Fibromyalgia is Declared as a new Long_term Disability

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.

Is Fibromyalgia A Long Term Disability?

Fibromyalgia is difficult to prove as a disability since it is a condition with largely subjective symptoms.  Because of this, obtaining long term disability insurance benefits can be challenging.  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.

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Fibromyalgia and Disability

Diagnosis

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

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

Disability Benefits for Fibromyalgia

Fibromyalgia is a common yet often misunderstood medical condition that affects approximately four million Americans. Fibromyalgia can be particularly complex within the context of disability benefits. If you are unable to work due to fibromyalgia symptoms, you should be familiar with the disease and how it is assessed in relation to disability benefits.

Table of Contents

• What Is Fibromyalgia?
• Can I Get Long-Term Disability Benefits for Fibromyalgia?
• Why Is It Difficult to Prove Disability Due to Fibromyalgia

What Is Fibromyalgia?

Fibromyalgia is a physical condition that causes widespread muscle pain throughout the body, as well as fatigue, headaches, sleep problems, emotional and mental distress, and difficulty thinking and concentrating (a.k.a. “fibro fog”). Irritable bowel syndrome can also coincide with fibromyalgia. While fibromyalgia can affect individuals of all ages, it is more common amongst women and is most commonly diagnosed during middle age.

Doctors can confirm the presence of fibromyalgia via objective testing measures – more specifically – the trigger point test. This test can identify up to 18 tender points associated with fibromyalgia that produce localized pain when the doctor presses on the area with their finger. If 11 out of those 18 tender points elicit pain or tenderness, than a diagnosis of fibromyalgia is proper.

Can I Get Long-Term Disability Benefits for Fibromyalgia?

Yes, it is possible to qualify for long-term disability benefits due to fibromyalgia symptoms. In fact, it is common for severe pain, fatigue, and/or fibro fog to prevent an individual with fibromyalgia from working on a consistent basis. You should submit a claim for long-term disability benefits if you are unable to perform the duties of your job due to any combination of those symptoms. However, it can be an uphill battle proving that your fibromyalgia symptoms prevent you from performing your job.

Why Is It Difficult to Prove Disability Due to Fibromyalgia?

Most disability insurers are skeptical of long-term disability claims filed by individuals who suffer from fibromyalgia due to the subjective nature of the disease. More specifically, insurers will typically deny payment of fibromyalgia-based long-term disability claims on the grounds that the claimant failed to provide an objective basis for their inability to work. While tender points are indicative of the presence of fibromyalgia, the severity of symptoms (namely pain, fatigue, and fibro fog) is based almost entirely on the patient’s self-reports. Thus, the “invisible” nature of fibromyalgia makes the claimant’s credibility a key factor of the disability claim.

Insurers will also commonly deny fibromyalgia-based disability claims based on a reviewing physician’s opinion that even if fibromyalgia symptoms are present, they do not rise to the level of preventing the claimant from performing their job. There is also a minority of physicians who erroneously believe that fibromyalgia can never be disabling.

Thankfully, many federal courts acknowledge the potentially disabling nature of fibromyalgia and can award long-term disability benefits accordingly. In Kennedy v. Eli Lilly & Co., 856 F.3d 1136 (7th Cir. 2017), our firm secured a favorable opinion from the Seventh Circuit Court of Appeals regarding a claimant who suffered from disabling fibromyalgia. The court confirmed that fibromyalgia symptoms of severe widespread pain, fatigue, and cognitive difficulties are “typically . . . very disabling.”

Nevertheless, you will still need to sufficiently support your disability claim to your insurer (or subsequently the court) in order to receive long-term disability benefits. There are several steps you can take to properly support your long-term disability claim, including:

• treating with a doctor who is familiar with fibromyalgia;
• confirming your diagnosis of fibromyalgia pursuant to the 1990 American College of Rheumatology Criteria for the Classification of Fibromyalgia, which utilizes the 11 out of 18 tender point criteria, or the more recent 2010 American College of Rheumatology Preliminary Diagnostic Criteria; and
• • providing your insurer with treatment records and statements from your treating doctor(s) that corroborate your self-reported symptoms and inability to perform the duties of your occupation.

  If you suffer from debilitating fibromyalgia symptoms that prevent you from working, you should reach out to an experienced disability insurance attorney who possesses the knowledge to guide you through your disability insurer’s attempt to deny you the long-term disability benefits that you deserve.

• If your long-term disability benefit claim was just denied, your first instinct is probably to gather more records and send them to the insurance company with the expectation that a little more evidence will suffice. That instinct is the right one, but the stakes are…