A Federal Court has determined that a claimant suffering from Chronic Fatigue Syndrome satisfied her burden of demonstrating that she was unable to perform the material duties of any occupation, entitling her to reinstatement of her disability insurance benefits. The Court held that the claimant had medical evidence of her condition (CFS), had subjective complaints which served as evidence of her impairment, along with strong support from her treating providers. Further supporting the opinion from the Court was Social Security’s determination of impairment.
The Court rejected the arguments from the insurer, who relied upon the results of a Functional Capacity Evaluation (FCE), in an effort to show that the claimant had residual functional capacity for work. As support for why the Court rejected the FCE, the Court noted that the conclusion of work capacity was not supported by the DOL classification of sedentary work, and that the FCE testing was not of enough duration to sustain an extrapolated finding of functional ability. The Court also rejected surveillance evidence, which the insurer sought to utilize to buttress its claim determination.
Finally, the Court rejected the insurer’s effort to rely upon a mental and nervous disorder limitation in the policy, which could have significantly curtailed the claimant’s benefits. Rather, the Court determined that the depression symptoms were secondary to her CFS.
The Court thus awarded benefits, interest and attorneys fees.
Perryman v. Provident Life & Acc. Ins. Co. Ariz. D. Ct. 2010.