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The process of filing an LTD claim under Chronic Fatigue Syndrome

On Behalf of | Jan 22, 2018 | Long-Term Disability Insurance

Chronic Fatigue Syndrome is not just a diagnosis. It affects every aspect of your life, including your livelihood. This, in turn, affects the children you are trying to raise and support and the home you may be afraid of losing. Unfortunately, not many insurance companies truly care about how the financial heaviness weighs on you or how it affects your family.

To insurance adjusters, whether or not your long term disability insurance claim is approved, it is just another series of paperwork and a task to check off. Sadly, the emotions behind your circumstances are not what moves decisions to be made, and the companies involved will want to save money and avoid paying claims whenever they can.

What is chronic fatigue syndrome?

Chronic Fatigue Syndrome (CFS), is associated with symptoms of extreme fatigue lasting more than six months. It is also known to produce pain and malfunctioning sleep patterns. What makes symptoms more severe is any type of accelerated physical activity. Unfortunately, symptoms are persistent and do not improve even after getting adequate rest.

Chronic Fatigue Syndrome affects many more women than men, especially women between the ages of 19 to 40 years of age. Incidentally, this is the prime age range for working adults and mothers raising children. All these factors taken into consideration, you can see just how detrimental this type of diagnosis can have on anyone, but especially working mothers, who may be single, widowed, or still having to survive on two incomes.

What causes LTD claim denial or delays?

Approving an insurance claim for CFS individuals has its own unique set of obstacles.

  • Medical document wording and description— CFS is seen as only a syndrome and not a “disease”. A syndrome is a set of symptoms that point to a classification of a disease; not exactly a disease itself. The diseases associated with CFS are: systemic exertion intolerance disease (SEID) or myalgic encephalomyelitis (ME). It is important to have medical documentation that clearly states how your CFS symptoms are interfering with your ability to perform your job. The more detail of how your work requirements are directly hindered in your medical records, the easier it will be to move forward with your insurance claim.
  • Not keeping copious communication records Maintain an organized filing of all correspondence made between medical offices, human resources, and the insurance company will serve beneficial when managing the circle of communication between the various parties involved. Tracking and verifying document deliveries along with all papers can help you if your claim is denied and you need to seek legal counsel to overrule the decision. Oftentimes, insurance companies dispute approving a claim using ERISA, where it is possible to deny a claim and litigation is the only option. The only permissible information to argue your case at this point is what has been documented in your insurance claim. That is why having copious information on the claim is important.

This is also why your focus should be on presenting the facts and information by the deadlines indicated and if necessary, having the support of a lawyer who will not give up fighting on your behalf. Cases have more favorable outcomes when legal protocol is followed and matters are conducted according to laws and terms associated.

What other mistakes do people make when filing a disability insurance claim?

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