Chronic Fatigue Syndrome Leading to Long-Term Disability

Can I Get Long-Term Disability for Chronic Fatigue Syndrome in BC?
Yes. If chronic fatigue syndrome (also called ME/CFS) stops you from doing your job and you have long-term disability coverage, you may qualify for LTD benefits in British Columbia. Insurers often deny these claims because fatigue and pain are “invisible.” The right medical evidence, daily-life proof, and legal support can make the difference between a denial and a fair settlement.

In general, in order to receive a diagnosis of chronic fatigue syndrome, you must have both of the following two criteria:

1. You must have severe chronic fatigue for at least six months with other known possible medical conditions excluded by clinical diagnosis.

2. You must have concurrently four or more of the following symptoms:

• substantial impairment in short-term memory or concentration
• sore throat
• tender lymph nodes
• muscle pain
• multi-joint pain without swelling or redness
• headaches of a new type, pattern or severity
• unrefreshing sleep
• post-exertional malaise lasting more than 24 hours

The symptoms must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue.

Why seek legal advice and legal representation for Chronic Fatigue Syndrome?

If your Chronic Fatigue Syndrome is preventing you from working and if you have long term disability coverage, you are eligible for long term disability benefits.

However, many insurance companies deny long term disability applications from Chronic Fatigue Syndrome patients. If your application is denied, you should hire a lawyer and sue your insurance company.

Long Term Disability Lawyer Tim Louis has been acting for individuals with Chronic Fatigue Syndrome for over three decades.

Do not waste your time appealing your long term disability benefits denial. Your appeal will be dealt with by an employee of your insurance company. There is little likelihood that your appeal will be successful. What the appeal will do is delay the point in time when you start your lawsuit.

Your lawyer will typically hire experts to provide reports supporting your claim for long term disability Benefits. This is important as if your lawsuit goes to trial the judge will need to hear from experts and not just from yourself.

How insurers assess “disability” with chronic fatigue:

• • Work demands vs your functional limits

  • Consistency between your medical notes, claim forms, and daily activities

  • “Objective” vs subjective symptoms and why that distinction is unfair for CFS/ME

Common reasons CFS LTD claims are denied:

• • “Lack of objective evidence”

  • Surveillance or social media snippets taken out of context

  • Ignoring post-exertional malaise and “good day / bad day” cycles

Chronic Fatigue Syndrome Example Case

I acted for an individual suffering from Chronic Fatigue Syndrome. His insurance company had denied his long term disability application.

Like many others, his symptoms would wax and wain from day to day. Many days he would be bedridden for the entire day. Sometimes he would have a great day – a gift from heaven. It was always very difficult for him to resist the temptation to do all the activities he wanted to do on a great day.

Eventually, he learned to never do more than half of what he felt he was capable of doing on a great day. If he did more, there would be a devastating rebound effect the following day.

One day, there was a knock on his front door. He opened the door and a woman explained that her car had stalled in front of his home blocking traffic. She asked if he could help by pushing her car out of the way. He was a very kind man, and did so. Unbeknownst to my client, she was an actor. The insurance company had hired a private investigator to film him pushing her car. The insurance company knew that the video might be devastating to my client’s case at trial.

Fortunately, my client’s landlord was a retired RCMP officer. He lived above my client. He confirmed that my client spent many days every week bedridden.

I provided the landlord’s written statement to the insurance company letting them know that he was a retired RCMP officer. Days later, the insurance company came to the table re-settled, and we settled for over $300,000.