Chronic Fatigue Syndrome and Your Long-Term Disability Claim

Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), is a debilitating and often misunderstood condition. It causes persistent, unexplained fatigue that is not relieved by rest and can severely impair one’s ability to function in daily life. Because the symptoms of CFS are often subjective and difficult to measure using traditional medical tests, individuals filing for long-term disability (LTD) benefits frequently face resistance from insurance companies who insure employer-provided disability plans governed by the Employee Retirement Income Security Act of (1974), also known as ERISA.

If your ERISA disability claim for CFS has been denied, you are not alone—and recent federal court decisions have made it clear that insurers cannot ignore or unfairly discount legitimate claims based on this condition.

Insurance Companies Often Dismiss CFS Claims—But Courts Are Pushing Back

One of the most significant decisions in this area is the Ninth Circuit’s ruling in Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666 (9th Cir. 2011). In that case, the court criticized the insurer’s rejection of a CFS claim based entirely on a paper review that ignored the consistent opinions of the claimant’s treating physicians. The court emphasized that objective evidence is not required for conditions like CFS, where such evidence is typically unavailable. In fact, denying benefits solely due to the lack of objective proof—when the nature of the illness makes such proof inherently difficult—is considered an abuse of discretion.

This same principle was reinforced in the 2022 decision Veronica L. v. Metropolitan Life Insurance Company, 647 F. Supp. 3d 1028 (D. Or. 2022). Veronica L., a former UX writer at Google, had her LTD benefits terminated after her insurer, MetLife, claimed there was no objective evidence supporting her continued disability due to CFS. Yet the court found that MetLife had erred by failing to conduct an independent medical examination (IME) and by improperly discounting both the plaintiff’s self-reported symptoms and the assessments of her treating providers. The court remanded the case, instructing the insurer to properly consider the full record, including credible subjective complaints and medical narratives.

Treating Physicians and Credible Patient Narratives Matter

Both Salomaa and Veronica L. recognize that when it comes to CFS, the evaluations and opinions of treating physicians—especially those who observe a patient over time—carry significant weight. In Veronica L., the plaintiff’s care providers, including her primary care provider, psychiatrist, and therapist, uniformly affirmed that her fatigue was severe, unpredictable, and not attributable to mental health alone. The court agreed, noting that even if objective lab findings were limited, the condition could still qualify as disabling.

Another illustrative case is Perryman v. Provident Life and Accident Insurance Co., 690 F. Supp. 2d 917 (D. Ariz. 2010), where the court criticized the insurer for failing to adequately consider the cumulative weight of evidence documenting the claimant’s ongoing cognitive decline and functional limitations. Similar to CFS claims, Perryman involved fluctuating, subjective symptoms and highlighted the importance of evaluating the claimant’s real-world functionality—not just snapshots from medical records.

What This Means for Your Disability Claim

If you are facing a denial of LTD benefits due to CFS or another condition with primarily subjective symptoms, here are some important takeaways:

• You do not need “objective” lab results to prove you’re disabled by CFS.
• Insurers must give proper weight to your treating physicians’ opinions.
• Your own statements about how your condition affects daily life are important evidence.
• Insurers who fail to conduct a proper in-person evaluation risk reversal in court.

How We Can Help

At Roberts Disability Law, we understand the unique challenges that come with filing an ERISA disability claim for Chronic Fatigue Syndrome. We’ve represented many clients whose legitimate claims were denied because insurance companies refused to recognize the disabling nature of their condition. Drawing on key decisions like Salomaa, Veronica L., and Perryman, we work to build compelling administrative records and, when necessary, challenge unlawful denials in federal court.

If your CFS disability claim has been denied, contact us today. We’ll help you fight back against unjust denials and protect the benefits you deserve.