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Don’t Let Your Disability Insurer Discount Your Fibromyalgia

Friday, June 1st, 2018

Ask anyone with fibromyalgia if the disease is real. Because disability insurers often deny claims for fibromyalgia or chronic fatigue syndrome, claiming that are not illnesses, but “conditions”, and questionable ones at that. Today, medical science has proven that fibromyalgia is real.

Research has proven that fibromyalgia is related to brain activity that worsens the sensation of physical pain in the body. The disease causes widespread pain described as chronic, dull and aching, potentially in all parts of the body, according to the Mayo Clinic.

Since there is no lab test to objectively prove the diagnosis, it is easier for disability insurers to try to discount the validity of the symptoms and the activity limitations they cause. Lab tests will be taken to rule out other diseases.   Even the tender point testing, previously utilized for diagnosis, is no longer considered diagnostic.

In addition, the disability insurance claims adjuster or the third-party administrator will attempt to use any possible doctor notes to push the claim into the Mental/Nervous category, which often carries a limited benefit period which may not apply to a fibromyalgia claim.  In some cases, doctors prescribe antidepressants or other off-label medications to ease the pain and fatigue of fibromyalgia, or a muscle relaxant to help with sleep. If these prescriptions are in the medical records, or if there are notes addressing the patient being troubled by their diagnosis and has been advised to see a therapist for help, the disability company may seek to latch onto that as a reason to change the consideration of the claim, newly slanted toward a limited benefit claim.

Because of this and because of the challenge of providing evidence of subjective symptoms, anyone filing or appealing a claim for disability insurance based on disabling fibromyalgia and/or chronic fatigue syndrome should seek guidance from an experienced attorney to help navigate the issues.

Fibromyalgia sufferers also have another problem: even today, many doctors actually don’t consider it a real disease, and even those who do may not find it to be impairing as a general rule.  Women suffer disproportionally from fibromyalgia, symptoms are not straightforward and there is still no cure or subjective test that proves the diagnosis. The two main associations that deal with fibromyalgia, the American Fibromyalgia Syndrome Association and the National Fibromyalgia Association were founded in the 1990s, showing just how relatively new this disease is.

Mayo Clinic calls it a “disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues.” Other symptoms may include:

  • Weakness
  • Numbness
  • Headache
  • Impaired concentration
  • TMJ
  • Anxiety
  • Depression
  • Irritable bowel syndrome
  • Sleep disorders

Insurer surveillance

We have discussed the problems with insurance companies conducting physical and online surveillance of their claimants to try to find evidence of activities that conflict with their assertions of disability. This can be a particular problem with fibromyalgia claimants because one of the main ways to combat symptoms is to try to engage in regular exercise, aerobic if possible. Activity and exercise will be directly ordered by a treating doctor.

An insurance company with filmed evidence of a fibromyalgia claimant exercising may seek to assert that this activity demonstrates that he or she really does not suffer as greatly as reported by the claimant.  It is important to counter this kind of evidence with information about what the doctor has advised and the challenges faced by such a patient who is trying to increase their activity level as part of treatment.

Legal advocacy

At our law firm, we have advocated for many clients suffering from Fibromyalgia and/or Chronic Fatigue Syndrome. Don’t let your disability insurance company suggest that you are exaggerating or malingering. Seek legal representation to help you show the validity and severity of your fibromyalgia and why it prevents you from working.

We help our fibromyalgia clients to thoroughly develop their claim file to withstand the challenges from the disability insurance company. This is one battle you don’t want to take on alone –and with the Frankel Newfield disability law firm on your side, you don’t have to. Call us today at 877-LTD-CLAIM (877-583-2524) today and learn how we can help you.

Justin C Frankel

Written By:

Justin C. Frankel - Disability Insurance Attorney

Justin Frankel is a founding partner of the disability insurance law firm Frankel & Newfield and is a highly skilled litigator and advocate. He has published numerous articles on the challenges facing clients with private or individual disability insurance policies and those who own group or ERISA disability insurance policies.

Learn more about Justin | See Justin’s Publications



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