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Chronic Fatigue & Long-Term Disability Insurance

Commonly known as myalgic encephalomyelitis, chronic fatigue syndrome is a disease that, according to the CDC, may affect as many as 2.5 million Americans. Unfortunately, most active cases reportedly remain undiagnosed.

The disease causes a range of different symptoms, although not all of these are present in every case. In general, however, chronic fatigue causes people to lose the ability to carry out normal activities because of extreme tiredness. This fatigability can be both physical and cognitive.

If you have short- or long-term disability coverage from an employer-purchased group or individual disability insurance policy and you develop chronic fatigue syndrome, you may be entitled to monthly disability insurance benefits. 

What Is Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)?

Chronic fatigue syndrome has a wide range of potentially disabling symptoms. However, per the CDC, there are three “core” characteristics of ME/CFS that must be present for a diagnosis to occur, as well as one of two secondary symptoms.

First, you must experience a significant reduction in your ability to do things you could do without issue before you became ill. This loss of ability does not follow abnormally difficult activities (such as, for example, strenuous exercise), and it does not go away fully after periods of rest or sleep.

Next, you should notice symptoms of ME/CFS getting worse after activities (whether physical or mental) that would not have caused an issue before you got sick. This feature of the illness is sometimes called post-exertional malaise (PEM).

There must also be some issue with your sleep. Periods of sleep do not give chronic fatigue patients the same level of recovery as the average person, and sufferers of the condition may also have trouble getting to sleep or staying asleep. They may also wake up from sleep unrefreshed. 

Finally, to get diagnosed with ME/CFS, you must either experience:

  • Cognitive issues, such as difficulties with thinking clearly or processing thoughts, trouble remembering things, or executive functioning problems, or
  • Disimprovement in your symptoms while sitting or standing upright. This is known as orthostatic intolerance

Other Symptoms of Chronic Fatigue Syndrome

While the issues above are the official defining symptoms of ME/CFS, they are not the only ones. Patients suffering from this syndrome also report issues like:

  • Pain in muscles or joints
  • Headaches
  • Gastrointestinal (digestive) distress
  • Mental health issues, like depression and anxiety
  • Sensitivity to noise or light

Treating chronic fatigue syndrome can be very challenging, as it’s not always easy to determine the reason for the condition and there is currently no cure. Even if your physician can identify what caused you to develop chronic fatigue, that doesn’t guarantee they will be able to medically fix your problems.

Chronic Fatigue Syndrome & Long-Term Disability Insurance

Chronic fatigue is often debilitating enough to prevent sufferers from doing important professional or recreational activities. However, in order for ME/CFS to qualify you for monthly disability insurance benefits, there are certain requirements you must satisfy.

Firstly, you must have purchased a short- or long-term individual disability insurance policy, or have a group short and/or long-term disability group policy. Consulting with a California disability insurance attorney about this self-reported syndrome and the specific provisions of your policy is the best way to find out whether you’ll be eligible for compensation.

If you’re insured, you must secure a medical diagnosis from a suitably qualified healthcare professional before applying for monthly disability insurance benefits. While there is no single test for chronic fatigue syndrome, a physician will be able to diagnose you and objectively outline your functional limitations with specificity. You must have some of the hallmark symptoms of chronic fatigue for a period of at least six months to meet this “rule out” diagnosis.

You must also be able to objectively demonstrate the functional limitations chronic fatigue syndrome imposes on your ability to work. This will depend on the nature of the important duties of your profession and the severity of your symptoms. If you remain capable of working part-time or at a reduced capacity, you may qualify for partial disability insurance benefits to make up the rest of your income, depending on your individual policy or employer group plan.

When deciding whether to begin paying your monthly disability insurance benefits for chronic fatigue syndrome, your insurance company will carefully examine the opinion of your treating doctor. The insurance company will look very closely at your medical records to see how your physician reached their diagnosis and attempted to treat your condition. In addition, the carrier will examine all of your chart notes, documenting treatment, medication and objective testing.

Is Chronic Fatigue a Mental Disorder?

Historically, healthcare professionals believed that chronic fatigue was a psychological affliction, like depression. More recent research has proven this is not the case for the majority of patients. However, you should be aware that your insurance company may try to argue that your condition is, in fact, a mental disorder, as most long-term group disability insurance policies limit benefits to 24 months for mental or nervous conditions, as well as self-reported issues they cause or contribute to.

Can You Get Chronic Fatigue From COVID-19?

Medical professionals across the world are currently grappling with a new phenomenon called long COVID, a condition that arises in the weeks and months following an initial COVID-19 infection. The symptoms of the sickness can persist for months; many patients show no signs of improvement, which has led to fears that long COVID may be permanent. 

Though symptoms vary widely from one person to the next, the condition bears many similarities to chronic fatigue syndrome. Post-exertional malaise, for example, is a common complaint among COVID long-haulers. Significantly, up to 75% of people with chronic fatigue syndrome first experience symptoms of the condition after a viral infection. 

Staying Financially Healthy with Chronic Fatigue Syndrome

So, can your long-term disability insurance policy keep you out of financial trouble if you receive a diagnosis of chronic fatigue syndrome? It might, depending on the nature, treatment and duration of your condition and the wording of your policy. The best way to find out whether you’ll be entitled to monthly disability insurance benefits arising from chronic fatigue is to seek legal advice from a trusted long-term disability attorney.

At DarrasLaw, we can offer you a free initial case review and analysis of your individual or employer-sponsored policy. If you’ve already filed an ERISA disability claim only to have your insurer reject it, we can help plan your next move. Contact us today to learn more about how our California disability lawyers can help you today.

DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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