Employees in Chicago making claims for long term disability insurance under an ERISA disability plan can be frustrated when they suffer from fibromyalgia, chronic fatigue syndrome, or other pain or fatigue related conditions. The trouble often is proving you are disabled from a condition that has few objective tests to use in diagnosing, and largely is diagnosed through a process of elimination. Both your doctor and the insurer look at the same absence of positive test results in different ways. Your doctor uses it in a process of elimination to arrive at your diagnosis, where the insurer will often use the absence of this evidence to deny you suffer from any disabling condition. A similar dispute recently took place in Lervick v. Hartford Life and Accident Insurance Company, No. 13-2212 (W.D. Wa. Dec. 9, 2014), and the court held Hartford’s review wrongly denied Lervick disability benefits for Chronic Fatigue Syndrome.
In Lervick, the claimant worked as a senior finance manager and experienced symptoms of Chronic Fatigue. Like most individuals with this condition, it progressively worsened. Lervick was able to work through the symptoms for a while, but as they persisted and worsened, she eventually had to stop working altogether. The stress of her job only made the fatigue worse. Following the diagnostic protocol published by the Center for Disease Control on Chronic Fatigue Syndrome, Lervick’s treating physicians ran all the necessary tests. When all these various tests eliminated another possible cause for Lervick’s fatigue, her doctors properly diagnosed her with Chronic Fatigue Syndrome. Though Lervick had exercise tests demonstrating marked impairment in physical tolerance, and a physical capacity examination that concluded a consistent and predictable work schedule was not possible at any capacity level. Despite this evidence, the insurer denied the claim, asserting that there was no objective evidence or testing that supported a diagnosis of such work restrictions.
The court awarded Lervick her benefits, noting that Chronic Fatigue Syndrome is not shown through blood tests as the insurer implies. It further pointed to the record evidence that the insurer erroneously claimed was absent. The court also noted that a Social Security administrative law judge had awarded Lervick disability benefits. It determined that the opinions of doctors hired by the insurer deserved little to no weight.
If your claim for long-term disability benefits was denied, speak with a knowledgeable ERISA attorney regarding how to secure those benefits.