Chronic Fatigue and Long-Term Disability Benefits in Canada

Living with chronic fatigue can significantly impact an individual’s daily life and ability to work. For those facing challenges due to chronic fatigue, understanding their rights to long-term disability (LTD) benefits can provide much-needed financial support during difficult times.

Understanding Chronic Fatigue

Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), is a complex and debilitating condition characterized by persistent fatigue that is not alleviated by rest and may worsen with physical or mental activity. Individuals with CFS/ME often experience a range of symptoms such as cognitive difficulties (“brain fog”), muscle and joint pain, sleep disturbances, and post-exertional malaise (PEM) where activities can lead to a worsening of symptoms.

Figures from Statistics Canada outline that just over 1.3% of Canadians aged 12 years and older reported a CFS diagnosis. This data also shows that the prevalence of CFS is higher among women across all age groups.

Chronic Fatigue Syndrome and Long-Term Disability

Chronic fatigue can profoundly impact an individual’s ability to perform the essential duties of their occupation. The unpredictable nature of symptoms and the fluctuating energy levels associated with CFS/ME can make it challenging to maintain consistent work performance. As a result, individuals with chronic fatigue may be eligible for LTD benefits if their condition meets the criteria outlined in their insurance policy.

Seeking a Chronic Fatigue Syndrome Diagnosis

Diagnosing chronic fatigue can be complex as it requires ruling out other medical conditions with similar symptoms. Medical professionals typically use criteria such as the Fukuda criteria or the International Consensus Criteria (ICC) to diagnose CFS/ME. A thorough evaluation by healthcare providers specializing in chronic fatigue management is essential for obtaining a proper diagnosis and developing an effective treatment plan—essential supports that you will need to establish your LTD benefit claim.

Is Chronic Fatigue Covered by my LTD Policy?

Most LTD insurance policies in Canada cover disabilities resulting from chronic fatigue, provided that the condition significantly impairs the individual’s ability to work. Coverage may depend on specific policy terms, definitions, and the severity of symptoms impacting job performance. Reviewing the policy details or consulting with a disability lawyer can clarify coverage options.

Chronic Fatigue Disability Benefits

To support a disability claim for chronic fatigue, comprehensive medical documentation and evidence are crucial. This kind of support may include medical records, diagnostic test results, specialist evaluations, treatment history, and functional assessments detailing limitations in work-related activities due to chronic fatigue symptoms.

Can My Disability Benefits Be Denied?

Insurance companies may deny disability benefits for chronic fatigue due to various reasons such as insufficient medical evidence, policy exclusions, or administrative errors. Diagnosing CFS/ME can be challenging due to the complexity of symptoms and the absence of definitive biomarkers.

Patients may undergo multiple evaluations over time to monitor symptoms, assess response to treatments, and rule out other potential causes of fatigue and related symptoms. This process may complicate how quickly you can access LTD benefits because of how long it may take to obtain a definitive diagnosis. Similarly, such a process may also give insurance providers ample cause to question the validity of your claims, by insisting you see one of their own specialists. Chronic Fatigue is also an “invisible” condition, meaning that many people living with the disability may not appear to be disabled at all, which invites further scrutiny from insurance benefit providers when a long-term disability claim is made.

All of this process can create undo duress for someone living with CFS/ME. If benefits are denied, understanding appeal rights and gathering additional supportive evidence is very important. Consider speaking to a disability lawyer about your case to fully understand your options.

What To Do If My LTD Benefits Have Been Denied?

If LTD benefits for chronic fatigue are denied, seek legal assistance from an LTD disability lawyer. They can review the case, advise on appeal strategies, gather necessary evidence, and advocate on behalf of the individual during the appeals process or legal proceedings.

Why You Should Contact an LTD Disability Lawyer

Navigating LTD claims for chronic fatigue can be complex, especially when facing denials or challenges from insurance companies. An experienced disability lawyer can provide invaluable support by understanding legal nuances, protecting rights, advocating for fair treatment, and helping secure the disability benefits deserved for financial stability during the management of chronic fatigue.