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Chronic fatigue syndrome (CFS) is a debilitating illness that makes performing daily tasks of living difficult and at times, impossible. The typical symptoms include extreme and ongoing fatigue that does not improve with rest. Other symptoms are headaches, muscle pain and joint pain. Many people who have CFS find it difficult to get out of bed every day. They have little or no energy, and it is hard to concentrate. Individuals who have been highly functioning throughout their entire lives find themselves frustrated, as they simply don’t have the physical and mental capacity they did before becoming sick with CFS.
Diseases like CFS, sometimes referred to as myalgic encephalomyelitis (ME) or Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) and fibromyalgia, are especially challenging because those suffering from these illnesses don’t look sick. Employers and co-workers don’t see a physical change, so they can’t understand why performing complex tasks, or making quick decisions, necessary for a high-level executive, have suddenly become impossible.
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Like fibromyalgia, Chronic Fatigue Syndrome claims are extremely problematic for the disability insurance policyowner. These and related illnesses are considered “subjective conditions” because a diagnosis is not determined by specific test results. There is no single blood test, x-ray or MRI result that clearly indicates that a person is suffering from CFS.
For long term disability insurance companies, seeing Chronic Fatigue Syndrome on a claim form immediately sends up a red flag. The disability insurance company will take the position that a condition must be supported by “objective evidence,” something virtually impossible to provide with CFS.
The disability claim is scrutinized to an extreme degree, with any small detail, misspelling or incorrect date used as a reason to either deny the claim outright or request further information, further delaying payment.
One issue that Frankel & Newfield sees often with CFS claims is the use of the Independent Medical Exam (IME) for a CFS patient. A doctor who has little or zero experience in this particular group of illnesses conducts a physical examination or reads select documents from the person’s medical records. There is nothing that clearly demonstrates a specific reason for the illness, only the symptoms of extreme fatigue and weakness, headaches and joint and muscle pain.
If your primary care physician is not up to date with the diagnostic threshold set by the Center for Disease Control (CDC) that is used to diagnose CFS, your medical record may not support your disability claim properly. He or she may not know the importance of having your medical record outline, in very specific terms, the limitations and task constraints that this condition causes.
The lack of specific diagnostic tests by the claimant’s treating physician are used to delay and deny claims. Unless your physician has had other patients who have been represented by experienced disability lawyers, they won’t know how your medical records need to be prepared and what tests need to be included to bolster your claim.
We often work with medical providers to develop this support, with specific testing. In the CFS universe, we utilize CPET (Cardio Pulmonary Exercise Testing) to seek objective evidence of functional impairment, or Neurocognitive Testing to seek objective evidence of cognitive impairment. Often, these tests can yield support which will help prove a claim.Ready To Talk?
Frankel & Newfield has worked with many CFS claimants and their treating physicians. Jason Newfield has many years of experience focusing on this illness, including serving on the Chronic Fatigue Syndrome Advisory Committee, a federal committee that advises the U.S. Department of Health and Human Services about CFS. Our attorneys understand how a CFS claim needs to be prepared, if possible from the very start, before the claim is even filed, to overcome the many obstacles that the disability insurance company presents.
The disability insurance company personnel also treat people with CFS and related diseases as if they are malingerers, when nothing could be further from the truth. CFS claimants want their old lives and their prior energy levels back. All they can do is try to learn how to live within the severe physical restrictions of this disease.
Claimants find fighting back against enormous insurance companies, with their teams of claims managers and lawyers, overwhelming and impossible That’s where Frankel & Newfield comes in.
If you have been diagnosed as having CFS, contact Frankel & Newfield. We are an experienced disability insurance claim law firm that has successfully represented CFS patients. The disability insurance process is a complex minefield that is not easily navigated, and claims concerning a subjective condition are even more challenging.
Further complicating a disability claim for CFS is that patients often suffer from depression and anxiety, either as part of the disease or because of the disease and how it impacts their ability to enjoy a full and active life. Be careful not to allow yourself to be put in a mental and nervous claim category by your disability insurance company, as coverage for this group of claims is extremely limited, even in many of the best disability policies. Insurers will often seek to apply a limited pay period to claims for CFS, if they in fact accept liability of the claim at all.
Policies that have been issued in the past few years are also likely to contain a provision similar to that of the mental/nervous claim that limits disability insurance payments for more than two years.
This article examines the special challenges faced by CFIDS claimants when applying for Long Term Disability Insurance benefits.
We have developed strong strategies to combat the challenges faced with Chronic Fatigue Syndrome claims. Working with professionals to develop objective evidence of functional deficits, both physical and cognitive, has helped lead to significant success for our client population.
At Frankel & Newfield, we have a long record of successful representation of CFS patients at all phases of the claim process: before filing, during the process of being denied or delayed, in the appeals process, and in litigation. We understand the special challenges that CFS patients face in the disability claim insurance process. Call our offices today at 1-877-LTD-CLAIM (1-877-583-2524) to speak with a partner about your situation or, if you prefer, click here to send us an email.
Justin C. Frankel - Disability Insurance Attorney
Justin Frankel is a founding partner of the disability insurance law firm Frankel & Newfield and is a highly skilled litigator and advocate. He has published numerous articles on the challenges facing clients with private or individual disability insurance policies and those who own group or ERISA disability insurance policies.
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