Ask A Lawyer: Frequent and Common Questions About Chronic Fatigue Syndrome

Chronic Fatigue Syndrome, or CFS, is a long term illness that affects your ability to function with a constant feeling of being tired, pain, digestive problems, and problems focusing. (This condition is also known as systemic exertion intolerance disease - SEID - or myalgic encephalomyelitis - ME. Sometimes it's abbreviated as ME/CFS.) Not being able to work because of your CFS may mean you need to apply for long term disability (LTD).

We have compiled some specific questions you may have related to your CFS and disability claim.

My Chronic Fatigue Syndrome is really terrible right now. My doctor told me to take some time off, but my employer disagrees and told the case manager at our group insurance company that I seemed fine. The case manager stated that there is no evidence of a disability and denied my claim. I would like to file an appeal. What can I do to strengthen my case?

It is very important to have strong support from your treating physicians; however, many are too busy or don’t understand the claims process. So, if your claim has been denied and both you and your doctors feel that you are not capable of returning to work, you should consult a lawyer well-versed in disability insurance law.

Because of all the symptoms of my CFS, I have been to several specialists and doctors. For my disability policy, what does, "regular and continuous care of a physician" mean?

Most disability policies contain a provision requiring claimants to be under the continuous care of a physician. It may also require the claimant to be participating in reasonable treatment. We see many cases where benefits are terminated due to an alleged failure of the claimant to be under the regular care of a physician. This then results in a failure to obtain appropriate treatment for their disabling medical condition. In order to avoid being faced with this problem, all efforts should be made to ensure that you are receiving and following the treatment plan that is being prescribed for you.

If access to medical care prevents you from complying with this requirement, all efforts to obtain appropriate medical treatment and the reasons it cannot be obtained should be documented if at all possible. Otherwise, it will be much more difficult for an insurer to rely on this type of defence to a valid disability claim.

I am not surprised that I have been refused my disability claim. My employer has always been difficult, and not understanding at all about me having to take time off because of my CFS. Can my employer influence my insurance company to deny my disability claim?

Unless your employer is self-insured, they have nothing to do with the insurance company's decision to refuse the disability benefits. The insurance company alone makes the decisions regarding acceptance, non-acceptance, or termination of benefits.

The one question you might have when your claim is denied is, “Do I have to do this alone?” Share Lawyers is here to tell you that you are not alone when it comes to fighting for your long-term disability. We have the experience and knowledge to get you the settlement your deserve.

Has your long-term disability claim been denied? Contact Share Lawyers and put our experience to work for you. We offer free consultations and there are no fees unless we win your case. Find out if you have a disability case.

We have recently settled cases against Great West Life, Desjardins, Manulife, RBC Insurance, Sun Life, and much more.We love hearing feedback from our clients, so please share your own experience with us.

Denied your long term disability claim?

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