Medically Documenting A Long Term Disability Insurance Claim
Some private employers offer short and long-term disability insurance coverage to eligible employees as part of an ERISA welfare benefit plan. The LTD Plan provides a percentage of pre-disability income in the event the worker becomes disabled.
Individuals can also privately purchase disability income insurance directly through an insurance broker for a specific monthly benefit amount. The latter are not governed by ERISA, but rather state insurance laws.
Just as a physician must provide medical documentation for an ME/CFS SSD claim, she must also medically document the LTD claim. A patient must accurately report the ME/CFS symptoms/limitations to the physician to assist in devising a treatment plan and to clinically document the medical chart for both SSD and LTD claims.
Demonstrating Why You Deserve Disability Benefits
Studies show that fewer than a quarter of people with chronic fatigue syndrome are able to hold down full-time jobs. The symptoms of CFS can severely limit your ability to complete basic work tasks. If you cannot work due to CFS, we can help you apply for benefits.
We will work with your doctor to carefully document your symptoms so as to support the diagnosis of chronic fatigue syndrome and establish your work limitations.
Dont hesitate to contact us to discuss how our experienced disability benefits lawyers can help you obtain the benefits you deserve from the Social Security Administration.
Severity Stages Of Chronic Fatigue Syndrome
As studies showed, CFS may be progressed through 3 stages of severity.
1. Mild CFS
You may limit a leisure activity, but still be okay with regular daily tasks, like household, day-time study or a job.
2. Moderate CFS
At this stage, motivation to move becomes a problem. You prefer to spend more time at home and find such things like shopping really hard proper diagnosis is really important here to prevent serious consequences and disease progression.
3. Severe CFS
Most patients start to look for a wheelchair and additional help to move. They cant live alone anymore, because physical and mental troubles are in progress. Every morning they feel unable to leave the bed and even to make breakfast.
Tip: Did you know some symptoms of CFS overlaps with the High Blood Pressure Symptoms?
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Documenting Disability In Myalgic Encephalomyelitis/chronic Fatigue Syndrome
Issue title: Special Section: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Guest editors: Amy MooneyMS OTR/L
Article type: Research Article
Affiliations: Clinical Professor, Department of Family Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA | Independent Consultant, Connecticut, USA | Law Offices of Barbara Comerford, Paramus, NJ, USA
Correspondence: Address for correspondence: Richard Podell, 30 Ogden place, Morristown, NJ 07960, USA. Tel.: +1 973 650 6028 E-mail: .
Keywords: Myalgic Encephalomyelitis, Chronic Fatigue Syndrome, ME/CFS, disability, functional impairment
Journal: Work, vol. 66, no. 2, pp. 339-352, 2020
When To Ask Your Doctor For An Opinion
If your application for Social Security disability benefits has been denied and you have appealed, you should get a medical source statement from your doctor to use as evidence at the hearing.
When is the best time to request an opinion from your doctor? Many disability attorneys wait until they have reviewed the file and the hearing is scheduled before requesting an opinion from the treating doctor. This has two advantages.
- First, by waiting until your attorney has fully reviewed the file, he or she will be able to refine the theory of why you cannot work and will be better able to seek support for this theory from the treating doctor.
- Second, the report will be fresh at the time of the hearing.
But this approach also has some disadvantages.
Here is an alternative. Suggest that your attorney request your doctor to complete a medical opinion form on the day you retain your attorney. This will provide a snapshot description of your residual functional capacity early in the case. If you improve and return to work, the description of your RFC provides a basis for showing that you were disabled for a specific period. If you change doctors, your attorney can get an opinion from the new doctor, too. If you stop seeing doctors, at least your attorney has one treating doctor opinion and can present your testimony at the hearing to establish that you have not improved.
There are times, though, that your attorney needs to consider not requesting a report early in the case.
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Even The Va Is Still Learning About Chronic Fatigue Syndrome
CFS could be part of a bigger VA disability claim for a higher rating. This official document from the VA talks about CFS being part of a MUCMI claim. A Medically Unexplained Chronic Multisymptom Illness is something that is affecting many soldiers after they come home from the Persian Gulf and other recent conflicts. If you have enough symptoms that point to a MUCMI VA claim, then well present that to the VA instead of just trying to win your claim for chronic fatigue syndrome.
Our staff talks every day with veterans with hard-to-prove disabilities. We know how to work with you, your spouse, and the VA to get you a fair and just hearing. We can even help you appeal a denial and fight for an earlier effective date in case the VA tried you cheat you out of back pay.
Persons Deemed To Be Disabled
A10. The Act provides for certain people to be deemed to meet the definition of disability without having to show that they have an impairment that has a substantial and long-term adverse effect on the ability to carry out normal day-to-day activities. Regulations provide for a person who is certified as blind, severely sight impaired, sight impaired or partially sighted by a consultant ophthalmologist to be deemed to have a disability.
A11. Anyone who has an impairment which is not covered by paragraphs A9 and A10 will need to meet the requirements of the definition as set out in paragraph A1 in order to demonstrate that he or she has a disability under the Act.
What Are The Symptoms Of Chronic Fatigue Syndrome
Like fibromyalgia, there is no known cause or gold standard test for a diagnosis of chronic fatigue syndrome . The nine official signs and symptoms include:
- Loss of memory or concentration,
- Sore throat,
- Enlarged lymph nodes in the neck or armpits,
- Unexplained muscle pain,
- Pain that moves from one joint to another without swelling or redness,
- Unrefreshing sleep, and
- Extreme exhaustion that lasts more than 24 hours after physical or mental exercise.
It is crucial that you provide the result of a Functional Capacity Evaluation or cognitive testing that objectively documents your functional limitations.
Get Help With Your Chronic Fatigue Disability Case
A disability lawyer can use the Institute of Medicine report, which was supported by the Social Security Administration, to rebut a judges assertion that CFS is not a real disease.
At Levine Benjamin Law Firm, we welcome this new name and diagnostic criteria for a disease that we have found to be quite real and limiting for a number of our clients.
If you have CFS, this report can help in winning your disability claim. Youll also need records from your medical treatment showing that your condition is severe enough to prevent you from working.
Levine Benjamin lawyers can gather all your evidence and present it in a way that makes sense to Social Security.
From applying to appealing, we help you every step of the way.
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Does Chronic Fatigue Syndrome Qualify For Canadian Disability Benefits
Also known as Post-Viral Fatigue Syndrome , chronic fatigue syndrome is an umbrella term for a variety of debilitating disorders.
Chronic fatigue syndrome is characterized by consistent fatigue unrelated to exertion, and is not remedied by rest. Fibromyalgia is one such example of chronic fatigue.
The list of chronic fatigue syndrome symptoms is extensive, due to the breadth of debilitating disorders and includes: Widespread muscle and joint pain Cognitive troubles Cardiac problems Respiratory disturbances
The causes of chronic fatigue syndrome are hazy, though statistics show chronic fatigue is more common in people 40-50 years old, with women more susceptible to the condition than men.
It Is Difficult To Get Social Security Disability Benefits For Cfs But Here’s How You Can Improve Your Chances
By Aaron Hotfelder, J.D., University of Missouri School of Law
The Social Security Administration is generally skeptical of disability claims based solely on chronic fatigue syndrome . Claims are rarely approved at the initial or reconsideration levels, and even at the hearing level, most Administrative Law Judges are reluctant to pay benefits except in the most compelling cases.
In cases involving chronic fatigue syndrome, Social Security regulations require that objective medical signs and laboratory findings support the existence of the diagnosis. Self-reported symptoms alone are not enough, despite the subjective nature of many symptoms of CFS. In addition to providing objective evidence of your condition, it’s critical that you request an opinion from your treating doctor regarding your work-related limitations.
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Disability: Equality Act 2010
This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: .
Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.
This publication is available at https://www.gov.uk/government/publications/equality-act-guidance/disability-equality-act-2010-guidance-on-matters-to-be-taken-into-account-in-determining-questions-relating-to-the-definition-of-disability-html
This guidance was first published in May 2011 in PDF format by the Office for Disability Issues .
This HTML version was published in February 2022 to provide the content in a more accessible format. The content has not been changed or updated from the original publication.
How Do I Get The Social Security Disability Benefits I Deserve
CFS can interfere not only with your daily activities but with your ability to work. If you can no longer work or your doctor has told you to apply for Social Security disability, you should hire Nancy Cavey to help you:
The SSA is in the business of denying claims and will use any reason to deny your benefits. The odds of getting your Social Security benefits are greater when you are represented by an experienced Social Security Disability attorney like Ms. Cavey.
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Recurring Or Fluctuating Effects
C5. The Act states that, if an impairment has had a substantial adverse effect on a persons ability to carry out normal day-to-day activities but that effect ceases, the substantial effect is treated as continuing if it is likely to recur. Conditions with effects which recur only sporadically or for short periods can still qualify as impairments for the purposes of the Act, in respect of the meaning of long-term , see also paragraphs C3 to C4 .)
C6. For example, a person with rheumatoid arthritis may experience substantial adverse effects for a few weeks after the first occurrence and then have a period of remission. See also example at paragraph B11. If the substantial adverse effects are likely to recur, they are to be treated as if they were continuing. If the effects are likely to recur beyond 12 months after the first occurrence, they are to be treated as long-term. Other impairments with effects which can recur beyond 12 months, or where effects can be sporadic, include Menières Disease and epilepsy as well as mental health conditions such as schizophrenia, bipolar affective disorder, and certain types of depression, though this is not an exhaustive list. Some impairments with recurring or fluctuating effects may be less obvious in their impact on the individual concerned than is the case with other impairments where the effects are more constant.
It May Be Helpful To Keep A Daily Log Of The Nature And Severity Of Your Symptoms Which You Can Submit To Social Security
Statements from family members, friends, or former co-workers, can also aid in documenting the extent of your impairments. Qualifying for Social Security Disability Income under a diagnosis of chronic fatigue syndrome is not easy. Enlisting the assistance of a qualified disability attorney can greatly increase your chances for a successful claim.
In order to qualify for Social Security Disability, you will need to satisfy a few specific requirements in two categories as determined by the Social Security Administration.
The first category is the Work Requirements which has two tests.
The second category is the Medical Eligibility Requirement.
More details can be found on our Qualifying for Disability page.
What Is Reasonable Accommodation
If you qualify as disabled under the ADA, you have the right to ask for reasonable accommodations from your employer.
A reasonable accommodation is any change to your job or work environment that gives you equal access to employment. Examples of reasonable accommodation for symptoms of FMS or ME/CFS may include:
- Part-time or modified work schedules
- Changing tests, training materials or policies
- Providing written, instead of verbal, instructions
- Reassignment to a vacant position
- Medical leave
- Adjustable lighting
- Relocation of a workstation to a more appropriate location
It’s up to you, not your employer, to come up with what accommodations would help you do your job better.
Residual Functional Capacity Assessment For Chronic Fatigue Syndrome
What Is RFC?
If your chronic fatigue is not severe enough for you to be considered disabled at Step 3 of the Sequential Evaluation Process, the Social Security Administration will need to determine your residual functional capacity to decide whether you are disabled at Step 4 and Step 5 of the Sequential Evaluation Process.
RFC is a claimants ability to perform work-related activities. In other words, it is what you can still do despite your limitations. An RFC for physical impairments is expressed in terms of whether the Social Security Administration believes you can do heavy, medium, light, or sedentary workin spite of your impairments. An RFC for mental impairments is expressed in terms of whether Social Security Administration believes the claimant can do skilled, semi-skilled, or unskilled work in spite of impairments, or whether the claimant cannot even do unskilled work.The lower your RFC, the less the Social Security Administration believes you can do.
RFC and Chronic Fatigue Syndrome
If you have chronic fatigue syndrome, you may have significant residual limitations that could potentially result in allowance of your claim.
In determining your RFC, the Social Security Administration adjudicator should consider all of your symptoms in deciding how they may affect your ability to function. Symptoms of chronic fatigue that the adjudicator should consider include those mentioned in the Center for Disease Controls definition of CFS:
- Mental problems .
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Winning Social Security Disability Benefits For Chronic Fatigue Syndrome By Equaling A Listing
To determine whether you are disabled at Step 3 of the Sequential Evaluation Process, the Social Security Administration usually considers whether your impairment is severe enough to meet or a listing. The Social Security Administration has developed rules called Listing of Impairments for most common impairments. The listing for a particular impairment describes a degree of severity that the Social Security Administration presumes would prevent a person from performing substantial work. If your impairment is severe enough to meet or equal the listing, you will be considered disabled.
The Social Security Administration has no listing for chronic fatigue syndrome. Since CFS is not a listed impairment, you cannot be cannot be found to meet a listed impairment based on your CFS alone. However, the specific findings in your case should be compared to any pertinent listing to determine whether medical equivalence may exist. In other words, you may be entitled to Social Security disability benefits if the severity of your condition equals an existing listing for a different impairment.
Main Elements Of The Definition Of Disability
A1. The Act defines a disabled person as a person with a disability. A person has a disability for the purposes of the Act if he or she has a physical or mental impairment and the impairment has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities ).
A2. This means that, in general:
- the person must have an impairment that is either physical or mental
- the impairment must have adverse effects which are substantial
- the substantial adverse effects must be long-term
- the long-term substantial adverse effects must be effects on normal day-to-day activities
This definition is subject to the provisions in Schedule 1 .
All of the factors above must be considered when determining whether a person is disabled.
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