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Fibromyalgia Disability Insurance Benefits Claim


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Disability insurance carriers often challenge a diagnosis of fibromyalgia. How Can Disability Insurance Attorneys Dell & Schaefer Assist You?

As disability attorneys, Dell & Schaefer have represented numerous long term disability claimants that have been unable to work as a result of suffering fibromyalgia. Disability Attorneys Dell & Schaefer have an expansive understanding of the significant restrictions and limitations that a person with fibromyalgia must live with on a daily basis. We have worked closely with top physicians in order to sufficiently satisfy a disability carrier’s threshold of evidence necessary to prove that a client is disabled by fibromyalgia.

Not everyone suffering from fibromyalgia qualifies for long-term disability benefits, therefore the medical records of each client must be reviewed to determine the level of restrictions. We welcome the opportunity to discuss your long-term disability claim. You can contact us for a free initial consultation.

In the past several years the courts have accepted fibromyalgia as a disabling condition. Disability carriers often challenge fibromyalgia as a disabling condition due to the lack of objective testing available to verify the diagnosis. While there are objective criteria for a fibromyalgia diagnosis, their simply is no objective test such as blood work, x-ray, ultrasound or an MRI which confirms the diagnosis. The important thing is that a person disabled by fibromyalgia must be able to prove how their level of pain prevents them from being able to work with reasonable continuity. In order to be successful with your claim, a claimant must have a treating physician that is experienced in both treating fibromyalgia and taking detailed notes of how your medical condition causes restrictions and limitations.

What is fibromyalgia?

Fibromyalgia is a chronic condition characterized by widespread pain in the muscles, ligaments and tendons, fatigue and allodynia (a heightened and painful response to pressure).

Fibromyalgia occurs in about 2-4 percent of the population in the United States. Women are much more likely to develop fibromyalgia then men, and the risk of fibromyalgia increases with age. Doctors do not know what causes fibromyalgia. Fibromyalgia symptoms often begin after a physical or emotional trauma, but in many cases there is no triggering event. Fibromyalgia may also be genetic, as the disease tends to run in families, there may be certain genetic mutations that may make a person more susceptible to developing the disorder.

Some researchers believe the pain caused by fibromyalgia centers around a theory called “central sensitization”. This theory states that people with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals. Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain’s pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.

How the symptoms of fibromyalgia can affect you

Fibromyalgia isn’t progressive and generally doesn’t lead to other conditions or diseases. It can, however, lead to pain, depression and lack of sleep. These problems can then interfere with your ability to function at home or on the job, or maintain close family or personal relationships. The frustration of dealing with an often-misunderstood condition also can be a complication of the condition.

The pain associated with fibromyalgia is described as a constant dull ache, typically arising from muscles. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.

The American College of Rheumatology has established two criteria for the diagnosis of fibromyalgia: widespread pain lasting at least 3 months and a person must have 11 positive tender points out of 18.

People with fibromyalgia often suffer from sleep disturbances and are rarely able to reach a deep restorative stage of sleep. Sleep disorders that have been linked to fibromyalgia include restless leg syndrome and sleep apnea.

Some people may also exhibit difficulty in swallowing, bowel and bladder abnormalities, numbness and tingling and cognitive dysfunction. The cognitive dysfunction some people experience is commonly referred to as “brain fog” or “fibrofog”. These symptoms are often characterized by impaired concentration, short and long-term memory problems, short-term memory consolidation, impaired speed or performance, an inability to multi-task, cognitive overload and a diminished attention span.

Many people who have fibromyalgia also suffer from co-existing conditions such as; chronic fatigue syndrome, depression, endometriosis, headaches, irritable bowel syndrome (IBD), lupus, osteoarthritis, post-traumatic stress disorder (PTSD) and rheumatoid arthritis.

Resources

There are many valuable sources of fibromyalgia information available. You can also access resources over the internet such as:

Prescription Drugs for Fibromyalgia and Additional information:

There are 14 opinions so far. Add your comment now.

Lynette Stone:

I am in a terrible battle with my employer, the IRS. This is the second time they have tried to take away my FMLA time from me. I filed a grievance with my Union the first time and won. To make a long story short, they are trying to force me out. I am considering filing for disability because if I get fired I will loose my medical insurance and my pension. I have a long history of Fibro with my Rheumatologist. My biggest fear is how will I survive during the waiting period. Can I work at all while I am waiting? I am single and therefore am my sole support. Any answers you have would be greatly appreciated.

Attorney Stephen Jessup:

Lynette,

Without a copy of the policy that would govern any disability claim it would be impossible to advise you of your options. If you don’t have a copy of your policy, I would suggest obtaining one. Please feel free to contact our office for a free consultation so we can review the policy and discuss your options.

Jennifer Brown:

I have had Fibromyalgia for at least 20 years. I will be losing my insurance the end of Sept. through my state once my child has turned 19. I can not afford other insurance, even the HIRSP plan that we have is more expensive than I can afford as I can not work a full time job. I am currently in school trying to make a better life for myself and even that takes all of the energy I have and then some. I can not take the Lyrica and Cymbalta because I am allergic to them. I do have medications that I take to at least take the edge off of the pain most times but once I have no insurance, I have no medications. This is truly a very bleak scenario for me. Do you have any suggestions?

Attorney Stephen Jessup:

Jennifer,

I am sorry to hear of your troubles. With respect to insurance, specifically any disability related insurance, if you do not have any employer or private insurance in place your only option will be to apply for SSDI. With respect to any health insurance, I would not be able to give you any suggestions on how to secure same.

Suzanne:

Hello – I am a RN who has been on LTD approaching the 2 year limitation for treatment resistent depression with Lincoln Financial. I also have fibromyalgia. The symptoms that are most debilitating are physicial exhaustion, I can’t concentrate, can’t think clearly and am forgetful, I have difficulty carrying on conversations, I have trouble finding the right words to say. I am unable to take care of any commitments or responsibilities. I am simply overwhelmed by the smallest things. My symptoms are so unpredictable that I find myself unable to get out of bed on some days. If I am active one day and go to an appointment or manage to clean a room or vacume, I end up sleeping the next day and laying around the day after that. I can’t stand long enough to do the dishes most days. I have been barely getting by with lack of energy and ability to focus on what’s important. (fibro fog?) Physically, my legs and arms get weak if I stand very long or lift my arms up like to do the dishes for more than 5 minutes. walk from one end of the house to the other and have to sit down and rest.

Over the past year my symptoms have become completely debilitating. I am giving you the details of symptoms I have been dealing with that in no way are related to depression. Emotionally, I am depressed other than for the loss of my once active and productive and successful life earning a six figure income. I have basically ignored the fibromyalgia component of my illness and have not challenged the insurance company about the fibro diagnosis. I told my insurance rep about 1 1/2 years ago about my Rheumatologist and fibromyalgia and that he didn’t have those records and he stated that because the fibro was not part of the reason for my disability claim it was irrelevent and not to send the records. The fact that my medical issues have not been resolved in any way with treatment for depression, I would think means they are related to fibro. I just have not focused on that, I did what I had to do to keep the depression claim going, going to my psych and therapist.

In thinking back, I was in an auto accident many years ago with a lumbar disc injury and my treating physician then told me based on an exam that I had fibre. I didn’t think much of it. I have an appointment with this physician from years ago on Monday and I think he will document well. I was again told I had fibro by a chiropracter and acupuncturist, at different times several years ago. I just didn’t have the exhaustion, memory, anxiety, poor sleep, etc, etc. then, just very painful trigger points.

Since this is ERISA should I notify them by letter and then if they deny and I need an appeal call you? My 2 year limitation will be paid as of 10/31/2013. I know, very late notice. If so, how much info? Should I put in the letter? Do I need representation now? I filed for SSDI in July and it is pending. I have not worked for 2 1/2 years.

Thank you for reading this.

Sincerely,
Suzanne

Attorney Stephen Jessup:

Suzanne,

It is imperative to be actively treating with a doctor for your fibromyalgia or you will have a very difficult time trying to secure any benefits beyond the 2 year period Lincoln is paying you benefits under. Please feel free to contact us for a free consultation to determine how we may be able to assist you.

Rene Phillips:

Hello,

I have had a claim with The Standard Insurance company for almost 2 years. I was diagnosed with major depressive disorder, anxiety and agoraphobia. I have since been found to be treatment resistant.

Recently, I was diagnosed with fibromyalgia. I had never focused on any of my physical issues during these 2 years for 2 reasons:

1) I thought the most important issue to deal with was the depression because it was the one that scared me, and

2) Because of the number of symptoms, I was afraid of being considered a hypochondriac.

I believe there are 2 symptoms that I had discussed with my primary care physician BEFORE I was diagnosed with depression. I even went to physical therapy for one.

With a 2 year limitation on mental illness my LTD insurance will be ending soon.

I am wondering if, because I haven’t been treated for my other symptoms (which are severe) if you think I would have a basis to appeal the termination of my benefits. It is quite possible that the mental health issues are just another symptom of fibromyalgia.

I have kept a journal off and on since my depression diagnosis that does include descriptions of other symptoms but I don’t know if that would be of any use to an appeal.
Any comments or advice would be greatly appreciated.

Attorney Stephen Jessup:

Rene,

It is imperative to let Standard know of the recent diagnosis as I would suspect your policy has a two year limitation for mental health conditions that is fast approaching. Please feel free to contact our office to discuss how we may be able to assist you in securing your benefit beyond any two year limited benefit period.

Laura Lynn S.:

Hi… I have fibromyalgia, migraines, depression and I still have back issues even though I have had back surgeries and I have a neurostimulater in my back. I am trying to apply for short term disability through work but I am having an issue with my doctor taking me off so that I am not denied for it because my doctor did not take me off. I have used up my fmla so this is the next step. My doctor has said that I should quit my job but yet she says she will not approve taking myself off because I am in pain all the time. I sit all day and I type all day. My fingers swell up due to the fibro. and I cannot type well anymore. I am tired all the time and my medicines can make me sleepy sometimes. I also do have insomnia. What can I do to get my doctor to be able to prove I have these issues and get her to approve me off on STD? She has referred me to a fibro. clinic but the hours I would need to go are during the hours I work and the3re is no way I can make these hours up. I am a single mom and I need to keep money coming in due to owning my own house.

Attorney Stephen Jessup:

Laura,

Unfortunately, if your doctor is not willing to certify disability there is little that can be done. The only other option you may be able to explore is seeking new medical treatment from a doctor who would be willing to certify your disability.

Leah:

In February I found out I had Nutcracker Syndrome add that to the Fibromyalgia, depression and anxiety I already was dealing with, I was having a very rough time and had been feeling ill for some time. Went to Vascular Surgeon and had to have a procedure done to see what was going on so stopped working. Work advised me to go on short term disability so I did. The insurance company has been horrible to deal with just about the whole time even though I was going above and beyond with what I needed to give them and sent emails with clinic notes after each doctor visit. They threatened to cancel at least once, asking for information I had already gave them. Short term ended and I was still not able to work so they said they would go ahead and get me started on long term – two months later we are still nowhere. I just did an IME and have to do see an independent psychologist exam at the end of the month. We all know how those go and 99% of the time they use it to deny benefits. They have not been treating me right this whole time and I feel that I should have received some long term disability money by now. I feel like the Insurance company is playing games with my livelihood and I feel it needs to be rectified. Since they are making me do those independent exams, does that mean my chances are over and I should just start the process for SSI instead?

Attorney Stephen Jessup:

Leah,

Insurance companies don’t often send claimants to IMEs, so there does stand a chance that they are just building their case to deny your benefit. Please feel free to contact our office to discuss how we may be able to assist you.

TL:

I’ve been on Short Term Disability for 5 months. I am now in my last month of eligibility and now the STD insurer is pending and trying to deny my final month of benefit citing “no objective medical findings” and also stating that the fact that I’m only 37 and have pain and headaches does not justify me to continue to be off of work. It’s as if they are completely ignoring my diagnosis of fibromyalgia and all of the symptoms that I have reported to mz doctor, whom I have seen every 30 days. I am a healthcare professional and well aware that there are no objective findings for fibromyalgia and fibromyalgia pain and headaches are not your typical everyday pain and headache. What I don’t understand is why they have approved me each month prior and wait until my last month of eligibility to try to deny me. I am also in the process of applying for LTD and SSD. I have tried working with fibromyalgia for quite some time and the condition has just gotten progressively worse and the pain and migraines are constant and debilitating. This company does not seem to be taking my physician’s statement of limitations and office notes seriously. Do you have any suggestions on anything else that I can do_ Do you think that me writing a letter would help any? What should I say?

Attorney Stephen Jessup:

TL,

The likelihood is that the carrier is creating the argument it will use to deny LTD benefits as it is typically at the LTD stage that the carrier is responsible for issuing benefits. Please feel free to contact our office to discuss how we may be able to assist you.

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