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Long Term Disability Claim Tips | Fibromyalgia

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Those with fibromyalgia know how difficult daily living can be: coping with debilitating chronic pain, ending up exhausted for days from light activities, struggling to concentrate enough to complete even simple tasks. Many people suffering from fibromyalgia find themselves unable to continue working.

Fibromyalgia is a condition with largely subjective symptoms. Because of this, obtaining disability benefits can be challenging to prove under a long-term disability policy. Insurance companies are skeptical of claims based on self-reported subjective symptoms. They often insist that a claimant supply objective evidence in support of disability.

If you are disabled because of fibromyalgia, our disability insurance lawyers can help you assemble the evidence that insurers demand to approve a claim. See below for tips on filing for long term disability with fibromyalgia.

Fibromyalgia and Disability

Diagnosis

chronic fatigue syndrome disability

Fibromyalgia is a disorder causing pain throughout the muscles and bones. It is a complex condition not yet well understood by medical professionals – its exact cause is unknown, and the symptoms overlap with many other conditions as well.

When filing a disability claim for fibromyalgia, your insurance company will require proof of a diagnosis from your doctor.

Unfortunately there is no clear-cut testing to diagnose fibromyalgia. Because it has symptoms in common with other conditions, doctors often will order various laboratory tests to rule out other possible causes such as arthritis.

If a person suffers from widespread muscle and bone pain for a minimum of three months and doctors cannot find another cause, a fibromyalgia diagnosis may be appropriate. The American College of Rheumatology has designated 18 trigger points on the body. Tenderness at 11 out of 18 trigger points indicates fibromyalgia.

Symptoms

In order to file a long term disability claim for fibromyalgia, your insurance company will want to know your exact symptoms and how they interfere with your ability to perform your job duties. Fibromyalgia manifests in varied ways with each sufferer. However, it is generally characterized by the following symptoms:

      • Chronic musculoskeletal pain
      • Tenderness
      • Severe fatigue
      • Sleeplessness
      • Cognitive issues (“brain fog”, inability to focus, short attention span, etc.)
      • Bowel irritation

Proving a Fibromyalgia Disability Claim

Your Diagnosis is Key

chronic fatigue fibromyalgia doctor diagnosis

Central to proving a claim for long term disability benefits based on fibromyalgia is convincing the insurer you have the correct diagnosis. Insurance companies are leery of primary care physicians who diagnose fibromyalgia simply because they can’t find any other explanation for your symptoms.

Your chances of success are best if you see a rheumatologist who will follow the established criteria in diagnosing your condition. For fibromyalgia, your insurance company will want trigger point proof from your doctor for a diagnosis and will deny your claim if you don’t provide it. While fibromyalgia cannot be objectively diagnosed at the present time, there are objective medical tests that are consistent with it. These tests should be obtained.

Additional Testing Can Help

In addition to your regular doctor visits, neuropsychological testing is often a good idea. It can provide objective evidence of the cognitive deficits from which fibromyalgia victims often suffer.

Finally, it may be helpful to obtain a functional capacity evaluation.  An FCE tests a claimant’s ability to lift, carry, push, pull, sit, stand, and perform other functions necessary to one’s occupation. These are particularly useful when fatigue is a significant symptom.

Our disability insurance lawyers are familiar with all the testing that should be part of a fibromyalgia disability claim or appeal and will refer you for any testing you need.

Beware of Insurer Attempts to Characterize Your Disability as a Mental Disorder

Most long term disability group policies limit benefits to two years when the disability is caused or contributed to by a mental illness. Insurance companies frequently use these provisions as a shield because the symptoms of fibromyalgia are often similar to symptoms of depression. It is much harder for your insurance company to make this claim when your treating doctor has followed the proper diagnostic criteria and performed the right tests to rule out other conditions.

Conclusion

The disabling effects of fibromyalgia are very real – but unfortunately particularly difficult to prove. Help from a professional disability attorney before you file your claim or appeal can make all the difference.

The New York disability insurance lawyers at Riemer Hess will use our years of experience to assist you. Let us take over the case so you can focus on the most important thing: your health.  Call Riemer Hess, LLC, Attorneys at Law today at 212-297-0700.

 

 

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