Chronic Fatigue Syndrome (CFS), also known as Systemic Exertion Intolerance Disease (SEID) or Myalgic Encephalomyelitis (ME), can significantly impact your ability to work. Unfortunately, insurance companies often challenge or deny claims for Chronic Fatigue Syndrome disability benefits, citing a lack of objective evidence or the subjective nature of symptoms. Understanding your rights and how to document your condition is essential for securing the benefits you deserve.
What Is Chronic Fatigue Syndrome?
Chronic Fatigue Syndrome is a complex, chronic condition with no single known cause. Contributing factors can include:
Viral infections
Hormonal imbalances
Immune system deficiencies
CFS is typically diagnosed and managed by specialists such as rheumatologists, who recognize the combination of symptoms and contributing factors. While insurance companies sometimes argue that the absence of a single definitive test makes the diagnosis uncertain, thorough medical evaluation and testing can confirm the condition.
Common Symptoms of Chronic Fatigue Syndrome
Symptoms can vary but often include:
Persistent, debilitating fatigue not relieved by rest
Muscle or joint pain without clear cause
Headaches
Impaired memory or concentration
Unrefreshing sleep
Enlarged lymph nodes or sore throat
Management may involve medications, cognitive therapy, and tailored exercise programs to improve quality of life.
Why Chronic Fatigue Syndrome Disability Claims Are Denied
Insurance companies frequently deny Chronic Fatigue Syndrome disability benefits for several reasons:
Subjective symptoms: Insurers often claim that CFS complaints are unverifiable because they rely on patient-reported experiences.
Limited policy language: Some policies include definitions or exclusions that insurers may attempt to use to reduce benefits.
Lack of objective findings: While a proper medical evaluation can document the condition, insurance companies may argue that standard tests do not confirm disability.
It is important to review your Short Term Disability or Long Term Disability policy carefully to ensure that any limitations or exclusions do not unfairly restrict your claim.
How a Disability Attorney Can Help
Working with a disability attorney experienced in CFS claims can improve your chances of obtaining benefits. Attorneys can:
Review policy language to determine coverage scope
Help gather detailed medical documentation from treating specialists
Prepare a strong claim or appeal addressing insurer objections
Advocate for you throughout the administrative or legal process
At Herbert M. Hill, P.A., our firm focuses almost exclusively on disability insurance claims, including both Short Term Disability and Long Term Disability. The attorneys never represent insurance companies and are skilled in ERISA and private policy disputes.
Frequently Asked Questions
Q: Is Chronic Fatigue Syndrome recognized as a disabling condition by insurers? A: Yes, CFS can qualify for Short or Long Term Disability benefits if your symptoms prevent you from performing your occupation. Proper medical documentation is crucial.
Q: What types of documentation are most effective for a CFS claim? A: Medical records from specialists, functional capacity evaluations, physician statements, and symptom logs or diaries all strengthen a claim.
Q: Can I appeal a denial for Chronic Fatigue Syndrome disability benefits? A: Absolutely. A skilled disability attorney can review your case, identify deficiencies in the insurer’s reasoning, and guide you through the appeal process.
Take Action to Protect Your Benefits
If you are seeking Chronic Fatigue Syndrome disability benefits, you do not need to navigate the claims process alone. Herbert M. Hill, P.A. provides experienced legal guidance for claimants across Florida and the southeastern United States.
Contact us today to schedule a free consultation and discuss your case with an attorney who is skilled in disability claims. We will review your policy, evaluate your medical documentation, and help you pursue the benefits you are entitled to receive.
After discussing your case, we can set up a conference. For most circumstances, that conference would be free of charge. You would not be under any obligation to hire our firm.
Herbert M. Hill, P.A., is located in Orlando, Florida with a practice that extends throughout the state. While the vast majority of the cases we handle are for disability insurance benefits; other areas of practice include employee benefit claims of all sorts. Our firm handles any claims arising under the Employee Retirement Income Security Act (“ERISA”), disability benefits, retirement benefits, medical benefits, pensions, 401ks, termination agreements and the like, as well as claims arising under private disability policies.
