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CFS/ME and Long-Term Disability Claims: What You Need to Know

Long-Term Disability Benefits for CFS/ME

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a disorder that causes overwhelming tiredness and fatigue that won’t go away. For many, this condition can be debilitating, and simple tasks and chores can be a challenge to complete. Since other illnesses have similar symptoms that mimic CFS/ME, it can pose many obstacles when it comes to a diagnosis. These obstacles can leave someone with CFS/ME without the long-term disability benefits they deserve. Here are seven questions you should know the answers to so that you can protect yourself and avoid a claim denial.

1. Can I get Long-Term Disability Benefits for CFS/ME?

Yes, long-term disability benefits do cover chronic fatigue syndrome. However, they are difficult to diagnose. Since there are no diagnostic tests available, like MRIs and CT scans, the only way for a doctor to determine if a person has CFS/ME is to rule out other conditions that have similar symptoms. You may have CFS/ME if you experience the following symptoms:

  • Extreme fatigue - tiredness that worsens with exertion and does not improve with rest.
  • Flu-like symptoms - body aches, swollen glands, and sore throat.
  • Feeling “foggy” - lack of concentration/ cognitive impairment.
  • Sensitivity to light - you may also be sensitive to noise and chemicals.

CFS/ME claims are often riddled with “red tape.” Since chronic fatigue syndrome cannot be diagnosed through diagnostic testing, there is no way to provide clear evidence of the condition, and diagnosis is based on a doctor’s opinion and experience with CFS/ME diagnoses. Even if your doctor supports that you have CFS/ME, insurance companies will often deny claims regardless of your doctor’s opinion.

It’s critical to keep in mind that you may be required to go through an independent medical exam (IME) by the insurance company’s doctor. The IME doctor works for the insurance company and will typically have an opinion that favors the insurance company. Having a skilled disability attorney, along with good medical documentation, is paramount to increasing your chances of getting the benefits you deserve.

3. What Type of Documentation Should be Included With My Claim?

Having a substantial arsenal of medical documentation that supports your claim can help increase the chances of an approval. When submitting a long-term disability claim for CFS/ME, include the following:

  • Lab work.
  • Statements and doctors’ opinions.
  • Medical records.
  • Letters from family and friends about your condition.

4. Is There a Difference Between Fibromyalgia and CFS?

Fibromyalgia is a disorder that stems from musculoskeletal pain that is also accompanied by fatigue and mood issues. Fibromyalgia and CFS do have similar symptoms. However, those with fibromyalgia often experience more pain-related symptoms, and people with CFS/ME often complain that fatigue is more dominant. Here are the symptoms that they have in common:

  • Trouble sleeping
  • Headaches
  • Loss of concentration
  • “Foggy” memory
  • Dizziness
  • Bloating
  • Diarrhea and/or constipation
  • Anxiety
  • Depression

5. Why Do CFS/ME Claims Get Denied?

There are many reasons why CFS/ME claims get denied. Doctors are often reluctant to make a diagnosis of chronic fatigue syndrome since they cannot use diagnostic testing to do so. They must rely on ruling out other conditions first before giving a definite diagnosis of CFS/ME. Here are some reasons why your CFS/ME claim could be denied:

  • Missing paperwork.
  • Paperwork errors.
  • Lack of proof.
  • Insufficient medical documentation.

6. How Can I Win My CFS/ME Long-Term Disability Case?

Attempting to take on a disability case without legal representation could be detrimental to the outcome of your case. Not only are CFS/ME claims challenging to prove, but insurance companies are also notorious for denying these claims due to a lack of diagnostic evidence. One of the best ways anyone can increase their chances of winning a long-term disability claim for CFS/ME is to have an experienced long-term disability lawyer in their corner.

7. Will I Need a Long-Term Disability Lawyer?

Whether you are putting in a new claim or appealing a denied decision, it’s highly recommended to seek the advice of an attorney that knows how to deal with the toughest insurance companies. Since insurance companies go through each claim with a fine-toothed comb to find the slightest mistake, your attorney will know what they look for and how to combat any pushback that an insurance company tries to give.

Disability Insurance Companies Have Lawyers. Shouldn’t You?

Because this law firm was created to focus on disability insurance, we have developed an expertise in this complex area of the law.

Our expertise in long-term disability claims means our clients have the backing of a law firm that has attorneys who:

  1. Are experts in disability claims;
  2. Fought all major disability insurance companies and know their tactics;
  3. Have a track record of success;
  4. Won major disability lawsuits that created good law; and
  5. Recovered millions of dollars in disability benefits.

All our lawyers commit every day of their legal career to help people get disability benefits from UNUM, MetLife, Prudential, Northwestern Mutual, Hartford, CIGNA, and others.

Because federal law applies to most disability insurance claims, we do not have to be located in your state to help. We help clients nationwide.

Call to get experienced disability lawyers on your side with:

Call for a free consultation with a disability attorney.