Our client was a skilled and compassionate registered nurse in Bronx, NY and enjoyed working at a busy fertility clinic when she was diagnosed with COVID-19. After a few weeks of rest and quarantine, her symptoms subsided, but she was not the same when she returned to work. Sadly, our client was extremely fatigued and had difficulty processing information, multi-tasking, concentrating, and explaining important information to patients.
She quickly started seeing a doctor and was diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Even after this diagnosis, our client tried to keep working but was hospitalized with exhaustion on numerous occasions and eventually realized she had to file for long-term disability (LTD) benefits.
Fortunately, our client had a policy with First Reliance Standard Life Insurance Company for exactly this kind of situation. When she made a claim for LTD benefits, however, Reliance Standard denied it.
Puzzled, our client called Dabdoub Law Firm.
Understanding Our Client’s ME/CFS Claim
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious disease that affects many bodily symptoms. Patients with ME/CFS feel physically and mentally exhausted after minimal exertion – regardless of how well they sleep and care for themselves.
When it comes to LTD policies like the one our client has with Reliance Standard, ME/CFS is a qualifying medical condition that prevents claimants from performing the material duties of their regular occupations. Our client, specifically, attempted to return to work but was unable to do so because of her ME/CFS symptoms, and she provided ample evidence of this fact.
Still, Reliance Standard determined that our client’s medical records did not support the presence of a disabling medical condition. We set the record straight by explaining ME/CFS to the insurance company. For example, we compared the core diagnostic criteria for ME/CFS to our client’s symptoms and medical testing.
The core diagnostic criteria for ME/CFS include:
- Impairment in function with profound fatigue – our client cannot shower, eat, talk, or get ready for bed without feeling exhausted; much less walk around the workplace.
- Post-exertional malaise (PEM) – our 33-year-old client’s performance on an exercise bike was less favorable than a 79-year-old woman’s, and she could only sustain exercise for 1-2 minutes.
- Sleep abnormalities – our client does not feel refreshed after sleep.
- Cognitive impairment – our client demonstrated significant cognitive impairments during a neuropsychological examination.
- Orthostatic intolerance – A cardiopulmonary exercise test protocol (CPET) confirmed problems with our client’s autonomic bodily symptoms (such as delivering oxygen to the heart, brain, and muscles).
- Pain – our client regularly experiences muscle pain, chest pain, and shortness of breath
According to her doctors, our client does not have sufficient energy to perform sedentary work on a sustained basis. Trying to work will only make her symptoms worse, provoke additional symptoms, and contribute to her overall functional decline.
It takes our all client’s energy to wash a few dishes or carry in her groceries – how is she expected to work with patients facing one of the most sensitive moments of her life?
Dabdoub Law Firm posed this question to Reliance Standard.
Reliance Standard Gets Another Chance
Our client purchased her disability insurance policy with Reliance Standard when she was bright, young, intelligent, and healthy. She paid her premiums and trusted the insurance company to take care of her if anything went wrong. Unfortunately, something has gone very wrong. ME/CFS has stolen our client’s strength, mental clarity, and the life she had before the diagnosis.
As a result, Reliance Standard has the duty to payout LTD benefits. The insurance company has objective medical evidence from CPET reports, neurophysiological examination reports, and independent reviews of our client’s medical records, including one from the top ME/CFS expert in the United States.
By failing to conduct a full and fair review, Reliance Standard violated the Employee Retirement Income Security Act of 1974. To avoid litigation, Dabdoub Law Firm gave Reliance Standard an opportunity to correct its errors.
Unsurprisingly, the insurance company complied and promptly approved our client’s LTD benefits claim.
Help from a Lawyer with Expertise in Disability Insurance
Dabdoub Law Firm was built to be a disability insurance law firm.
That focus means:
- All our lawyers specialize in disability insurance claims.
- We have experience with every major disability insurance company.
- We have won important long-term disability lawsuits.
Our disability lawyers can help you with:
- Submitting a disability insurance claim,
- Appealing a long-term disability denial,
- Negotiating a lump-sum settlement, or
- Filing a lawsuit against your disability insurance company.
If you are having trouble recovering disability benefits, you need an experienced disability insurance attorney. Because federal law applies to most disability insurance claims, our lawyers do not have to be located in your state to handle your claim.
Call us at (800) 969-0488 or contact us online for a free consultation with a dedicated disability lawyer. You will not owe us any legal fees unless we recover the benefits you deserve.
