When you have been diagnosed with fibromyalgia or another chronic pain disorder it can feel like no-one believes you. These are serious conditions that can severely limit your ability to work and live a normal life. But insurance companies often deny long-term disability benefits for fibromyalgia or chronic pain. Find out how to fight back and get the coverage you need when you can no longer work due to the pain.
This blog post will discuss why it can be difficult to get long-term disability benefits for fibromyalgia and other types of chronic pain. It will address the problems proving pain and occupational limitations, and insurance companies’ tendency to discount patient reports of symptoms. It will also address how having an experienced attorney can help improve your chances to receive benefits.
Fibromyalgia Pain Can Make Working Impossible
Fibromyalgia is a physical disorder that scientists believe amplifies painful sensations, affecting the way your brain processes pain signals. It can cause widespread musculoskeletal pain across a variety of tender points on your body, as well as fatigue, sleep issues, cognitive trouble, memory problems, and trouble regulating mood. Fibromyalgia may be triggered after:
- Physical trauma
- Psychological stress
In other cases, symptoms accumulate over time, seemingly without any single cause. There is no cure for fibromyalgia, and often it can take significant time and effort simply to get a diagnosis. Importantly, because Fibromyalgia can mimic the symptoms of many other illnesses, it is important that a thorough evaluation be pursued to rule out other causes. Fibromyalgia is often called a diagnosis of exclusion for this reason. There are medications and treatments to help with symptoms, but even under a doctor’s care, many fibromyalgia patients eventually find it impossible to keep working.
Why Insurance Companies Say No to Long-Term Disability Benefits for Fibromyalgia
When they can no longer work, many fibromyalgia patients turn to their private or employer-provided long-term disability insurance to help pay the bills. But insurance companies love to say no to claims for long-term disability benefits based on fibromyalgia and other chronic pain diagnoses. When you file a claim for benefits based on your disability, the insurance company could claim:
- You don’t have the disorder or have been improperly diagnosed
- You have fibromyalgia, but it doesn’t affect your ability to work
- You just aren’t getting the right treatment
- You can still do some work despite your diagnosis
- Your medical restrictions are unsupported
- There are no objective studies or findings to support your symptoms
Many of these denials come about because fibromyalgia symptoms are subjective — you, the patient, are the only one who can measure the problem. Since insurance companies never trust the person filing a claim, they want you to produce objective evidence of your disability. Unfortunately with fibromyalgia, Chronic Fatigue Syndrome, and similar conditions that are clinically diagnosed by a constellation of symptoms, you are often unable to satisfy this requirement for “objective evidence.”
Proving Your Fibromyalgia Disability
There are, however, accepted clinical tests to support a fibromyalgia diagnosis. Courts have supported the use of 18-point tender point tests and functional capacity evaluations to measure the effect of fibromyalgia on your ability to live and work. By working with a doctor familiar with the condition and its treatment, you can get the objective evidence the insurance company is looking for and improve your chances of receiving long-term disability benefits for fibromyalgia. In the Social Security context, the Social Security Administration has recognized various criteria to establish a FM diagnosis. While not binding on insurance companies, this detailed policy guidance can be instructive in applying a set of medically accepted criteria to your case.
There are also several things you can do yourself to improve your long-term disability claim:
- Be specific about your condition and the things you can and can’t do (avoiding broad terms like “fibro fog” or saying you “hurt all over”).
- Document your good and bad days, listing what you could do and what was difficult for you at work (keeping a daily journal can be a helpful way to catalog your symptoms).
- Follow all your doctor’s medical recommendations and discuss any alternative or holistic medicine options you are trying with him or her to receive their recommendations. Not receiving adequate treatment is another boilerplate reason insurance companies use to deny claims.
- Gather evidence of your condition including witness statements, letters from doctors, and your own day-to-day journals.
- Apply for Social Security Disability Insurance to establish your disability.
How a Long-Term Disability Attorney Can Help
When an insurance company denies your claim for long-term disability benefits for fibromyalgia, it is often because according to the company you haven’t proven you are actually disabled. An experienced long-term disability attorney can help you gather the evidence and find doctors to perform evaluations that will support your claim. At Bross & Frankel, our long-term disability attorneys understand how fibromyalgia can play games with your body and leave you unable to work. We can also work with your doctors to create reports that properly reflect your abilities and disabilities so the insurance company can’t pick them apart. We know how to work with employers, doctors, and your insurance company to get you the benefits you need to stop working and still meet your needs. Contact us for a complimentary consultation.