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We often get questions about the whether or not claims can be successfully made for fibromyalgia and/or Chronic Fatigue Syndrome. This question was recently addressed in the case of Cochran v. Reliance Standard Life Insurance Company, et al, a case from the U.S. District Court for the Central District of California.
In this case, the Plaintiff appealed the denial of his disability benefits. The Plaintiff claimed that he was disabled based on having Chronic Fatigue Syndrome (CFS) and fibromyalgia. In the Findings of Fact and Conclusions of Law section of the opinion, the Court examined the relevant plan provisions and made an extensive examination of the medical history. The Court noted abnormal results of pulmonary testing and the diagnosis of possible CFS.
The Court further notes that the examining agency for the Defendant insurance company found that, while some weakness may have been found, most of the tests were within normal parameters. The insurance company’s report also heavily implied that the Plaintiff was merely malingering.
The Plaintiff than had a psychological evaluation where the doctor found that the Plaintiff was preoccupied with his medical condition, but could not say for certain that he as malingering.
Later medical reports show that the Plaintiff was improving and that his condition was somewhat managed with medication.
The Court examines all the proof and decides that the claimant must not be required to prove a subjective complaint (unmeasurable or not subject to proof by medical test or scan) by objective evidence, when the diseases in question — here CFS and fibromyalgia — are not objectively provable. The Court finds that forcing objective proof when it cannot exist is an abuse of discretion, as well as arbitrary and capricious. The Court found that the IME doctors on behalf of the insurance company had done just this. The doctors basically disregarded the Plaintiff’s subjective complaints and tried to make objective observations which is not possible for these types of conditions.
For these reasons, the Court reversed the insurance company’s decision and found the Plaintiff to be “totally disabled” under the terms of the plan.