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Long Term Disability Claim Tips: Chronic Fatigue Syndrome Disability & Fibromyalgia

Chronic fatigue syndrome Illnesses Fibromyalgia


Chronic fatigue syndrome and fibromyalgia are conditions with largely subjective symptoms. Therefore, obtaining disability benefits can be challenging to prove under a long-term disability policy. Insurance companies are skeptical of claims based on self-reported subjective symptoms. They often insist that a claimant supply objective evidence in support of disability. If you are disabled because of fibromyalgia or chronic fatigue syndrome, our disability insurance lawyer can help you assemble the evidence that insurers demand to approve a claim. 

Fibromyalgia: Symptoms and Diagnosis

chronic fatigue syndrome disabilityFibromyalgia is a complex condition that manifests in varied ways with each sufferer.  Its cause is unknown.  Chronic pain, sleeplessness, bowel irritation, chronic fatigue, and cognitive difficulties are among the many symptoms that a patient may experience.  In diagnosing fibromyalgia, doctors often will order various laboratory tests to rule out other possible causes, like arthritis.  But there is no laboratory test that will confirm the diagnosis.

The American College of Rheumatology has designated 18 trigger points on the body. Tenderness at 11 out of 18 trigger points indicates fibromyalgia.

Chronic Fatigue Syndrome: Symptoms and Diagnosis

A diagnosis of Chronic Fatigue Syndrome can be based on the criteria established by the American College of Rheumatology. These criteria require widespread pain in all four quadrants of the body (i.e., left and right side, above and below the waist) that has lasted more than three months, along with other symptoms characteristic of the condition.


Like fibromyalgia, the cause of CFS is not known.  Also, like fibromyalgia, there is no laboratory test that can confirm the diagnosis. A doctor will look for these criteria to confirm a diagnosis:

  • Severe chronic fatigue that significantly interferes with daily activities and work; and
  • Lasts for six or more consecutive months; and
  • Is not explained by some other medical condition; along with

At least four of these symptoms:

  • malaise after exertion lasting more than 24 hours.
  • unrefreshing sleep.
  • significant impairment of short-term memory or concentration.
  • muscle pain.
  • multi-joint pain without swelling or redness.
  • headaches of a new type, pattern, or severity.
  • tender cervical or axillary lymph nodes.
  • a frequent or recurring sore throat.

Proving a Fibromyalgia or Chronic Fatigue Syndrome Disability Claim

Central to proving a claim for long term disability benefits based on fibromyalgia or CFS is convincing the insurer you have the correct diagnosis.  Insurers are leery of primary care physicians who diagnose fibromyalgia or CFS simply because they can’t find any other explanation for your symptoms.

Your chances of success are best if you see a rheumatologist who will follow the established criteria in diagnosing your condition. Insurers will want trigger point proof from your doctor for a diagnosis of fibromyalgia and will deny your claim if you don’t provide it.  Similarly, while chronic fatigue syndrome cannot be objectively diagnosed at the present time, there are objective medical tests that are consistent with it. These tests should be obtained.

In addition, neuropsychological testing is often a good idea. It can provide objective evidence of the cognitive deficits from which CFS and fibromyalgia victims often suffer.

Finally, it may be helpful to obtain a functional capacity evaluation.  A FCE tests a claimant’s ability to lift, carry, push, pull, sit, stand, and perform other functions necessary to one’s occupation. These are particularly useful when fatigue is a significant symptom.

Our disability insurance lawyer is familiar with all the testing that should be part of a fibromyalgia or Chronic Fatigue Syndrome disability claim or appeal and will refer you for any testing you need.

Beware of Insurer Attempts to Characterize Your Disability as a Mental Disorder

Most group policies limit benefits to two years when the disability is caused or contributed to by a mental illness. Insurers frequently use these provisions as a shield because the symptoms of fibromyalgia and CFS are often similar to symptoms of depression.  It is much harder for an insurer to make this claim when the treating doctor has followed the proper diagnostic criteria and performed the right tests to rule out other conditions.

Consult with our Trusted New York Disability Insurance Attorneys

CFS and fibromyalgia are particularly difficult to prove, so get professional help before you file your claim or appeal. A disability insurance lawyer at Riemer & Associates will use our years of experience to assist you. Let us take over the case so you can focus on your health.  Call Riemer & Associates, LLC, Attorneys at Law today at 212-297-0700.


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