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MetLife Approval of Fibromyalgia and Chronic Fatigue Syndrome Claim

On Behalf of | Aug 31, 2018 | Insurance Company Tactics |

Fibromyalgia and Chronic Fatigue Syndrome, also referred to as Myalgic Encephalomyelitis, are debilitating conditions characterized by feelings of extreme exhaustion, muscle and joint pain, memory problems, brain fog, and problems with concentration. Many of our clients who suffer from one or both of these conditions come to us frustrated that, despite letters and documentation from their doctor and health care professionals confirming that their condition is severe and greatly limits their ability to function at work, many insurance companies question these claims stating a lack of evidence or proof of disability. Unfortunately, the cause of these conditions remains unknown and it is often diagnosed only after physicians have run numerous tests to exclude other disorders. However, the disorder is real and for some, incapacitating.

Our client, Ms. W, came to us after applying for benefits with MetLife and being stonewalled and questioned incessantly by her carrier about her limitations and why she cannot work. Additionally, she was told that surveillance indicated that she did not appear to be in pain or tired. Understandably upset, Ms. W was ready to give up. Once involved, we obtained medical information and statements from her physicians that explicitly detailed the basis of their diagnosis, the findings on clinical examination, why she was unable to work, and her plan of treatment. They also addressed the surveillance video, which we were able to obtain, noting that overall, it showed very brief moments in time and pointing out evidence of pain and fatigue. To further supplement the claim we sent MetLife a detailed explanation of her symptoms and limitations, her job duties and the physical and mental requirements that are integral to her occupation, as well as a response to the surveillance video. Within a few weeks, MetLife advised that based on the information provided they were approving the claim. We continue to handle Ms. W’s claim and work with her doctors and her to make sure that the quarterly claim forms required by MetLife continue to support her claim for benefits.

If you or someone you know has questions about a current or potential claim for disability benefits, please contact Disability Insurance Law Group at (866) 363-3628 for a free consultation. More information about disability insurance claims can be found on our website www.DiLawGroup.com