Insurance Company Wrongfully Denies Chronic Fatigue Syndrome Sufferer

Detroit, MIDespite the fact that disability insurance is supposed to protect policyholders in the event they become disabled prior to retirement, some insurance companies still practice bad faith insurance by wrongly denying disability claims for chronic fatigue syndrome. Why was Christine denied benefits by Cigna, her Insurer, yet immediately recognized as disabled by Social Security?

Although Christine’s final denial occurred in 2006, she hasn’t given up the appeals process. “I have been researching denied disability reversals and Cigna class-action settlements,” she explains. “In some states Cigna had to pay out settlements to policyholders suffering from chronic fatigue syndrome who were denied long-term disability benefits. And Cigna had to reopen some cases older than mine, so I am still hopeful that an insurance attorney can help me.”

Christine says that many people with this disorder or disease have a difficult time collecting benefits because insurance representatives don’t believe they are disabled. Instead, they are often considered “lazy” and “hypochondriacs,” and capable of work. The name itself (i.e., fatigue) doesn’t help: Currently some medical associations are trying to change the name of this disorder because it affects the brain and the central nervous system, which Christine knows all too well.

“I worked at the Henry Ford Health System as a medical technologist for 32 years, up until December 2004,” Christine says. “I had prepared a Christmas dinner for my family but it almost killed me, and I was unable to return to work after that. I was so ill that I could barely get out of bed in the morning; just trying to get dressed for work was torture. Judging from my symptoms, my doctor thought I had multiple sclerosis so he put me in hospital for a few days and I went through a battery of tests, but all of them came back negative.”

That year Christine was taken twice by ambulance to the emergency room with severe muscle spasms. One hospital doctor opined on her medical record that she “probably has chronic fatigue syndrome,” but he neglected to tell Christine. “Instead, like so many other health professionals, he probably saw me as an obese and depressed female,” she says. “A neurologist even tried to tell me that I had a severe mental disorder - hypochondria. I just got the runaround from physicians.”

In 2006, an internist diagnosed Christine with chronic fatigue syndrome. He wrote to Cigna that this diagnosis explains her inability to work and also explains her symptoms. Christine interpreted this diagnosis as positive: she knew that Social Security - the federal government - recognized the disorder as 100 percent disabling. Cigna still denied her disability claim by saying that her medical record doesn’t show an inability to work and that it wasn’t a serious enough illness to prevent her from working. But Christine had tried her hardest to work.

“I tried working at a clinic for the Detroit hospital where I had been employed for 32 years but they let me go after 90 days because I couldn’t keep up the pace and I wasn’t able to multi-task,” Christine says. “I tried to learn surgical technology but I wasn’t able to do that either; it entailed too much standing. I enrolled in grad school and almost completed my masters but I was just too tired.”

Interestingly, Christine says that when you apply to Cigna for long-term benefits, the insurer makes you apply for Social Security benefits at the same time - it is a pre-requisite. If you end up retiring with a disability from your place of work, they subtract your Social Security and pay you the difference. Social Security approved Christine upon her first application but she had a six-month waiting period. “The Social Security’s doctor examined me and I was surprised; I didn’t get any runaround,” she says. “But I had only received five months of short-term benefits from Cigna when they cut me off so I still needed to work. I asked the hospital to employ me part-time but they wouldn’t take me back. They knew I was having a hard time functioning and thought I would be a detriment to the lab, so I was forced to retire and that was very traumatic: I was only 55 years old and a single parent struggling to put my daughter through college. I wasn’t ready for that.”

Christine had no income for almost a year and her benefits were not retroactive. She was entitled to long-term disability benefits for the rest of her life. Instead, she ended up losing her job and losing her house. And she had used up her appeals to Cigna.

“My wrongfully denied claim is criminal,” Christine says. “I paid premiums for all those years only to be denied and treated with such disrespect. The people at Cigna are so uncaring, they just beat you down. This disease is bad enough so making you financially crippled just makes me cry.”

Christine gets $1,800 per month in Social Security benefits. Since 2005, she should have been getting 70 percent of her salary from Cigna. “I wasn’t able to find an attorney willing to take my case and help me with the appeals process back in 2006, but there is a substantial amount of money at stake now, so I am optimistic that an experienced disability insurance lawyer will be interested.”