Insurance Lawyers for Denied Chronic Fatigue Syndrome Claims

Insurance claims for chronic fatigue syndrome (also called systemic exertion intolerance disease or myalgic encephalomyelitis) cases are often unfairly scrutinized because CFS lacks a single definitive test. Insurers commonly deny or terminate long-term disability (LTD) benefits by arguing there are “no objective findings.” That is not the legal standard. When credible medical evidence documents functional limitations, especially hallmark symptoms like post-exertional malaise (PEM), unrefreshing sleep, and cognitive dysfunction (commonly referred to as “brain fog”) disability can be proven and benefits should be paid.

If you have been denied disability insurance for CFS decision, you are not alone. Many denials rely on paper-only reviews, misinterpretation of clinical notes, or reliance on outdated criteria. With proper medical support, narrative letters from your treating physicians, and corroborating evidence (e.g., functional capacity evaluations, neurocognitive testing, activity logs, workplace records), your claim can be strengthened by a insurance lawyer for chronic complex conditions.

Symptoms of Chronic Fatigue Syndrome

  • Fatigue which does not go away with rest
  • Decreased cognitive functioning
  • Muscle or joint pain
  • Headaches
  • Sleeplessness
  • Dizziness
  • Extreme exhaustion after physical or mental exertion
  • Irritable Bowel Syndrome (IBS)
  • Irregular heartbeat

Why Chronic Fatigue Syndrome Insurance Claims Get Denied

Attempt to deny disability claims caused by chronic fatigue syndrome. Denials are common for long-term disability claims where the symptoms are subjective in nature.  Insurance companies will often say that if there are no objective symptoms then the disability cannot be supported.  This is not true.  If you have doctors on your side confirming your disability, then you should be getting the benefits you are entitled to.     

Some of the more common reasons for insurance companies to deny an insurance claim for chronic fatigue syndrome are:

  • Overreliance on “objective test” requirements that don’t fit CFS.
  • Document reviews that ignore PEM or discount treating-physician opinions.
  • Misapplication of “own occupation” vs “any occupation” definitions.
  • Failure to consider comorbid conditions (e.g., fibromyalgia, POTS, long COVID) that compound disability in chronic complex conditions.

How We Help

As an insurance lawyer for chronic complex conditions, Taylor & Blair LLP builds the medical and occupational bridge your policy requires. We:

  • Map your symptoms to job-critical duties using recognized diagnostic frameworks (ME/CFS/SEID).
  • Gather and organize medical evidence (FCEs, neuropsychological testing, specialist opinions).
  • Prepare persuasive appeal submissions addressing each denial ground.
  • Advise on insurer requests (IMEs, surveillance issues) and timelines for LTD appeals and litigation.
  • Coordinate with your care team and, where relevant, CPP-Disability considerations.

Experienced Insurance Lawyer for Chronic Complex Conditions

Dealing with an insurance denial can be a stressful and complicated process.  It involves complex contractual issues as well as an understanding of the medical information required to prove your claim.  Having an insurance lawyer who specializes in insurance denial on your side will help to reduce your stress and ensure you get what you are entitled to.  Our insurance lawyers have extensive experience with insurance denials for chronic complex conditions. If your chronic fatigue syndrome long-term disability claim has been denied, contact the lawyers at Taylor & Blair LLP today.