After months of wondering, you’ve finally received a diagnosis for your chronic pain: fibromyalgia. Maybe you have increasing symptoms, or you’re taking off a little more work than you’d like because you’re in pain and tired all the time. Or you need to take some time off to take care of yourself. Is it time to retire and take long-term disability? Or have you reached the point where you can’t get through the day at work anymore?
Fibromyalgia afflicts as many as an estimated 10 million Americans but doesn’t have a specific diagnostic (like a blood test.) Characterized by widespread chronic pain, fatigue, and sensitive sore spots, the causes and workings elude doctors and refuse to be nailed down.
People who have fibromyalgia live with varying degrees of pain, fatigue, difficulty concentrating (called “fibro-fog” by patients), depression, and other symptoms that leave them eventually unable to work. It’s known as an “invisible illness” because of the difficulty of diagnosis. Fibro is also thought of as a “women’s disease,” since women are more likely to be diagnosed with it than men.
So what makes fibromyalgia so difficult? And why do insurers turn down claims for fibromyalgia so often?
Mental or Physical?
As anyone with fibromyalgia will tell you, they frequently hurt all over, and they’re tired, but they’re not crazy.
Even with repeated trips to their physicians, there’s no way to definitively diagnose fibro, unlike diabetes or cancer. Insurers tend to think of it as a mental illness that manifests itself physically rather than a specific illness with obvious physical causes. Many label fibro as a “subjective” illness, and therefore mental. Most policies cap mental illness benefits at 24 months, leaving you without benefits after that point.
Proving Your Claim
If fibromyalgia can’t be diagnosed with actual physical proof and standard medical testing, how do you prove it?
- Relevant medical records—fibromyalgia is an illness with symptoms that are self-reported; there is no medical testing available. Your doctor will have to make a clear diagnosis in the records, not vague like “reporting symptoms of fibromyalgia.”
- In addition to your regular physician, a rheumatologist can also give a positive diagnosis for fibro, which includes testing “tender points.” If you have 11 of the 18 points, you’ll usually receive a positive diagnosis.
- Repeated occurrences of at least six fibromyalgia symptoms (fatigue, memory problems, depression, anxiety, muscle weakness, dizziness, abdominal pain, etc.)
- Lab tests—while there are no specific diagnostic tests for fibro, any tests taken to rule out other conditions (i.e., hypothyroidism) should be documented with results.
- Doctor’s opinions—any additional opinions you get should also be in writing.
- First-hand statements from family and associates—these are strong evidence that you are having difficulties in everyday life because of fibro.
- Keep a diary of all your symptoms, physical and mental, and use it both in doctor visits and in your claim file.
Increasing Your Chances Of Approval
While there are no guarantees, there are some things you can do to improve your chances of getting long-term disability payments for fibromyalgia.
- A confirmed diagnosis from your rheumatologist
- Relevant related medical records (lab tests, prescriptions, hospital visits, etc.)
- Dates of visits and contact information for doctors, therapists, hospitals, etc.
- Doctor’s report on the extent of your work-related limitations
- Any treatments you are currently receiving
A lawyer should supply you with an assessment form for your doctor to complete that asks for greater detail of your limitations than an insurance company might provide.
Hiring a Houston lawyer experienced in long-term disability claims and who understands the law around long-term disability claims can help ensure that you’re following the process properly. He or she can also work with you to submit any appeals that you’re allowed to.
Don’t Let Fibromyalgia Stop You
If your insurance company has denied you benefits based on fibromyalgia, we’re ready to help you. The Herren Law Firm in Houston, TX can assist with your application, appeals and help you get the long-term disability benefits you need so you can get the help and medical care you need. Contact us today at 713-682-8194 to schedule your free consultation. There’s no obligation and no up-front fees. We’ve helped over 4,000 Houstonians get their disability benefits, and we only collect a fee if we win your case.