Chronic Fatigue Syndrome, often called CFS, is a debilitating condition that is still relatively ambiguous to the medical field. CFS is also referred to as Immune Dysfunction Syndrome (CFIDS) and Myalgic Encephalomyelitis (ME). Led by persistent, unexplained, recurring feelings of exhaustion, CFS can have debilitating side effects, leaving the sufferer unable to perform most daily tasks or hold a steady job. Disability insurance companies label cases of CFS as self-diagnosed conditions, somewhat similar to Fibromyalgia, making CFS based disability claims much more difficult to get approved. Developing solid, concrete evidence is critical. Today I am going to describe the symptoms that are often present with CFS and how to present the information needed for a successful disability insurance claim.
First, it’s important to recognize the symptoms of CFS before you visit a physician, since many of the symptoms can come and go. This will help you to properly and completely explain your symptoms during doctor visits, allowing your doctor to produce a more accurate and thorough report and disability claim forms for the insurance company. These symptoms are based on a 1994 CDC study that is often used to determine eligibility by the Social Security Administration.
- Clinically evaluated, unexplained, persistent or relapsing chronic fatigue
- Impairment is short-term memory and concentration
- Sore throat
- Tender cervical or axillary lymph nodes
- Muscle pain
- Joint pain absent of swelling or weakness
- New patterns and types of headaches
- Unrefreshing sleep
- Postexertional malaise lasting more than 24 hours
If you are experiencing chronic fatigue along with any or all of the other listed symptoms such that you can’t work, there’s a good probability you are entitled to benefits from your disability policy.
It’s also important to find a doctor who’s experienced in CFS cases. You can find such a doctor through referrals sources, using both on-line searches and more traditional methods like described in this article. If you’re pursuing alternative treatments, please make sure to include MD treatments as well to fully document your claim.
Disability insurers are wary of a diagnosis such as CFS and actively try to delay and deny any such claims. Common claim defense tactics include raising issues such as lack of appropriate medical care, policy exclusions for mental and nervous conditions, self-reported symptoms, and pre-exisiting conditions. It’s important to follow the tips listed below in order to ensure a less rocky claims process.
- A CFS specialist should make your diagnosis and be involved in your care. CFS is commonly misdiagnosed. Make sure your treating physician keeps detailed records of all symptoms and limitations you are experiencing. Having a board-certified doctor such as a rheumatologist, internist or infectious disease specialist should help meet the appropriate care clause in your policy as well as eliminate any questions about the course of treatment or diagnosis.
- Visit a doctor as soon as you begin to feel bad or limited at work. Your date of disability is determined by the date of diagnosis, not the date you began to feel bad. If you continue to try and work through the disability but end up diluting your occupational duties or work schedule, you may be harming or at least delaying your claim. As you try and work through the fatigue, your job responsibilities will start to dwindle as both you and your employer need to compensate for the lack of production. This means that by the time you file a claim, your job duties may be considered so minimal that it’s difficult to qualify for disability benefits at all.
- Do not exaggerate your symptoms to the claims examiner. Many claimants do not realize that every statement they make is taken literally by the claims examiner. For example, if you say your CFS causes you to sleep all day, every day. If a private investigator hired by the insurance company sees you running errands or walking your dog, they can claim you lied about your symptoms. Always be sure to be very specific, detailed, and thorough when describing the effects of CFS on your work life as well as your everyday life.
- Create a thorough and detailed job description. Alone, a diagnosis for CFS doesn’t guarantee that you will receive disability benefits. Make sure your job description clearly shows how your symptoms impair or restrict your ability to perform the everyday tasks of your job. List all of your job responsibilities individually and make sure they are detailed. For example, if you spend a large portion of your day meeting with clients, make sure to describe what kinds of travel is entailed; the durations of the meetings; the level of concentration and attention to detail needed during the meetings; how many meetings you had per week; the how’s, who’s, and when’s of the preparations that go into your meetings, etc.
- Never give up! Insurance companies will try to deny and delay any claim they can – it’s not personal, it’s just business. Unfortunately, this often includes CFS. The companies have come to realize that some claimants will be intimidated by or aren’t healthy enough to fight through the claim adjudication process. While claim denials can be appealed, you must thoroughly prepare and file your appeal, meeting all deadlines. Insurance companies know that some people will misunderstand their obligations or deadlines or will even give up on otherwise legitimate claims.
Chronic Fatigue Syndrome affects over one million Americans each day. Make sure you’re not left in the dark without a source of income if your CFS gets worse. If the disability claim process seems overwhelming, there’s no reason to worry – Royal Claims Advocates was formed to help in such circumstances. Our team of experts have handled many CFS claims, and we’re waiting to help many more. You can reach our firm at (855) 828-4100 or request a free consultation at our website. If you have any comments or would like to share your own story, please feel free to comment below.