Invisible disabilities present some of the most challenging long-term disability (LTD) claims in Alberta. Conditions such as chronic fatigue syndrome (also known as myalgic encephalomyelitis or ME/CFS) and fibromyalgia can be profoundly disabling. Yet, their symptoms often fluctuate, lack obvious external markers, and are notoriously difficult to measure with traditional medical tests. For many individuals, these conditions disrupt every aspect of daily living, including employment, relationships, routine tasks, and long-term well-being, despite appearing “healthy” to the outside world.
For Alberta workers who rely on LTD benefits when symptoms become unmanageable, an invisible disability can become a double burden. Not only must they cope with persistent pain, exhaustion, and cognitive difficulties, but they must also overcome skepticism from insurers who frequently question whether these conditions are “real,” “objective,” or “severe enough” to prevent employment. Alberta courts consistently recognize invisible disabilities, but claimants still face significant evidentiary hurdles.
Understanding Invisible Disabilities in the Context of LTD Claims
The term “invisible disability” refers to a medical condition that significantly impairs function but does not present outwardly obvious symptoms. Chronic fatigue and fibromyalgia are among the most common and debilitating of these conditions. Symptoms often include extreme exhaustion, muscle pain, joint pain, headaches, cognitive impairment (“brain fog”), sleep disturbances, memory issues, and post-exertional malaise (where even minor activity causes a disproportionate and sometimes days-long crash).
What makes these conditions particularly complex is their variability. A person may appear functional for short periods but be unable to sustain work consistently over time. From an insurance perspective, this fluctuation can lead to unfair judgments about motivation or credibility. Insurers often expect “objective” medical proof, even though the medical community acknowledges that imaging, blood tests, or other traditional diagnostics cannot confirm many invisible disabilities. Instead, diagnosis frequently relies on a detailed clinical history, exclusion of other conditions, and functional assessment.
Despite these medical realities, LTD insurers often scrutinize invisible disability claims more aggressively, searching for inconsistencies in medical notes, surveillance footage, gaps in treatment, or activities of daily living that they believe undermine the claim. The claimant’s lived experience (and the treating physician’s opinion) must therefore be presented clearly and comprehensively to overcome insurer skepticism.
Chronic Fatigue Syndrome (ME/CFS): Debilitating Exhaustion That Cannot Be “Pushed Through”
Chronic fatigue syndrome is characterized by severe, unexplained fatigue that is not improved by rest and worsens with physical or mental exertion. Post-exertional malaise is a hallmark symptom, often leaving sufferers bedridden or unable to function after even routine tasks. Many individuals with ME/CFS also experience cognitive dysfunction, unrefreshing sleep, dizziness, and widespread pain.
From a disability claim standpoint, ME/CFS raises unique challenges because there is no single diagnostic test. Physicians rely on established diagnostic criteria such as the Canadian Consensus Criteria. Insurers, however, frequently question these diagnoses, arguing that clinical criteria are “subjective” or that symptoms overlap with psychological conditions. Some insurers also point to normal test results as evidence that the claimant should be capable of working, ignoring the medical consensus that ME/CFS is a complex, multi-system illness not captured by standard testing.
Claimants must therefore demonstrate not only that they have been properly diagnosed, but also that their symptoms prevent them from fulfilling the duties of their occupation. This requires consistent reporting, detailed medical charting, and documentation that captures how symptoms fluctuate and how work-related tasks exacerbate the condition.
Fibromyalgia: Chronic Pain Without Visible Signs
Fibromyalgia is another invisible disability that frequently leads to LTD claims. It involves widespread musculoskeletal pain, tenderness, fatigue, memory problems, and sleep disturbance. Imaging and lab work typically appear normal, which often leads insurers to challenge the diagnosis or the severity of the impairment.
Medical professionals diagnose fibromyalgia according to national guidelines and other benchmarks, including the American College of Rheumatology criteria, which include widespread pain index scoring and symptom severity measures. These criteria are well recognized, yet claimants often face barriers because insurers misinterpret the lack of “objective findings” as evidence that the condition is not disabling.
In reality, fibromyalgia can be profoundly disabling. Many claimants struggle to sit, stand, concentrate, or perform repetitive motions for extended periods. Workplaces built around predictability, stamina, and cognitive endurance become impossible to sustain. Still, because fibromyalgia is invisible, claimants frequently encounter unfair characterizations of exaggeration or poor motivation.
Supporting evidence is therefore essential. Detailed clinical notes, functional limitations assessments, reports from specialists such as rheumatologists or pain physicians, and long-term treatment records can all play a crucial role in establishing credibility and demonstrating impairment.
Why LTD Insurers Frequently Deny Invisible Disability Claims
Canadian LTD insurers commonly reject chronic fatigue and fibromyalgia claims for several recurring reasons. These denials tend to focus on perceived “insufficient objective evidence,” alleged inconsistencies, or an overly narrow interpretation of the disability test in the policy.
One of the most common denial reasons is the demand for objective proof of disability. Insurers argue that because tests like MRIs or bloodwork may be unremarkable, there is no evidence of impairment. This line of reasoning overlooks the fact that these conditions are typically diagnosed through clinical assessment, rather than laboratory confirmation. Courts across Canada, including Alberta, have repeatedly recognized fibromyalgia and ME/CFS as legitimate disabling illnesses.
Another common denial involves the insurer’s reliance on paper reviews by medical consultants who have never met the claimant. These consultants may downplay symptoms, misinterpret diagnostic criteria, or conclude that the claimant should be capable of sedentary work without understanding the severity of fatigue, cognitive dysfunction, or post-exertional symptoms.
Insurers also frequently mischaracterize activities of daily living. For example, a claimant who manages to prepare a simple meal or attend a short appointment may be portrayed as capable of full-time work. These portrayals ignore the medical reality that activity tolerance for people with chronic fatigue or fibromyalgia is extremely limited and often requires prolonged rest afterward.
Finally, insurers may deny claims based on “lack of treatment compliance” if the claimant has not pursued every possible therapy, even when certain therapies are ineffective, unavailable, or counterproductive. Understanding how to respond to these denial strategies is critical to securing LTD benefits.
Alberta’s Legal Framework and the “Own Occupation” vs. “Any Occupation” Tests
Most LTD insurance policies in Alberta apply a two-stage test for disability. During the initial period (typically the first 24 months), the claimant must demonstrate that they are unable to perform the essential duties of their own occupation. This period is generally more favourable for invisible disability claimants because the test focuses on their actual job requirements.
After the “change of definition” at around 24 months, the test becomes stricter. The claimant must demonstrate they are unable to perform any occupation for which they are reasonably suited by education, training, or experience. This transition is where many chronic fatigue and fibromyalgia claims are terminated, even if the insurer continued paying benefits during the own-occupation period.
Insurers often point to theoretical jobs the claimant “could” do, despite medical evidence showing that symptoms prevent sustained attendance or performance. Courts, however, emphasize that the ability to perform work must be realistic and achievable. It is not enough for an insurer to argue that a claimant might be capable of sitting at a desk if symptoms make concentration, consistency, or predictability impossible.
A thorough legal analysis of job duties, functional limitations, medical evidence, and vocational assessments can make the difference between a terminated claim and successfully continued benefits.
The Importance of Medical Evidence and Consistency
For invisible disability claims, documentation is key. Consistency between the claimant’s reported symptoms, medical charting, specialist opinions, and functional limitations forms the foundation of a strong LTD claim. Because insurers often argue that subjective symptoms lack credibility, the way those symptoms are described and recorded becomes critically important.
Treating physicians play a central role. Their clinical notes should reflect the frequency and severity of symptoms, the impact on daily activities, response to treatment, and the patient’s functional limitations in relation to work. Many denials stem from chart notes that appear too brief or do not explicitly connect symptoms to disability.
Specialists, such as rheumatologists, neurologists, chronic pain physicians, or occupational therapists, can provide additional layers of evidence. Their reports often include standardized assessments, functional evaluations, and differential diagnoses that strengthen the overall credibility of the claim.
In some cases, further documentation such as fatigue journals, pain diaries, or reports demonstrating post-exertional malaise can be helpful, provided they are consistent with the medical records. Objective tests, when available (such as cardiopulmonary exercise testing for ME/CFS), may also support the claim, although they are not necessarily required for diagnosis.
Surveillance, Social Media, and Misinterpretation of Activities
Invisible disability claimants are disproportionately targeted for surveillance. Insurers may hire investigators to record short snippets of daily activity, such as carrying groceries, walking a pet, or attending an appointment. These activities are then used to imply the claimant is capable of full-time employment, even when the recordings represent only brief moments in an otherwise debilitating day.
Canadian courts do not always view surveillance evidence favourably. Short clips that do not capture the claimant’s condition afterward, or that misrepresent context, carry limited weight. However, inconsistencies between surveillance and reported limitations can harm credibility, making honest and accurate reporting essential.
Social media is also a common source of misinterpretation. Photos that show a claimant smiling, socializing, or attending a family event are often taken out of context, failing to capture the physical cost of participation. Claimants should be mindful of how their posts may be perceived and understand that insurers closely monitor online activity.
Appealing or Litigating an LTD Denial for Invisible Disabilities
When an LTD claim for chronic fatigue or fibromyalgia is denied, claimants often face a difficult decision: pursue the insurer’s internal appeals process or begin litigation. Internal appeals rarely succeed because they are processed by the same insurer that issued the denial. However, in some cases, an appeal may be strategically useful to add missing medical evidence or correct errors before litigation.
Litigation offers stronger protections, including access to discovery, the right to cross-examine the insurer’s medical consultants, and the ability to present comprehensive expert evidence. Alberta courts have repeatedly affirmed that subjective symptoms, when consistent, credible, and medically supported, can be disabling.
A plaintiff-side LTD lawyer can identify the strongest grounds for appeal or litigation, gather the necessary evidence, and ensure the insurer complies with its contractual and legal obligations. Early legal advice often prevents claimants from inadvertently harming their claim through inconsistent documentation or incomplete reporting.
Supporting Your LTD Claim When You Live With an Invisible Disability
Individuals with chronic fatigue or fibromyalgia can take proactive steps to strengthen their LTD claims. Clear communication with medical providers is essential. Physicians must understand the full impact of symptoms, including flare-ups, variability, and post-exertional consequences. Claimants should avoid minimizing symptoms during appointments, as medical notes can influence the insurer’s view of the claim.
Regular and ongoing treatment is also essential, not because every therapy must be successful, but because insurers often question claims when treatment appears sporadic. Documenting treatment failures, side effects, or financial barriers helps ensure the record reflects a realistic picture of the condition.
Finally, claimants should keep track of factors that worsen symptoms and activities that are no longer possible. With invisible disabilities, functional impairment, not laboratory findings, is the real measure of disability, and detailed accounts of that impairment can make a significant difference.
If You Are Struggling With an Invisible Disability-Related LTD Denial in Alberta, Cuming & Gillespie LLP Can Help
Living with chronic fatigue, fibromyalgia, or another invisible disability is difficult enough without facing an insurer that questions the legitimacy of your condition. If your long-term disability claim has been denied or terminated, or if you are preparing to apply for benefits and want to avoid common pitfalls, Cuming & Gillespie LLP is ready to support you. Our Calgary-based LTD lawyers understand the unique challenges associated with these conditions and will work to secure the benefits you are entitled to, allowing you to focus on your health and stability. To book a confidential consultation, please contact us online or call (403) 571-0555.