Managing the pain and exhaustion of chronic fatigue syndrome (CFS) and fibromyalgia can be overwhelming. At times, you might feel like you don’t have the energy to focus on anything but your health—much less navigate the administrative labyrinth of insurance claims. Yet, securing your rightful access to benefits might be essential to maintaining a stable and comfortable lifestyle. So you could likely use some help, and not from just anyone—you need the experienced assistance of a long-term disability lawyer.
Proving your eligibility for long-term disability benefits is, unfortunately, not always a simple or straightforward process. Insurance companies grant benefits sparingly because disability claims are costly. It's possible that they may deny your claim—even if you're entitled to long-term disability. Therefore, you might have to put up a fight to receive your benefits.
For this reason, among others, having a long-term disability lawyer craft and submit your claim can be invaluable. To understand why, here’s a guide to navigating insurance claims for CFS and fibromyalgia.
Understanding Chronic Fatigue Syndrome (CFS) and Fibromyalgia
Both CFS and fibromyalgia are chronic conditions that have severe and debilitating impacts on your mental and physical health.
The primary symptom of CFS—sometimes referred to as myalgic encephalomyelitis (ME)—is an all-encompassing exhaustion that persists even after rest. Clearly, such symptoms can make daily life incredibly challenging. Oftentimes, the degradation of the suffers’ lifestyle may trigger anxiety and depression. And, on top of the fatigue CFS brings, it can also leave you with “brain fog,” pains, and overall flu-like symptoms.
Fibromyalgia mirrors many of the symptoms of CFS in terms of chronic exhaustion and mood disorders. However, this condition is characterized by pain—which spreads through the entire body and is often much more intense than the aches brought on by CFS.
A growing understanding of long-haul Covid-19 within the medical community suggests a link between the lasting impacts of the virus and the development of CFS/ME and fibromyalgia. So, it’s no surprise that viral infections can trigger these conditions. However, multiple other causes, such as genetics, immune system shifts, and hormonal changes, also facilitate these conditions.
The Complexities of Disability Claims for CFS and Fibromyalgia
One of the biggest challenges that you’ll face when filling a long-term disability claim for your CFS or fibromyalgia is a perceived lack of objective medical proof, specifically regarding the causes of the disease. The absence of a medical consensus on the physical manifestation of these conditions adds a degree of uncertainty to what would otherwise be an objective diagnosis.
Often, this can make it difficult to diagnose CFS or fibromyalgia in the first place. For instance, you might have had your condition confused with lupus, MS, or rheumatoid arthritis in the past.
Plus, on top of all these challenges, the Social Security Administration’s (SSA’s) Blue Book—which outlines the criteria a person needs to meet to receive SSDI or SSI without providing added medical evidence—doesn’t contain anything regarding fibromyalgia.
Your insurance company can leverage these combined factors to deny your claim. However, a long-term disability lawyer can fight these wrongful denials in court.
Take, for example, Kantor & Kantor’s recent win in the case of Cochran v. Reliance Standard Life Insurance Company, where a judge overruled a termination of long-term disability benefits in court. The insurance company, in this case, cited a lack of objective medical proof to justify their termination. The judge noted that there is currently no existing way to provide objective evidence regarding CFS and fibromyalgia. Thus, the judge struck down the initial denial.
The Role of a Long-Term Disability Lawyer in CFS and Fibromyalgia Claims
Your attorney will wade through the mire of paperwork, clauses, and legal structures that stand between you and your long-term disability benefits.
If you select a long-term disability lawyer who specializes in this unique practice area, you’ll be able to rely on their deep understanding of how to gather sufficient medical evidence to meet the necessary legal requirements. They’ll know how to avoid the hidden details buried in legal codes and insurance plan documents that might result in a denial of your claim. Plus, they can fight your case in front of the judge if your claim is denied.
Highly knowledgeable long-term disability lawyers can help you obtain additional documentation. These include vocational analyses and functional capacity evaluations (FCSs), which can make all the difference in court.
But your long-term disability lawyer can do so much more than just help you craft an airtight claim. An attorney specializing in CFS and fibromyalgia disability claims can also leverage their in-depth knowledge to ensure that you’re receiving the full compensation available to you.
Even if your claim is accepted, you might not be granted the full extent of what you are owed. In fact, it's possible that you would never know you're being shortchanged without a professional looking out for your best interests.
Empowering Individuals with CFS and Fibromyalgia
You might feel like you’re up against the world, trying to battle both your symptoms and your insurer. However, it might give you comfort to know that while the process of obtaining benefits might be trying—so long as you’re resilient—the odds are in your favor.
Law firms like Kantor & Kantor have a track record of reversing denied claim appeals. For example, in one instance, we managed to help our client obtain long-term disability benefits despite defendant Paul Revere’s initial 24-month limitation on the claim.
It’s also important to remember that your FCS or fibromyalgia might define how you feel at times—but it doesn’t need to define who you are. If you’re struggling with the mental effects of physical pain or exhaustion, then try to find a support system.
There are many support groups out there specifically trying to help you and others going through similar struggles. Here are some excellent places to start:
- ME/CFS & Fibromyalgia Self-Help is a non-profit with low-cost online courses and resources
- The Centers for Disease Control and Prevention (CDC) offers helpful information on how to apply for disability benefits
- The Gupta Program aims to retrain your brain to support recovery from CFS and fibromyalgia
- The Arthritis Foundation details specific treatments and changes to try
Finding the Right Long-Term Disability Lawyer
Obtaining a long-term disability lawyer increases your chances of success in submitting a claim. And, if you do have to go to court to secure your benefits, you've already set yourself up ideally. Plus, your lawyer will ensure that you receive the maximum amount allowed in your plan.
That said, you need a law firm that specializes in these types of cases. Kantor & Kantor is a leading firm in long-term disability benefits. Our ERISA Watch keeps our client community updated on current legal developments regarding this issue around the country. The Kantor & Kantor team has extensive experience fighting for long-term disability claimants—and we’re ready to help you win your case too.
Reach out for a consultation with Kantor & Kantor today.