Our client had been a successful executive in her 50s, working for the same employer for more than 20 years. She did more than work. She loved hiking, boating, concerts, and traveling with her family. Then her world became so small that even ordinary activity left her bedridden for days.
She found herself unable to continue working because of debilitating fatigue, post-exertional malaise (PEM), cognitive dysfunction, dysautonomia, and Postural Orthostatic Tachycardia Syndrome (POTS). Despite initially approving her disability claim, New York Life later terminated her benefits and denied her long-term disability claim.
Becoming disabled was only the beginning of the struggle. The physical limitations caused by her serious illness paled in comparison to the emotional and financial burden that followed when the New York Life disability insurance company questioned and then denied her short term and long term claims. Following an extensive administrative appeal prepared by Newfield Law Group, New York Life ultimately reinstated her benefits and approved her long-term disability claim.
Her case demonstrates the importance of identifying the necessary objective medical evidence to support the impairments, experienced legal advocacy, and a thorough understanding of how complex chronic illnesses affect the ability to sustain full-time employment. Collectively, this helped to present a submission that NY Life could not overcome.
A Successful Career Interrupted by a Devastating Illness
Before becoming disabled, our client enjoyed a career as a Senior Brand Manager of Community Engagement for a large regional supermarket chain with more than 160 locations and annual sales exceeding $4 billion.
Her position demanded more than a traditional office schedule.
She was responsible for strategic planning, executive-level presentations, coordination with internal departments and outside organizations, community outreach initiatives, branding decisions, project management, and approximately fifteen major community events every year in addition to her normal workweek.
The position required sustained concentration, executive decision-making, multitasking, travel, and the ability to consistently perform at a high level under pressure.
For more than twenty years, she successfully met those expectations. Then everything changed.
Living with ME/CFS, Long COVID, POTS, and Dysautonomia
Following a serious post-infectious bout of Lyme disease, our client developed a constellation of medical conditions that dramatically altered every aspect of her life.
Her treating physicians diagnosed multiple conditions, including:
- Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
- Postural Orthostatic Tachycardia Syndrome (POTS)
- Dysautonomia
- Significant cognitive impairment
- Reduced functional capacity
- Persistent fatigue not relieved by rest
Unlike ordinary fatigue, ME/CFS is recognized as a serious medical disorder that can produce profound reductions in quality of life and functional ability. One of its defining characteristics is post-exertional malaise (PEM)—the delayed worsening of symptoms after even minimal physical, cognitive, or emotional activity.
A person may appear capable of performing an activity for a brief period, only to experience severe exhaustion, cognitive decline, pain, dizziness, and worsening symptoms hours or even days later. Recovery can take days or weeks.
This pattern makes sustained full-time employment extraordinarily difficult.
Objective Testing Confirmed Severe Functional Impairment
One of the central issues in the appeal involved the existence of objective medical evidence. When New York Life terminated her short-term disability benefits, our client informed the insurer that additional specialized testing was underway to better document the extent of her impairments.
According to the appeal, the benefits were nevertheless terminated before that testing was completed. Once available, the results painted a remarkably consistent picture.
The Two-Day CPET Confirmed Significant Disability
Among the most persuasive evidence was a two-day Cardiopulmonary Exercise Test (CPET), widely regarded as the gold standard of objective assessments of functional capacity in patients with ME/CFS and post-exertional malaise. Unlike routine exercise testing, a two-day CPET measures how the body’s cardiovascular, respiratory, and metabolic systems respond to repeated exertion.
The results were striking. The testing laboratory reported that our client demonstrated normal effort throughout the evaluation with no evidence of malingering or symptom exaggeration.
Yet despite her genuine effort, the objective findings showed:
- Moderate to severe functional impairment
- Abnormal oxygen consumption
- Reduced workload capacity
- Impaired cardiovascular response
- Abnormal respiratory performance
- Delayed recovery following exertion
Rather than relying solely upon subjective complaints, these findings objectively documented that her body simply could not sustain normal physical activity. For patients suffering from post-exertional malaise, this distinction is critically important.
Extensive Neurocognitive Testing Supported Her Cognitive Limitations
Physical impairment was only part of the story. Our client also underwent an extensive battery of neuropsychological testing conducted by a qualified specialist. The evaluation included numerous standardized assessments measuring attention, executive functioning, learning, memory, verbal fluency, processing speed, sustained concentration, visual memory, auditory discrimination, behavioral symptoms, and psychological functioning.
The examining clinician concluded that the objective testing supported her reports of significantly diminished cognitive abilities.
Among the areas affected were:
- Sustained attention
- Executive functioning
- Learning
- Memory
- Mental efficiency over extended periods
- Information processing
Equally important, the examiner concluded that despite numerous treatments and therapies, her prognosis for meaningful improvement remained poor. These findings were consistent with the opinions expressed by her treating physicians.
Treating Physicians Documented an Inability to Sustain Full-Time Work
Throughout her claim, multiple treating physicians consistently documented significant restrictions and limitations. They explained that because of the unpredictable and fluctuating nature of her illnesses, she could not reliably sustain activity throughout a normal workday or maintain performance over consecutive days.
That distinction often matters.
Disability insurance policies generally evaluate not whether an individual can occasionally perform isolated tasks, but whether they can perform the substantial and material duties of their occupation on a regular and continuous basis. Attendance, reliability, endurance, and consistency are fundamental requirements of competitive employment.
An individual who experiences frequent symptom flare-ups, excessive absences, or unpredictable functional decline may be unable to maintain employment even if they have moments of temporary improvement. The appeal argued that this reality was supported by the medical evidence throughout the administrative record.
The Appeal Challenged the Weight Given to Internal Paper Reviews
According to the appeal, New York Life relied heavily on internal medical file reviews while assigning less weight to the opinions of physicians who had personally treated the claimant over an extended period. The appeal also argued that important objective evidence—including specialized testing performed after the initial termination—deserved careful consideration.
When insurers evaluate complex illnesses such as ME/CFS, Long COVID, dysautonomia, and POTS, paper reviews may present particular challenges because many of the disabling symptoms involve impaired endurance, delayed symptom exacerbation, and fluctuating functional capacity that may not be fully appreciated through a records-only review.
The appeal asserted that a comprehensive evaluation required consideration of the totality of the evidence rather than isolated medical records.
Every Medical Condition Must Be Considered Together
Another important aspect of the appeal involved the interaction of multiple medical conditions. Our client was not suffering from a single diagnosis. Rather, she experienced numerous coexisting illnesses that compounded one another. Her fatigue affected her cognitive functioning. Her dysautonomia worsened her exercise tolerance. Her POTS limited her ability to remain upright for prolonged periods. Medication side effects further affected concentration and stamina.
The appeal argued that evaluating each diagnosis separately failed to capture the cumulative effect of these conditions on her ability to function in the workplace.
Federal courts have repeatedly recognized that disability evaluations must consider the combined impact of all medically supported impairments rather than examining each diagnosis in isolation.
Family Members Described the Human Cost of Disability
Medical records tell only part of the story. Our client’s husband and daughters also submitted personal statements describing the dramatic changes they witnessed after her illness. Before becoming disabled, she enjoyed boating, camping, hiking, concerts, sporting events, travel, and family vacations.
She planned activities. She organized events. She actively participated in family life. After becoming ill, those activities largely disappeared.
The family described a woman whose daily life became centered on managing debilitating symptoms rather than enjoying the experiences she once loved.
These observations helped illustrate how profoundly her medical conditions affected her daily functioning outside the workplace.
The Importance of a Full and Fair ERISA Review
ERISA governs many employer-sponsored disability insurance plans and requires insurers to provide claimants with a “full and fair review” of denied claims. In this case, the appeal presented a detailed medical and legal analysis addressing objective testing, treating physician opinions, vocational demands, neurocognitive evidence, family observations, and current medical literature regarding ME/CFS and related disorders.
The appeal argued that the evidence demonstrated an inability to sustain the demands of her own occupation and that the administrative record, when viewed as a whole, supported continuing disability benefits.
Newfield Law Group Gets Her Benefits Reinstated After a Comprehensive Appeal
Following the submission of the appeal, New York Life reinstated our client’s disability benefits and approved her long-term disability claim.
The result provided more than financial security. It validated years of medical treatment, extensive diagnostic testing, and the consistent opinions of the physicians who had cared for her throughout her illness.
After years of faithfully serving her employer, she finally received the disability benefits designed to protect employees when serious illness makes continued work impossible.
What This Case Means for Other Disability Claimants
This case illustrates several important lessons for individuals facing disability insurance denials.
The administrative appeal is the most important stage of an ERISA disability claim. Once litigation begins, opportunities to add new evidence are often extremely limited.
Complex illnesses such as ME/CFS, Long COVID, POTS, and dysautonomia can be objectively documented through appropriate testing, careful medical evaluation, and consistent clinical evidence.
Equally important, disability insurers evaluating ERISA claims must consider all relevant evidence—including treating physician opinions, objective testing, vocational requirements, family observations, and the cumulative impact of multiple medical conditions.
An experienced disability insurance attorney can help ensure that the administrative record fully documents both the medical condition and its real-world impact on the ability to sustain competitive employment.
For our client, that comprehensive approach made all the difference. After the successful appeal, her short-term disability benefits were reinstated, her long-term disability benefits were approved, and she was finally able to focus on what mattered most—managing her health rather than fighting for the long term disability insurance benefits she deserved.