DATE POSTED 10. 03. 2011, By

Suffering from a Condition which Objective Tests Do Not Show Does Not Disqualify You for Long-Term Disability Benefits

Employees and executives in Chicago and the Joliet area who suffer from certain diseases and syndromes such as Fibromyalgia or Chronic Fatigue Syndrome face an uphill battle if they need to make a claim for long-term disability (“LTD”) benefits. Fibromyalgia and Chronic Fatigue Syndrome are conditions that are characterized by, among other things, a lack of an objective test that can confirm or dispel a diagnosis with a mere paper review of the test results. However, this is precisely what administrators of long-term disability plans are looking for. The administrator will show your written test results to a physician who will never meet you face-to-face, and will inevitably opine that based on the test results, you are not disabled. Couple this opinion with the plan terms investing discretion in the plan administrator or construe and interpret the terms of the plan, and you have a near certain denial of benefits. LTD claimants need not lose hope, though.

Recently, an employee of American Honda Motor Company was similarly denied LTD benefits following a diagnosis of Chronic Fatigue Syndrome. See Salomaa v. Honda Long Term Disability Plan, 2011 U.S. App. LEXIS 4386 (9th Cir. Mar. 7, 2011). Solomaa became ill with what he thought was merley a stomach flu. He took several days off of work and returned to work, but was never the same. Where he once had plenty of energy, he found himself constantly exhausted. In the beginning, Salomaa went to work, but was lethargic and moved slowly, and then spent nearly all his time off of work in bed. Salomaa even lost 14% of body weight because he was usually too tired to get out of bed for dinner.

As his condition progressed, Salomaa could not even go to work. His physicians noted he lacked the energy to even climb up onto the seat in the examination room. While Mr. Salomaa had some good days where he would be able to do up to 30-60 minutes of sedentary work, that would so exhaust him he would need to spend the next several days in bed. On a typical day, even several minutes a day of work was unbearable. Solomaa also suffered from insomnia and memory loss. Salomaa’s doctors labored over test result after test result, ruling out alternatives to Chronic Fatigue Syndrome. He had comprehensive blood work, MRIs, and an echocardiogram performed. Doctors attempted placing Salomaa on various medications, noting the ineffectiveness of each.

Salomaa applied for and was denied LTD benefits. The administrator cited the lack of any positive objective physical findings. It also cited that Salomaa’s blood work came back normal. The administrator also ignored the previous illness and weight loss, and claimed a changed diagnosis from depression to Chronic Fatigue Syndrome meant Salomaa’s depression improved.

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