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Winning Disability Benefits for Chronic Fatigue Syndrome

Posted by
David Brannen
on March 24, 2018
Are you suffering from the long-term symptoms of Chronic Fatigue Syndrome? Does your illness prevent you from fulfilling your duties at work?

If you have started to apply for long-term disability benefits or are considering beginning the process to lift the financial weight off your shoulders, you probably already know that winning disability benefits is no walk in the park. Because insurance companies consider Chronic Fatigue Syndrome an invisible medical condition, you will have to prepare diligently for this fight.

You might have already managed the long-term symptoms, endured the social stigmas, and slugged through the difficult process of gaining a formal doctor’s diagnosis for Chronic Fatigue Syndrome. The last thing you want now is a bureaucratic nightmare on top of your debilitating long-term illness. We can help you avoid that extra pain and prepare you for the singular challenge of applying for long-term disability benefits.

Just because Chronic Fatigue Syndrome isn’t a leading cause of disability from the workplace in Canada doesn’t mean you shouldn’t get the benefits from the insurance you’ve already paid for. If you are suffering from Chronic Fatigue Syndrome in Canada, I can help you take first steps towards securing the support that you are entitled to. This article is part of our series examining medical conditions and disability benefits


Have Patience and Take Care of Yourself When Securing a Diagnosis

A successful doctor’s diagnosis of Chronic Fatigue Syndrome isn’t a guarantee that your disability claims will also be successful, but it is a great start. You should take a gradual and patient approach to gaining your diagnosis.

There’s no single test to diagnose Chronic Fatigue Syndrome. Like other invisible illnesses such as arthritis or fibromyalgia, it can be difficult to secure a clear diagnosis, get acknowledgment from your employer, or understanding from family and friends.
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You may have already fought this uphill battle, but if you’re still at the diagnosis stage, remember there is no single test for Chronic Fatigue Syndrome. The reason for this is because it mimics other health problems. Your doctor must rule out sleep disorders, medical problems, and mental health issues.

In the case of sleep disorders, a sleep study can rule out insomnia, restless legs syndrome, or obstructive sleep apnea. Common medical problems which your doctor must account for, possibly by using a blood test, include hypothyroidism, diabetes, and anemia. Other common health issues like anxiety, depression, or bipolar disorder yield chronic fatigue and can be ruled out by a counselor.

Remember, diagnostic criteria for chronic fatigue syndrome includes at least six months of unexplained and persistent fatigue with at least four of the following symptoms: loss of memory concentration, sore throat, enlarged lymph nodes in your neck or armpits, unexplained muscle pain, pain that travels from joint to joint without swelling, new type or pattern of headache, unrefreshing sleep, or extreme exhaustion lasting a day or longer after physical or mental exercise.

You may already have a firm doctor’s diagnosis and be on medications like antidepressants or sleeping pills. For therapy, you may already engage in graded exercise or psychological counseling. On top of this, you are probably aware of setting time aside for yourself to reduce stress, improve your sleep, and maintain steady daily activity.

Because it can take some time to secure a winning disability insurance claim, coping and support from family and friends and counseling can help you deal with the chronic illness while you prepare your case.

Once you’re properly diagnosed, you’ve taken a critical step toward winning your disability benefits. The next step is preparing a successful disability insurance claim. You could be up against insurance companies willing to confuse your illness to avoid paying the benefits you paid for. You’ve spent the time fighting chronic fatigue and meeting with doctors to gain the diagnosis—now it’s time to get the financial help you deserve.

Before I share details about insurance claims specifically related to Chronic Fatigue Syndrome, you should be aware of which disability benefits you qualify for.


Which Disability Benefits Do I Qualify For?

When it comes to claiming long-term disability benefits, you might be eligible for one of two types of disability benefits if you are a worker. These are the Canada Pension Plan (CPP) disability benefits and the long-term disability insurance benefits.

The Canada Pension Plan (CPP) for Chronic Fatigue Syndrome:

The CPP, designed to support you after retirement, also covers disability benefits that start once you become disabled and last until you are 65. After that, these disability benefits are converted into regular pensions.

In order to be eligible for the CPP disability benefits, you have to have worked for four out of the past six years and paid payroll taxes. The CPP requires you to prove that your disability is both prolonged and severe, leaving you unable to work.

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Long-term disability insurance benefits for Chronic Fatigue Syndrome:

Group disability insurance policies are the most common type of disability insurances in Canada. If your employer has insured you as part of a group, you are receiving your disability insurance through your job. These group disability insurance policies provide both long-term ad short-term disability benefits.

If you are suffering from a chronic form of Lyme disease, you can apply for the long-term disability benefits if eligible. If successful, these will provide you with monthly income payments during long absences from work to take the financial pressure off you.

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Specific Challenges of Applying for Long-Term Disability Benefits for Chronic Fatigue Syndrome

I’ve already described the difficulty of gaining a firm diagnosis for Chronic Fatigue Syndrome. The root of this is the simple fact that there is no single test to confirm a diagnosis of Chronic Fatigue Syndrome. Because of this difficulty, you probably won’t be surprised to find that this directly impacts how insurance companies and the CPP will handle your disability claim. The insurance companies and the CPP disability program generally aren’t enthusiastic to give out disability benefits for an illness such as Chronic Fatigue Syndrome.

Barrier.jpgYou will have to present a very well organized application that includes well-documented medical evidence ruling out all other causes of your fatigue.

The CPP disability administration will not approve your CPP disability benefits just because a doctor diagnosed you with the condition. To win CPP disability benefits for Chronic Fatigue Syndrome, the true challenge is to prove that your symptoms render you unable to function in any workplace while taking into account your age and work experience.

Here are some detailed considerations:

  • You must show that you are unable to do your regular work, past jobs you have held, and any other gainful employment.
  • You must have medical documentation to show your doctors have ruled out the fatigue being caused by other underlying medical conditions noted above, like depression, anxiety, sleep disorders, Anemia, or an underactive thyroid.
  • You must clearly identify the diagnostic criteria outlined above and these criteria must be clearly documented in the medical records by the treating physicians.
  • In addition, laboratory findings can be very important if they show elevated antibody titer to Epstein-Barr virus, capsid antigen equal to or greater than 1:5:120 or early antigen equal to or greater than 1:640.
  • If you have claimed any deficits in mental functioning, including short-term memory problems, information processing problems, concentration deficits, comprehension deficits, or visual-spatial problems, you must have medical documentation to support them.
  • Above all, and even if the diagnosis of Chronic Fatigue Syndrome is not undisputed, it is critical to have your symptoms and impairments well documented.

Denied Disability Benefits for Chronic Fatigue Syndrome? What You Should Do Next

You’ve filled out the forms and you’ve compiled as much evidence as you could get – and yet, the letter you get politely denies you the right to disability benefits, effectively forcing you back to work.

This is a tough time, and I know that – I’ve seen it over and over again with my clients. You don’t know what you’ve done wrong, and a rejection can feel like an unjustified slap in the face. Being told your condition doesn’t warrant financial support to give you some space to breathe and focus on your recovery adds humiliation and frustration to the chronic fatigue. Having to force yourself back to work can have devastating consequences for your physical and mental health.

There is a light at the end of the tunnel. The good news is that you don’t have to simply accept that your rightful claims have been denied. You can appeal the insurance company's decision instead. I have accumulated years of experience with disability benefits claims, including cases of Chronic Fatigue Syndrome. I know what you are going through, and I’m confident that I can help you. You have a choice. You do not have to let insurance companies get away with denying you the support you are entitled to by law.

Still Feeling Unsure About Your Disability Claim? Sometimes a quick call with us can answer your concerns and help you move forward with confidence. Call us now at 888-732-0470 for a free consultation or click here to request a free consultation.

Tags: Disabling Medical Conditions

David Brannen
Founder & Managing Lawyer, Resolute Legal
David is a former occupational therapist turned disability lawyer. He is the founder of Resolute Legal and author of A Beginner's Guide to Disability Insurance Claims in Canada and The Beginner's Guide to CPP Disability.