actual functional limitations.
Reconciling Conflicting Medical Opinions
Disability claims often involve differing medical opinions but typically the doctors-for-hire retained by the insurance company find it more profitable to find claimants are able to work, even when the medical evidence says otherwise.
Just as in so many other LTD appeals we have handled, there was a significant contrast between the opinions supporting continued disability and opinions obtained during Guardian’s claim review.
Our appeal emphasized the importance of considering the opinions of physicians who had treated and observed the client over time, together with objective testing and evidence from family members and other individuals familiar with her struggles with daily functioning.
It also addressed what we believed were omissions and selective interpretations of the medical record. The appeal contended that the claim review did not adequately account for the full body of evidence, including the claimant’s personal statement, family observations, neuropsychological testing, CPET results, treating physician opinions, and documented restrictions and limitations.
Why was the Appeal Successful?
For an individual living with a complex and disabling illness, having the record fully developed and the evidence meaningfully considered is an essential part of the disability claims process.
This case also demonstrates why disability claims involving Long COVID and ME/CFS require careful preparation. These conditions may involve fluctuating symptoms, delayed post-exertional worsening, cognitive impairment, and limitations that cannot always be captured during a brief clinical encounter.
What This Case Teaches About ERISA Disability Claims
This case illustrates several important principles for individuals seeking disability benefits under an employer sponsored disability plan.
First, a claimant’s diagnosis is not a reason for disability benefits to be paid. Any claims filed must explain how the medical conditions affect the person’s ability to perform the actual requirements of the occupation.
Second, objective testing is critical to document functional limitations, particularly when the claimant’s symptoms are difficult to measure through routine examinations.
Third, cognitive limitations deserve careful attention when the occupation depends heavily on concentration, processing speed, executive functioning, memory, and sustained mental effort.
Fourth, a claimant’s ability to continue working despite significant symptoms should not automatically be treated as evidence that she is capable of maintaining full-time employment indefinitely. The circumstances under which the work was performed, including extraordinary accommodations and compensatory strategies, can provide important context.
Finally, the complete record matters and how it gets developed is critical. Medical records, testing, physician opinions, personal statements, family observations, employment information, and vocational evidence can collectively provide a far more accurate picture of disability than any one document considered in isolation.
A Dramatic Change in Function
Perhaps the most important evidence in this case was the contrast between our client’s life before and after her illness – and how we demonstrated this.
She had once been an independent, highly accomplished professional with substantial responsibilities at a New York City law firm. She was deeply involved with family and friends and managed the demands of a successful career.
After COVID-19 and the subsequent development of a complex post-infectious illness, she became increasingly limited.
She required substantially more sleep and rest. She experienced severe fatigue and migraines. She struggled with cognitive tasks that had once been routine. Driving for extended periods became difficult. Household responsibilities increasingly required assistance.
Most importantly, she could no longer reliably sustain the physical and cognitive demands of her occupation.
Her experience demonstrates why disability should be evaluated through the lens of actual functional capacity rather than appearance alone.
A person does not have to appear visibly ill to be profoundly limited by a chronic illness.
For individuals facing a disability claim involving Long COVID, ME/CFS, cognitive impairment, or other complex conditions, careful documentation of functional limitations can be critical. A well-developed record can help ensure that the claim reflects the claimant’s actual medical condition and ability to function over time.
Newfield Law Group represents individuals seeking disability benefits under ERISA and individual disability insurance policies. Every disability claim is different, and the outcome depends on the terms of the applicable policy, the medical evidence, the claimant’s occupation, and the facts of the individual case.