Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties. While fibromyalgia affects millions of people worldwide, it is still often stigmatized and misunderstood, making the disability insurance claims process even more challenging to navigate successfully. When filing a fibromyalgia short or long term disability insurance claim, it’s essential to understand how to best present your claim to your insurance company.
Understanding the intricacies of these insurance policies, particularly under the Employee Retirement Income Security Act (“ERISA”), can be overwhelming. That’s where The Maddox Firm can help. In this article, we’ll discuss strategies for proving your fibromyalgia short or long term disability claim and how the experienced team at The Maddox Firm can maximize your chances of benefit approval.
How Does Fibromyalgia Cause Disability?
Fibromyalgia can cause disability due to an array of physical and cognitive symptoms that may significantly impair your ability to perform daily activities and perform your occupational duties.
Here are some ways in which fibromyalgia can lead to disability:
Chronic Pain: Widespread and persistent pain is a characteristic symptom of fibromyalgia. The pain can be debilitating, making it challenging to engage in physical activities, perform work tasks, or even carry out simple daily routines.
Fatigue and Sleep Disturbances: Many individuals with fibromyalgia experience chronic fatigue and sleep disturbances, such as insomnia or non-restorative sleep. This fatigue can be severe and overwhelming, affecting concentration, cognitive function, and physical stamina required for work.
Co-Morbidities: Fibromyalgia often overlaps as a diagnosis with other conditions, such as Chronic Fatigue Syndrome (“CFS”) and Postural Orthostatic Tachycardia Syndrome (“POTS”). These conditions often share similar symptoms such as chronic fatigue, pain, sleep disturbances, and cognitive difficulties. While the exact relationship between the three conditions is not fully understood, there is evidence to suggest that autonomic dysfunction and abnormalities in the central nervous system may play a role in the development and manifestation of these overlapping symptoms.
Cognitive Difficulties: Fibromyalgia can cause cognitive impairments, often referred to as “fibro fog” or “brain fog.” This can manifest as difficulties with memory, concentration, attention span, and information processing. These cognitive symptoms can interfere with work tasks, problem-solving, and decision-making abilities.
Reduced Physical Functioning: Fibromyalgia can lead to reduced physical functioning, including limitations in mobility, flexibility, and strength. You may experience difficulties with prolonged standing, sitting, or repetitive movements required for certain occupations.
Sensitivity to Stimuli: Many individuals with fibromyalgia are highly sensitive to stimuli such as noise, light, odors, and temperature changes. These sensitivities can cause discomfort and exacerbate symptoms, making it challenging to work in environments with excessive sensory stimulation.
Mental Health Impact: The chronic pain, fatigue, and limitations associated with fibromyalgia can take a toll on your mental health. Anxiety, depression, and other psychological conditions are commonly associated with fibromyalgia and can further hinder your ability to function effectively in the workplace.
Impact on Work Attendance and Productivity: The unpredictable nature of fibromyalgia symptoms, including flare-ups and periods of increased pain and fatigue, can lead to frequent absences from work or reduced productivity. The condition can make it difficult to maintain a consistent work schedule and meet the demands of your employment.
Can I Receive Short or Long Term Disability Benefits for Fibromyalgia?
Yes, you may be eligible to receive short or long term disability insurance benefits for your fibromyalgia. However, the process can be challenging. Due to the subjective nature of fibromyalgia symptoms, establishing a disability claim can be more complex compared to conditions with more objective measures.
Success in obtaining disability benefits for fibromyalgia often depends on factors such as the specific terms of your insurance policy, comprehensive evidence supporting your diagnosis and functional limitations, and the assistance of an ERISA attorney. An experienced attorney can provide valuable guidance tailored to your individual circumstances and increase your chances of a successful disability claim.
How Do Insurance Companies Evaluate Fibromyalgia Disability Claims?
Your insurance company will evaluate your disability claim and evidence to determine whether your fibromyalgia prevents you from working. Fibromyalgia claims face higher scrutiny than many other medical conditions for a variety of reasons, including:
Subjectivity of Symptoms: Fibromyalgia is primarily characterized by subjective symptoms such as pain, fatigue, and cognitive difficulties. Unlike medical conditions with more objective evidence, it can be more challenging to provide concrete proof of the severity and impact of these symptoms, making it easier for insurers to question the legitimacy of the claim.
Lack of Objective Diagnostic Tests: There are no specific diagnostic tests for fibromyalgia. A fibromyalgia diagnosis is typically based on your reported symptoms, medical history, and the exclusion of other possible conditions. Without a specific diagnostic test, your insurance company may question the validity of your diagnosis.
Inconsistent Medical Opinions: Opinions among healthcare professionals regarding fibromyalgia can vary, leading to differences in the interpretation of symptoms and functional limitations. Insurance companies may exploit these discrepancies by seeking additional medical opinions from their own doctors or challenging the credibility of your treating physicians.
Difficulty Establishing Work Limitations: Fibromyalgia symptoms can fluctuate, and you may experience good and bad days. This variability makes it challenging to establish consistent work limitations, leading insurance companies to argue that claimants can still perform job duties during periods of lower symptom severity.
Lack of Understanding and Stigma: Fibromyalgia is often misunderstood, and a stigma may be associated with the condition. Your insurance company may have a biased perception of fibromyalgia as a “soft” or non-disabling condition, leading to skepticism and reluctance to approve your short or long term disability claim.
To overcome these challenges, it is essential that you gather comprehensive medical documentation, work closely with your treating physicians, and consult with an experienced ERISA attorney who can guide you through the process, address potential challenges, and present the strongest case for disability benefits.
How Do I Prove My Fibromyalgia Disability Claim?
Proving your fibromyalgia disability claim requires presenting compelling medical and vocational evidence to demonstrate the severity and functional limitations caused by your condition. Here are some specific types of evidence that can strengthen your claim:
Comprehensive Medical Records: Gather all relevant medical records, including your diagnoses, treatment history, and clinical notes from healthcare professionals who have treated your fibromyalgia. This documentation should cover a significant period to establish a long-term and consistent pattern of symptoms and treatment.
Specialist Evaluation: Seek evaluations from rheumatologists or other specialists experienced in diagnosing and managing fibromyalgia. Their professional opinions can carry more weight in supporting your claim, particularly if they document your symptoms, functional limitations, and the impact on your ability to work.
Diagnostic Criteria: Provide evidence that your fibromyalgia diagnosis meets recognized criteria, such as those established by the American College of Rheumatology. This may involve submitting medical reports that explicitly mention the criteria and ruling out other potential causes of your symptoms.
Objective Medical Findings: While fibromyalgia is primarily diagnosed based on subjective symptoms, including tender points, it is important to include any objective medical findings that support the severity of your condition. This can include abnormal test results, imaging studies, or other medical tests that demonstrate physiological abnormalities associated with fibromyalgia.
Medication and Treatment History: Document your adherence to prescribed treatments and medications for fibromyalgia. Include information about any side effects or lack of response to treatments, as well as alternative therapies you have explored.
Symptom Diary: Document each of your symptoms every day by keeping a diary. Rate your symptoms on a numeric scale, and provide a short description of the relevant details of your day. Try listing symptoms such as hours slept, fatigue, pain, brain fog, and ability to perform physical activity. By providing evidence that your symptoms occur daily, and/or that they are unpredictable, you will help the disability insurer understand which symptoms are stopping you from being able to work.
Vocational Evidence: Vocational evidence includes documentation related to your occupation and material job duties. You may provide your insurance company your resume, official job description, a personal affidavit outlining your job history and how the onset of your fibromyalgia has affected your job performance, and witness statements from your employer or co-workers that share their observations on how your condition has impeded your ability to work. You may also consider consulting with a vocational expert who can assess how fibromyalgia impacts your ability to perform your job or any other suitable work considering your functional limitations. A vocational expert can provide a professional opinion on your vocational capacity and the availability of reasonable accommodations in the job market.
Functional Capacity Evaluation (“FCE”): Consider obtaining an FCE, which is a comprehensive assessment conducted by a licensed physical therapist or evaluator. An FCE assesses your physical abilities and limitations, providing objective data on your functional capabilities and restrictions related to work activities.
Neuropsychological Evaluation: If your fibromyalgia causes significant cognitive symptoms, you may want to undergo a neuropsychological evaluation. A neuropsychological evaluation can provide an objective assessment of your cognitive impairments and functional limitations caused by your fibromyalgia. It can help substantiate the impact of the condition on your ability to perform work-related tasks, provide valuable evidence of cognitive difficulties, and support your claim for disability benefits.
Cardiopulmonary Exercise Test (“CPET”): The CPET can be valuable in proving a fibromyalgia disability claim by providing objective evidence of your functional limitations. CPET measures various physiological parameters during exercise, such as heart rate, oxygen consumption, and ventilation. The test can demonstrate reduced exercise capacity, cardiovascular abnormalities, and impaired physical functioning, supporting the claim that fibromyalgia significantly impacts your ability to engage in work-related activities that require physical exertion.
How Can The Maddox Firm Help Prove My Fibromyalgia Claim?
The experienced team at The Maddox Firm has helped many clients successfully file for short or long term disability benefits due to fibromyalgia. Here are a few ways we can help you with your fibromyalgia claim:
Examining your disability insurance policy: The Maddox Firm will carefully review your disability policy, medical records, and vocational evidence to assess the strength of your claim. We will guide you through the claims process, helping you understand the requirements outlined in your policy and the potential outcomes of your claim. It is crucial to understand the specific eligibility requirements stated in your disability insurance policy. Most policies initially require you to demonstrate that you are unable to perform the duties of your own occupation. As time goes on (typically 18-24 months), you may need to provide evidence that you are unable to engage in any reasonable occupation based on your training, experience, and education. However, it's important to note that the definition of disability can vary depending on your policy. Therefore, a careful review of your policy is essential to develop the best strategy for filing your fibromyalgia claim.
Reviewing your evidence and developing a personalized strategy: Our experienced team will conduct a thorough review of your existing medical and vocational evidence. We will identify any inaccuracies or missing information that could weaken your claim. Additionally, we will work with you to develop and gather additional documentation that clearly establishes the restrictions and limitations caused by your fibromyalgia, further strengthening your claim.
Gathering additional evidence on your behalf: The Maddox Firm will work to gather additional medical documentation on your behalf. Depending on the nature of your fibromyalgia symptoms, this may include a Functional Capacity Evaluation (“FCE”), neuropsychological evaluation, or Cardiopulmonary Exercise Testing (“CPET”). These assessments can provide objective measurements of your functional limitations and the impact of fibromyalgia on your ability to work. We will work closely with your doctors to obtain supplemental letters that explicitly support your disability claim, as standard office notes may not encompass the full scope of your fibromyalgia disability. We also help you develop vocational evidence to strengthen your fibromyalgia disability claim, including referring you to a vocational expert for a comprehensive vocational assessment, which evaluates your skills, abilities, and limitations in the context of your fibromyalgia.
Communicating with your insurance company: The Maddox Firm assumes all communications with your insurance company on your behalf. Our team will meticulously complete all necessary forms and paperwork accurately and promptly, ensuring compliance with all required deadlines imposed by your insurance company. In the event that your insurance company requests an interview, your attorney will thoroughly prepare you beforehand and be present during the meeting to protect your rights and shield you from any intrusive or improper questioning.
Filing an appeal, litigation, or negotiating a settlement: If your fibromyalgia short or long term disability claim has been denied, The Maddox Firm can prepare and file an administrative appeal on your behalf. Typically, if a claim is denied or terminated, you must go through the internal appeal process with your insurance company. If your claim is denied on appeal, you can sue your insurance company for the wrongful denial. Your insurance company may also at some point offer a lump sum settlement to buy out of your disability claim. The Maddox Firm routinely handles disability insurance appeals, litigation, and negotiations.
We always recommend speaking with a trusted attorney before filing, appealing, or litigating a fibromyalgia short or long term disability insurance claim. Whether you are looking for assistance in navigating the claims process, appealing a denial, or litigating a final adverse decision, The Maddox Firm can help. The team at The Maddox Firm will look over your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim.
Contact us to help you file your claim, appeal, or litigation the right way.