Ortiz Law Firm is dedicated to helping people recover the disability benefits they deserve. We handle group Long Term Disability (LTD) claims, individual disability insurance policy claims, ERISA disability claims, and Social Security Disability claims.

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Benefit Limitations In Long-Term Disability Claims For Chronic Fatigue Conditions

Chronic fatigue conditions are increasingly recognized for impacting a person’s ability to work and perform daily tasks. In many cases, sufferers of these conditions may need to resort to long-term disability (LTD) insurance. Unfortunately, the path to accessing these benefits is not always straightforward, with claimants often facing significant benefit limitations or wrongful denials.

Claiming Long-Term Disability for Chronic Fatigue Conditions

Long-term disability insurance provides income to individuals who cannot work due to a disabling injury or medical condition. In the case of chronic fatigue conditions, symptoms may include:

  1. Severe and unrelenting tiredness.
  2. Difficulty thinking or processing information.
  3. Pain symptoms may include muscle and joint pain, new or worsening headaches, or a sore throat.
  4. Sleep problems that persist for more than six months.

These symptoms can significantly affect a person’s ability to work. Many people with chronic fatigue syndrome (CFS) or other chronic fatigue conditions rely on LTD benefits from a disability insurance company.

Applying for LTD benefits for a chronic fatigue condition can be challenging due to the subjective nature of the symptoms. Providing objective medical evidence to support the claimant’s statements is difficult.

This is compounded by the medical community’s evolving understanding of these conditions and diagnostic criteria that can vary widely. This often leads to considerable skepticism and misjudgment surrounding these conditions. Insurers are more accustomed to dealing with disability claims for conditions that can be objectively diagnosed using standard medical testing.

Chronic Fatigue Condition Limitations in Long-Term Disability Claims

In many LTD policies, some limitations specifically apply to certain conditions. Such limitations may restrict the duration of benefits, often to 24 months. This can be a problem for individuals with chronic fatigue conditions, whose symptoms usually last longer than this period.

One such limitation applies to so-called “self-reported” or “subjective” conditions, including chronic fatigue conditions. Your insurance carrier may argue that your condition is a mental disorder despite recent research that proves otherwise.

Additionally, some LTD policies require the claimant to be under the regular care of a physician or demand objective evidence. Given the nature of chronic fatigue conditions, satisfying these requirements can often be a significant hurdle for claimants.

We have even seen policies specifically limiting the benefit period for chronic fatigue conditions. Here is an example of one such limitation:

Payment of long-term disability benefits is limited to 24 months during your entire lifetime for a Disability caused or contributed to by chronic fatigue conditions including, but not limited to:

  1. Chronic Fatigue Syndrome.
  2. Chronic Fatigue Immunodeficiency Syndrome.
  3. Post Viral Syndrome.
  4. Limbic Encephalopathy.
  5. Epstein-Barr virus infection.
  6. Herpesvirus type 6 infection.
  7. Myalgic Encephalomyelitis.

This limitation will not apply to:

  1. Neoplastic disorders.
  2. Neurological disorders.
  3. Endocrine disorders.
  4. Hematological disorders.
  5. Rheumatologic disorders.
  6. Depression.

Remember, each LTD policy and case is unique. Therefore, specific advice should be sought to consider the nuances of your circumstances. Navigating the complexities of chronic fatigue syndrome long-term disability claims can be challenging, but help is available. Consulting professionals with experience in chronic fatigue conditions and LTD claims can help ensure you take the proper steps.

Wrongful Denial of Claims

Diagnosing and understanding chronic fatigue conditions presents many challenges. As a result, claimants often face a high risk of having their LTD claims wrongfully denied. Insurers may argue that a claimant has not provided sufficient medical evidence or dispute the severity or impact of a claimant’s symptoms.

If your claim has been wrongfully denied, it’s essential to seek advice from a disability lawyer. Find someone who has worked with people diagnosed with chronic fatigue syndrome or another chronic fatigue condition. They can help you review the terms of your policy and understand your rights. They can also help you gather supporting medical records and guide you through the appeals process.

The Appeals Process

Getting long-term disability benefits for chronic fatigue conditions can be tough. But understanding the process ahead of time can help you navigate it better.

If your claim is wrongfully denied, you have the right to appeal. Many denied claims get approved during the appeals process. This may involve a review by the insurance company and potentially a lawsuit in federal or state court.

You must meet all deadlines during the appeals and provide as much evidence as possible. This could include new medical records, doctor statements, and expert opinions on how your condition affects your ability to work. You can even submit personal statements from family and friends describing how your condition impacts your life.

Professional assistance can improve your chances of obtaining disability benefits. Remember, your health is the priority, despite the obstacles. You’re not alone in this journey. Call the Ortiz Law Firm at (888) 321-8131 to schedule a free case evaluation with a long-term disability attorney.