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The challenges of getting disability coverage for chronic fatigue syndrome

On Behalf of | Nov 15, 2021 | Long Term Disability Claim Denial

Most people know what it feels like to be tired. Lack of sleep, a busy week or two, and excessive stress are common experiences that make tiredness almost universal in our country.

However, this common experience of being tired is not even close to the magnitude experienced by those suffering from chronic fatigue syndrome. And although this diagnosis is quite common (affecting millions of people) and quite debilitating, it is often denied for disability claims.

What is chronic fatigue syndrome?

Known as Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), chronic fatigue is difficult to diagnose. According to Mayo Clinic, no single test for CFS exists right now, although, as we discussed in a previous blog post, scientists have been working hard to find a biomarker that could isolate CFS.

To further complicate matters, CFS usually includes symptoms that appear very similar to other illnesses, like sleep disorders, medical problems that cause fatigue and mental health issues.

How do you know if you have CMS?

In order to obtain disability coverage for CMS, you would have to prove to your employer-provided disability insurance carrier that your symptoms fit the diagnoses.

According to Mayo, CMS includes:

Guidelines proposed by the United States Institute of Medicine define the fatigue associated with chronic fatigue syndrome as being:

  • Your fatigue has to be severe enough to interfere with your ability to engage in activities you formerly engaged in.
  • The fatigue has to be of recent onset, not ongoing from birth.
  • The fatigue has to be not relieved by rest.
  • The fatigue has to be worsened when you exert yourself physically, mentally or emotionally.

In addition, you must be experiencing at least one of these two symptoms:

  1. Difficulty with memory, focus or concentration, or
  2. Dizziness that worsens with movement, for example, sitting down, standing up or lying down

Having the symptoms of CMS and proving it to your insurance carrier are two different things.

This is where an experienced attorney can help you. Since coverage for CMS is so frequently denied by carriers, it is critical to get all of the elements of the elements of illness communicated clearly by a medical professional. Your doctor should list out your symptoms clearly and make sure they comply with the terminology demanded by the insurance carrier.

If you are experiencing these symptoms and think you might have a disability claim for CMS, seek legal and medical help immediately. The stakes are high. Proceeding correctly is critical to obtaining the benefits you need.