Fibromyalgia Disability Insurance Benefits Claim
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:
- The National Fibromyalgia Association
- The American Fibromyalgia Syndrome Association (AFSA)
- MyFibro.com – Information and support groups for people suffering with fibromyalgia.
- National Fibromyalgia & Chronic Pain Association – a great not for profit organization committed to educating patients and the medical community about Fibromyalgia and overlapping conditions.
Prescription Drugs for Fibromyalgia and Additional information:
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.
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.
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?
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.
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
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.
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.
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.
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.
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.
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?
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.
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?
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.
I have Unum as my disability insurance company. As of January they stopped paying me due to fibromyalgia. They had me apply for social security and I was just approved. Now, I have received a backpay lump sum. Rightfully, they should still be paying me until I am 65. I am 61. Would they still require the back pay or could I try to fight them in court for my forward pay? Help, please!
Renee,
Unum would still be entitled to seek repayment of any overpayment for benefits paid that overlap with a period SSDI is paying benefits. If your claim was denied in January did you ever appeal the decision as the 180 day deadline to file same has passed.
I receive monthly long term benefits from Unum, they contacted Social Security to make sure I wasn’t getting SSD. I became disabled in May 13, 2013, I was on short term disability on Nov 2013, long term began.
I need to know if Unum can withheld half of the amount they pay me because I took my Social Security Retirement in June 2013, not SSD.
Thank you and I’m sorry it took me so long to do this,
Diane
Diane,
Under many Unum policies Social Security Retirement disability is an offset of your monthly benefit. You will need to review your policy. If it lists the aforementioned Unum would have the right to offset your disability benefit.
I have a pre-existing (2007-present) condition of Fibromyalgia, Hidradenitis Supertiva (HS) and newer diagnosis of Anxiety.
I am looking to see if I can qualify for STD and/or LTD. My Fibro & HS has become more and more worse to the point of misery. I am on medication but it isn’t touching the problems and isn’t giving relief. I am now experiencing Memory issues and severe feelings of overwhelmedness. Since it is pre-existing, am I able to apply for STD and/or LTD? My insurance offers it. Please advise, as I am fearful that I will lose my job and want to make the right decision now.
Hal,
Most policies require that you be covered for at least 12 months prior to being able to file a claim for pre-existing conditions. You will need to refer to your policy to determine what coverage for pre-existing conditions your employer’s policy provided.
Have had fibromyalgia, disc degenerative disease amongst spinal issues and cfs. I’ve been in LTD with Hartford for 13 yrs. I’m 50. They did the interview with video of me going to dr appointment. Then reapproved me after their intimidating bullying. 3 yrs later and they’re at it again…interview, videos. Now they’re sending me to ime in December. I recorded this last interview, and it was such a joke that Hartford actually apologized for sending him out. My son was here ate him up and spit him out. I’m going to videotape the ime. Question: at what point do you get involved if I’m wanting to attain your services, and what’s protocol on your end from here?
Denise,
Please feel free to contact our office at any point. We get involved during monthly claims handling, in advance of any potential denials, as well as handle administrative appeals and litigation.
Currently out on FMLA due to jaw pain and headaches due dental occlusion problems and eating properly. Lost 25 pounds. I’m thin, lack stamina. In addition to this problem I have a back injury and take pain meds. Also insomnia and meds for that and chronic anxiety. See the doctor every month.
Question is how to I get around the pre existing clause of 90 days. I have worked for company for a year prior to insurance eligibility which was Nov 1 of 2015. My FLMA started November 22 of 2015. So my insurance coverage began November 1.
My jaw problem consult was in September but treatment began in October.
I don’t think migraines are part of my medical record nor is depression. I’m just wondering what to claim as my primary disability to stay out of the pre existing area.
I’m cognitive impairmented at this point with pain, lack of sleep and weight loss.
Any advice would be appreciated.
Sophie, unfortunately, as we do not represent you we would not be able to give you specific advice as to how to avoid the application of a pre-existing condition clause in the policy. If you have a copy of your policy please feel free to contact our office so we can look at the pre-existing language to determine if there is any assistance we can provide.
I have been receiving LTD from UNUM for the last 9 years or so now they say they are closing my claim because they feel I am no longer quailified. My condition hasn’t changed but actually gotten worse. I am currently being treated by my family physician who has sent them my limitations and I have been started with a Rheumatoligist who I have seen twice. The VA who I saw 9 years ago I have stopped seeing because I am now longer qualified to see them because of a divorce. I don’t know what to do I cannot work I know that I have panic and anxiety issues but the pain is also a huge problem. I don’t sleep well and am on medications to help with that but it isn’t working. I have trouble getting out of bed, off the couch and even problems with lifting and holding things with my hands. My sed rate has been evelvated for years and I just don’t know what to do. Social Security just recently did a review and consider me still disabled and I called UNUM telling them I will go see the Rhuematologist again for the restrictions and UNUM said that may not make a difference because they take the whole picture into consideration and their Drs. who have never seen me say I can work. I don’t understand how can my own dr. not be considered? This anxiety is making things worse and I can’t afford an attorney, I don’t know where to turn.
Donna, when was the claim denied? You do have rights to appeal the denial. Please feel free to contact our office to discuss how we may be able to assist you.
Good evening in December of 2013 I had an accident that I feel I first went to chiropractor and after about 10 day’s I was feeling even worse so I went to my primary DR at Kaiser they sent me to a back specialized he the 1st MRI January 16 2014 which show L2. 3 2MM bulge disk with minlde stenosis but did nothing about my neck shoulders arms ect ect
They give me 2 or 3 shots in my lower back area that did nothing to release the pain he referred me to physical therapy and acupuncture also I’ve been going to the chiropractor the whole time
In December 2015 my pain management Dr finally does a exray on neck and shoulders 20 minutes after leaving the doctor’s office they immediately called me and want me to come right back for an MRI I can’t make back that day so the next morning I go get a MRI c3-c4
C5-C6 secondary 2MM broad bace paracentral sac moderately to significant narrowing of both Neural foramina C6-C7 2MM paracentral posterior disk causing pressure over the anterior aspect of the thecal sac
I have also been diagnosed with fibromyalgia sleep apnea insomnia anxiety depression panic attacks been going to the doctor for two-and-a-half years
I have a long-term own occupation Disability Policy to 67 and now my disability company after a year-and-a-half is sending me to 2 IME one for 2 hours and one for 7 hours
I’m not very comfortable with there actions
What are your thoughts
Todd, it would sound like your carrier is looking to find a reason to deny your claim. Please feel free to contact our office to discuss your claim, rights, and what can be done to continue to protect your disability benefit.
Hi, I am a 47 year old woman that suffers from fybromyalgia, no thyroid, copd, diabetes 2 and high blood pressure. I resantly lost a job working in a preschool do to fybro fog. I was having a very bad day and could not concentrate on my job. I ended up leaving a child unattended with out realizing I had done it. He was not alone for long but it scares me to think what could have happened. I have more bad days then good and find it hard to concentrate on my task. Please give me advise on what to do to possibly get disability.
Mary, if you have a disability insurance policy please feel free to contact our office to discuss how we can assist in filing a claim under the policy. However, if you did have a policy and your benefits were terminated upon the loss of your job there may be a limited amount that can be done. If you do not have, or never had a private or employer provided disability policy your only potential option would be to file a claim for Social Security disability.
I am working with a lawyer but I am not very confident in her ability to get this pushed thru. I’ve done all of the legwork for medical records and research… all she keeps telling me is that I’m probably not sick enough… feeling like I should get a new lawyer before they schedule the hearing… How do I find one that is good with fibro cases?
Carol, from your information it sounds as if your claim is for Social Security disability. If that is the case, please be advised that we do not handle SSDI claims – only claims under private policies. That being said, we can assist you in contacting attorney who may be able to take your SSDI claim.
I teach and moved to a new district this year. I have maintained disability insurance without lapse for the last four years, but I know that my new policy does not pay for preexisting conditions. I have fibromyalgia-diagnosed 9 years ago, IBS-diagnosed 29 years ago, osteopenia-diagnosed 2 years ago, chronic kidney disease stage 2-diagnosed 2 years ago, chronic migraines, occipital neuralgia-diagnosed 2018 but seen by doctors for symptoms before moving and changing insurance carriers in August, ACDF neck surgery c5-7 2017, kidney cysts-diagnosed 2 years ago, plantar fasciitis-diagnosed 4 years ago, thoracic and lumbar bulging discs, carpal tunnel right wrist and hip pain. I am 56 years old and 4.5 years from retirement. I live in constant pain and fear that I won’t be able to teach much longer.
Can I apply for LTD through the carrier I had when I was diagnosed with these conditions? Or does it have to be through the current carrier? Or do I even have a disability case? The constant pain is wearing me down tremendously. The migraines and ON worsened after falling twice in September and hitting my head and jerking my neck.
Ann, typically, the only policy you can file a claim on is the policy that is in effect at the time you become disabled. Under most LTD policies, Disabled/Disability means that you are unable to perform the duties of your own occupation (or any occupation). Though you were diagnosed under the old policies, if you continued to work and now have coverage under a new policy as you are still working, the policy you are covered on while you are still working is likely the policy that you would need to file a claim on. But please be aware that most group policies will not cover a pre-existing condition if you have been covered under the policy for less than 12 months. If you have a copy of the new LTD policy from your new employment, we will gladly offer a free consultation to discuss its parameters with you. If you need help with your claim, please do not hesitate to contact us.
I just ended STD and now waiting for UNUM to approve LTD. I was diagnosed with Fibro many years ago but I had to stop working due to recent diagnosis of CFS and Allodynia. My type of work is high stress requires a high functional brain. The Cognative issues caused by CFS has created high stress and depression, anxiety is so bad while working.
A few questions:
1. I have had the insurance for many years, would they deny me under preexisting conditions?
2. I applied for SSDI, just Incase I don’t improve, if I get approved for SSDI do I have to pay UNUM back from the start of my STD?
3. If approved for SSDI my payments are a lot less than LTD, would UNUM pay any difference es through the length of my LTD policy?
The policy is very difficult to read through. Is there terminology I need to look out for to help me with these questions?
Thank you!
Shelley, pre-existing condition will only come into play if you have been insured under 12 months. If you get SSDI you will have an overpayment that you will owe to Unum. Unum would pay the difference if you are still disabled under the policy.