A decades-long debate in the medical community over whether myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) constitute a single disorder, or two separate but related disorders, or even if there is a possibility that CFS is actually a broader “umbrella” under which ME fits as a specific instance, have broken into the public consciousness in the past few years due to increasing awareness that the “Long Covid” symptoms some people experience for months or years after initial infection strongly resemble those of ME/CFS. The prevalence of Long Covid has brought renewed attention to chronic fatigue syndrome (CFS) in LTD policies, and thrown into relief the difficulties long-term disability claims for chronic fatigue often present.
In addressing chronic fatigue syndrome, long-term disability policies tend to impose documentation requirements whose demands can actively worsen symptoms for patients, a far from ideal situation. Meanwhile LTD coverage for ME/CFS is often limited, even after claims are approved. Healthcare professionals play a vital role in securing claim approvals, but ME/CFS patients are often forced to shoulder a substantial administrative burden in managing their own claims.
Does Chronic Fatigue Syndrome Qualify for Long-Term Disability?
ME/CFS may qualify for long-term disability benefits in some cases, but keep in mind that the coverage available in any particular situation will depend heavily on the terms of the long-term disability policy under which you are filing a claim for benefits. The duration of the benefit period offered by a specific policy, as well as the criteria established for identifying disability, may play a role in determining how effective any benefits are for a particular patient.
Is CFS a Permanent Disability?
The reason why the duration of long-term disability benefits merits particular scrutiny when considering the adequacy of coverage for chronic fatigue syndrome (CFS) in LTD policies is that the recovery rate for this condition is unfortunately quite low. For many people diagnosed with ME/CFS, the “chronic” part of chronic fatigue syndrome becomes lifelong.
Duration of ME/CFS Symptoms
Estimated recovery rates vary from one study to another, but many medical researchers believe that fewer than 5% of ME/CFS patients recover all or almost all of their pre-illness functioning and quality of life. A higher percentage do see significant improvements, but given how debilitating the illness often is for the most severely impacted patients, these improvements may or may not make a return to full-time work feasible in any specific individual’s case.
Financial Impact of ME/CFS for Patients
As a result of all these factors, individuals whose LTD benefits are designed to last only a few years may face substantial financial challenges once their benefits expire. Even individuals whose long-term disability insurance policies offer more extensive benefit periods may still struggle financially as time goes on if the LTD benefit payments do not make regular cost-of-living adjustments (COLAs).
Recovery and Relapse: Challenges in the Return to Work for ME/CFS Patients
Another factor which can complicate LTD coverage for ME/CFS is that many of the patients who do make measurable progress toward recovery nevertheless also experience periodic relapse. Sometimes these relapses have clear “triggers,” which may or may not be avoidable through careful planning. For other patients, however, the causes of relapse may be unclear, which can make planning to avoid likely triggers all the more difficult. Moreover, these relapse patterns can greatly complicate how long-term disability claims for chronic fatigue syndrome are handled, both for patients and for insurance claim reviewers.
Even in settings far more sympathetic than most claim review offices, developing an adequate and practical plan for the variability in personal function that some partially-recovered patients with ME/CFS experience can prove difficult. Trying to return to work, then once again seeking LTD coverage for ME/CFS, can lead to the development of an on-again, off-again rotation in long-term disability claims with chronic fatigue symptoms. Navigating chronic fatigue syndrome (CFS) in LTD policies can quickly become a complicated undertaking, so if this describes your personal situation you may find it helpful to speak with a disability lawyer who is in a position to help you identify options for coordinating residual benefits with your disability insurance provider.
How Long Can I Collect Long-Term Disability?
Despite their wide variability in personality, work history, and cultural backgrounds, individuals diagnosed with ME/CFS tend to report remarkably similar experiences of their disease onset and progression. One of the most notable and frequently reported of these experiences is a feeling of intense frustration over the persistence of symptoms.
Managing a Sense of Despair
In dealing with chronic fatigue syndrome, long-term disability policies can often be hindered to a degree by the same set of expectations that underlies many of the personal frustrations expressed by ME/CFS sufferers. Unlike an acute infection, or a severe external or even internal injury that shows visible damage on medical imaging scans if not to the naked eye, chronic fatigue syndrome is discernible primarily through the symptoms experienced by patients.
Because the dominant symptom is the severe, crushing fatigue that gives the disorder its name, and because most of us are operating from a lifetime of experience telling us that the cure for transient fatigue is rest, and the cure for lack of energy is to “get in shape,” individuals with chronic fatigue syndrome often feel a deep sense of impatience and even betrayal when neither approach offers improvement, months or years into their chronic illness journey. In the midst of wondering, “Will I ever feel normal again?” individuals who have sought LTD coverage for ME/CFS may have additional questions about the duration of benefits for chronic fatigue syndrome (CFS) in LTD policies.
Long-Term Benefits for Long-Term Illness
Unfortunately, there are very few “foolproof” answers to questions about how long anyone can remain on long-term disability benefits that will apply across all policies. The only way to be sure about the benefit periods for chronic fatigue syndrome long-term disability policies offer is to review the terms of each specific policy. In checking your long-term disability policy coverage, you may want to explore whether the plan you are on contains specific limitations for individual conditions or groups of conditions, as these can sometimes affect LTD coverage for ME/CFS.
Long-Term Disability Claims for Chronic Fatigue Syndrome: Benefit Renewals
You will also likely want to pay close attention to any requirements your policy imposes for benefit renewals. Requirements for new or updated medical documentation are very commonly found in the terms outlining procedures for the renewal of long-term disability benefits.
These requirements are important for anyone who hopes to renew LTD benefit payments due to continuing disability. However, reviewing these requirements well in advance of the submission deadlines and beginning the process of gathering the needed materials as early as possible can be especially helpful in individuals suffering from ME/CFS. Often the medical visits that may be needed to secure the necessary documentation can exacerbate symptoms for ME/CFS patients, and starting early is an imperfect but potentially impactful step toward putting yourself in position to practice careful pacing throughout the process.
Navigating Long-Term Disability Claims for Chronic Fatigue Syndrome
Navigating the complexities of LTD coverage for ME/CFS is a formidable challenge, made more difficult in many cases by the symptoms of the very condition that makes it necessary to file long-term disability claims for chronic fatigue. In handling chronic fatigue syndrome, long-term disability policies differ widely in their effectiveness and degree of coverage, a circumstance which can make it difficult for many ME/CFS patients to determine their options. Considering the stakes and the challenges of managing both your condition and the terms applied to chronic fatigue syndrome (CFS) in LTD policies, you may want to consider speaking with an attorney or disability rights advocate to get help conducting a thorough and proactive review of your own LTD policy terms. In many cases, professional legal guidance can bolster your own careful planning to help you make the most of LTD coverage for ME/CFS in meeting your needs.
