Insurance Companies – American ME and CFS Society

Austerity and identity formation: How welfare cutbacks condition narratives of sickness

Abstract:

In recent years, Swedish sick insurance has become more restrictive. In this article, we analyse how people not being granted payments, despite being seriously ill, are affected. Scholarship on identity formation and sickness stress the importance of constructing narratives in order to come to terms with one’s situation. Our analysis of 30 qualitative interviews with people diagnosed with ME/CFS shows that workfare politics conditions such identity formation and often prevents it from taking place.

Interviewees describe extreme stress as a result of their contacts with the Social Insurance Agency (SIA), which results in a perpetual crisis that is renewed with each new denied application. In particular, the sense of not having a future means that it is hard to construct narratives to make sense of one’s situation. To escape the perpetual crisis, some people have politicised their situation, constructing a narrative about themselves as suffering from oppressive politics. Others have escaped by not applying for sick insurance or other social insurances. But generally speaking, the most common effect of being denied sick insurance is an ongoing crisis that leads to deteriorating health.

Source: Altermark N, Plesner Å. Austerity and identity formation: How welfare cutbacks condition narratives of sickness. Sociol Health Illn. 2022 Sep;44(8):1270-1286. doi: 10.1111/1467-9566.13545. Epub 2022 Sep 6. PMID: 36066495. https://onlinelibrary.wiley.com/doi/10.1111/1467-9566.13545 (Full text)

Documenting disability in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

Abstract:

BACKGROUND: According to the 2015 National Academy of Medicine report, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) “is a serious, chronic, complex, and systemic disease that frequently and dramatically limits the activities of affected patients.” ME/CFS affects between 1 and 2.5 million Americans, leaving as many as 75% unable to work due to physical, cognitive and functional impairment. Unfortunately, many doctors and lawyers lack the knowledge of how to properly document an ME/CFS disability claim, leaving patients unable to access disability benefits.

OBJECTIVE: The goal of this article is to summarize the approaches used by experienced clinicians and lawyers in successful ME/CFS disability claims.

METHODS: The authors reviewed the types of US disability insurance programs and the evidence commonly required by these programs to demonstrate ME/CFS disability.

RESULTS: This article summarizes the range of methods used in successful US disability claims, which include documentation of the functional impact of post-exertional malaise and the use of methods that provide objective evidence of impairment.

CONCLUSIONS: Medical providers and lawyers can use these tested methods to obtain disability benefits for people with ME/CFS. Physical therapists, occupational therapists, and other specialists play an important role in providing objective evidence for ME/CFS disability claims.

Source: Podell, Richard, Dimmock, Mary E., and Comerford, Barbara B. ‘Documenting Disability in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)’. 1 Jan. 2020 : 339 – 352. https://content.iospress.com/articles/work/wor203178 (Full text)

Chronic fatigue syndrome poses management challenge

According to the Centers for Disease Control and Prevention, chronic fatigue syndrome affects between 1 and 4 million Americans. At least one fourth of these are unemployed or on disability because of CFS. Yet according to the CDC, only about half of those thought to suffer from CFS have consulted a physician for their condition.

Primary symptoms include unexplained fatigue for six months or more, in addition to any number of the following: cognitive dysfunction, postexertional malaise lasting more than 24 hours, unrefreshing sleep, joint pain without redness or swelling, persistent muscle pain, headaches of a new type or severity, tender lymph nodes, and sore throat. There are more than a dozen other less common symptoms.

Health plan medical directors find the situation vexing. “Like all managed care organizations, Independence Blue Cross struggles with establishing appropriate coverage policies and clinical programs to address conditions in which there is considerable clinical controversy,” says Donald Liss, MD, the plan’s senior medical director of clinical programs and policy. “Conditions such as chronic fatigue syndrome are particularly challenging because of the nonspecific nature of the diagnostic criteria, the lack of objective studies to confirm a diagnosis, and the wide spectrum of therapies prescribed.”

You can read the rest of this article here: http://www.managedcaremag.com/linkout/2010/10/24

Source: Atkinson W. Chronic fatigue syndrome poses management challenge. Manag Care. 2010 Oct;19(10):24-6. http://www.managedcaremag.com/linkout/2010/10/24 (Full article)

What causes chronic fatigue?

Comment on:

Chronic fatigue syndrome comes out of the closet. [CMAJ. 1998]

Chronic fatigue syndrome or just plain tired? [CMAJ. 1998]

Chronic fatigue syndrome get court’s nod of approval as legitimate disorder. [CMAJ. 1998]

The 3 excellent articles on chronic fatigue syndrome 1–3 reminded me of the desperate need for a discussion of the ethics — or lack thereof — related to independent medical examinations of patients with this condition.

A recent 21-page report from an independent medical examination of one of my patients with chronic fatigue syndrome included 2 pages of error-riddled history and the results of only a cursory physical exam, along with a bold admission that a full physical examination had not been done. The other 19 pages, clearly based on a word-processor template, were peppered with such clichés as “illness-seeking behaviour,” “somatization syndromes” and “preconscious motives.” The fee assessed for this report was $1200.

I used to be asked by insurance companies to perform independent medical examinations (for the standard fee suggested by the Alberta Medical Association), requests that I always accepted. However, when it became known that, in appropriate circumstances, I might support a diagnosis of chronic fatigue syndrome, such requests ceased abruptly.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1230108/pdf/cmaj_160_5_638.pdf

Source: Voth A. What causes chronic fatigue? CMAJ. 1999 Mar 9;160(5):638. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1230108/pdf/cmaj_160_5_638.pdf (Full article)

Chronic fatigue syndrome comes out of the closet

An Alberta court ruling and new guidelines for physicians issued by the Quebec medical college are giving chronic fatigue syndrome a legitimacy it never before enjoyed. What will this mean for physicians?

Chronic fatigue syndrome (CFS) is gaining unprecedented legitimacy in Canada because of a recent Alberta count ruling, new guidelines from the Quebec medical college and recent research suggesting that the syndrome may have a biological basis. There is little doubt these developments will affect physicians across Canada.

Although viewed as a modern phenomenon, CFS was first reported by Hippocrates and has been known this century under various names: myalgic encephalomyelitis, Iceland disease, Epstein-Barr virus and yuppie flu. It has been labelled as CFS since 1988, and is currently estimated to affect 20 000 to 30 000 Canadian adults. According to the Centers for Disease Control and Prevention, CFS involves chronic fatigue for at least 6 months and a minimum of 4 other symptoms (p. 519). Scientists and doctors have been debating its existence and symptoms for years, but the debate may be winding down because of an Alberta court case (p. 533).

In March an Alberta woman finally won her case against Crown Life when the court ruled that she qualified for long-term disability benefits because of CFS. The well-publicized case emphasized the difficulty physicians have in diagnosing the illness, and the Alberta College of Physicians and Surgeons hopes to respond with CFS guidelines within a year. Dr. Brian Ward, the assistant registrar in charge of standards, says the college’s interest “began long before the case.” He says it has received frequent complaints from patients with CFS who can’t find physicians willing to treat them or follow their conditions. “They’ve asked us to increase the level of awareness among physicians and to provide education,” says Ward.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1229658/pdf/cmaj_159_5_537.pdf

Comment in:

What causes chronic fatigue? [CMAJ. 1999]

Source: Sibbald B. Chronic fatigue syndrome comes out of the closet. CMAJ. 1998 Sep 8;159(5):537-41. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1229658/

Chronic fatigue syndrome gets court’s nod of approval as legitimate disorder

Lawyer Karen Capen looks at the implications of a recent Alberta court case involving chronic fatigue syndrome. She thinks Canada’s physicians should pay close attention to this precedent-setting case.

Few medical diagnoses are more hotly debated than chronic fatigue syndrome (CFS). Now, an Alberta court has added to the controversy. In Baillie v. Crown Life, a judge ruled that a women with CFS qualifies for long-term disability benefits.1 Crown Life was ordered to pay benefits to plaintiff Sharon Baillie, a former senior computer systems analyst with the insurance company.

Part of the case dealt with the insurance policy and the time requirements for filing a claim. For physicians, however, the ruling’s importance centres on how difficult it is to diagnose the condition.

This legal recognition of CFS, which the Alberta court handed down in March, should alert doctors of the need to understand the range of symptoms that fall within the condition’s diagnostic profile. The symptoms assigned to CFS generally include at least 6 months of extreme fatigue that reduces a person’s activity by 50% or more. This is accompanied by at least 4 other problems such as aching muscles and joints, headache, sleep disturbances, memory and concentration problems, and sore throat. Although the cause has yet to be determined conclusively, it is thought to involve a virus and/or a weakened immune system.

In recognizing CFS, the Alberta court recognized that a number of medical bodies have done the same thing, including the World Health Organization and the Centers for Disease Control and Prevention in Atlanta.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1229657/pdf/cmaj_159_5_533.pdf

Comment in:

What causes chronic fatigue? [CMAJ. 1999]

Source: Capen K. Chronic fatigue syndrome get court’s nod of approval as legitimate disorder. CMAJ. 1998 Sep 8;159(5):533-4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1229657/pdf/cmaj_159_5_533.pdf

Predictors of a medical-offset effect among patients receiving antidepressant therapy

Abstract:

OBJECTIVE: Characteristics of patients receiving antidepressant therapy were examined to identify factors that may be associated with a medical-offset effect.

METHOD: In a retrospective study, the authors analyzed claims data from a large health insurer in New England. The study subjects included 1,661 persons initiating treatment for depression with selective serotonin reuptake inhibitors or tricyclic antidepressants between July 1991 and June 1993.

RESULTS: Patients with anxiety disorders, coronary heart disease, cancer, and chronic fatigue syndrome and those remaining on their initial regimens of antidepressant therapy for at least 6 months were more likely to experience significant reductions in the costs of medical care services. The number of visits to mental health providers had no effect on the costs of medical services.

CONCLUSIONS: Specific comorbid conditions and sustained use of antidepressant drugs may be associated with a medical-offset effect for patients receiving treatment for depression.

Source: Thompson D, Hylan TR, McMullen W, Romeis ME, Buesching D, Oster G. Predictors of a medical-offset effect among patients receiving antidepressant therapy. Am J Psychiatry. 1998 Jun;155(6):824-7. http://www.ncbi.nlm.nih.gov/pubmed/9619157

Increased illness experience preceding chronic fatigue syndrome: a case control study

Abstract:

BACKGROUND: Almost all published work on chronic fatigue syndrome (CFS) has involved retrospective surveys of cases, which may introduce recall bias. Only medical records collected before diagnosis of CFS can eliminate this.

METHODS: Using data collected several years prior to the development of the illness, we performed a case control study, comparing the reported illness records of all people who subsequently made an insurance claim as a result of CFS, with those of future multiple sclerosis (MS) claimants, and those of non-claimant controls (NC).

RESULTS: The study encompassed 133 CFS, 75 MS and 162 NC cases. CFS cases had recorded significantly more illnesses at time of proposal for insurance than the two control groups, and had significantly more claims between proposal and diagnosis of their disorder. Almost all disease categories were reported higher in future CFS sufferers, lethargy having the highest odds ratio after adjustment in a multivariate model.

INTERPRETATION: The results of this paper on CFS patients who claim permanent health insurance do not support a specific viral or immunological explanation for CFS. We conclude that abnormal illness behaviour is of greater importance than previously recognised.

Comment in:

Increased illness experience preceding chronic fatigue syndrome. [J R Coll Physicians Lond. 1998]

Source: Hall GH, Hamilton WT, Round AP. Increased illness experience preceding chronic fatigue syndrome: a case control study. J R Coll Physicians Lond. 1998 Jan-Feb;32(1):44-8. http://www.ncbi.nlm.nih.gov/pubmed/9507441

Life insurance MDs sceptical when chronic fatigue syndrome diagnosed

There’s no middle ground when it comes to chronic fatigue syndrome (CFS) – it is either a bona fide clinical entity or a trendy media-made disease with no basis in fact.

This division was evident during the recent annual meeting of the Canadian Life Insurance Medical Officers Association (CLIMOA), the doctors who advise health and life insurance companies on the morbidity and mortality risks of every disease state.

CLIMOA’s members meet annually for an update on therapeutic and laboratory diagnostic testing developments. There are currently 187 members from 128 North American companies and this year’s meeting in Toronto was the largest to date, with 112 members attending.

Dr. Richard Proschek shed more heat than light on the CFS issue with a presentation that concluded family physicians are diagnosing CFS in patients who clearly have other medical conditions that would account for their fatigue.

With an alleged epidemic of CFS looming, insurance companies are caught in a dilemma. Should they pay disability benefits to people being diagnosed with the controversial syndrome? They want to know if it’s a real disease and how much it’s going to cost them if large numbers of people become afflicted.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1452254/pdf/cmaj00222-0063.pdf

Source: Olga Lechky. Life insurance MDs sceptical when chronic fatigue syndrome diagnosed. CMAJ. 1990 Sep 1; 143(5): 413–415. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1452254/