If you have a long-term disability claim involving fibromyalgia (or any other pain syndrome), then you need to read on. Fibromyalgia, and pain claims are often the subject of extra scrutiny from disability insurers. Here is why, and what you can do about it.
Pain syndromes are relatively new medical diagnoses. Not much is known about them. Furthermore, they are often the types of claims used by bad people trying to work the system. Add to that the following:
- They are subjectively diagnosed, and not objectively verifiable
- There is no medical test that can definitively diagnose them
- They are incurable and permanently disabling
- Insurance companies don’t want to set a precedent of paying such claims, and
- The consequences of pain on employability are, in the minds of insurers, debatable
Add all that up and you get a situation in which insurers ALWAYS resist paying such claims. If your claim is based on fibromyalgia, chronic regional pain syndrome, trigeminal neuralgia, occipital neuralgia, or generalized pain, then you will likely face strong resistance.
While you will face increased resistance, this does not mean you are not entitled to benefits. It means you should prepare for the struggle, and fight for your benefits. What you will need is a good attorney experienced in handling such claims and good documentation.
As an ERISA disability firm, we handle many of these cases.
We get the tougher cases; cases like fibromyalgia. Consequently, many of our clients suffer from pain syndromes. To prove these types of cases, you have to know how to put your best foot forward. And because these claims lack objective validation, you have to do so in creative manners. Here are some of things we do when faced with such cases:
- Focus on a prescription history – narcotic pain management is evidence of pain.
- Focus on the side effects of prescriptions – insurers love to neglect side effects, and narcotics carry many.
- Puts words to that which cannot be quantified – get testimonial letter from friends, family, and colleagues to describe the extent and severity of the pain from a third person perspective.
- Emphasize every different form of pain management attempted – has the claimant tried acupuncture, massage therapy, physical therapy, meditation, yoga, trigger point injections, steroid injections, nerve blocks, spinal stimulators, or the like? Some of these are immensely painful procedures (and costly too), and use of them evinces a desire to alleviate pain.
- Show how the pain affects employability – get testimonial letters from bosses and coworkers which illustrate how the claimant is limited in their work capabilities.
- Hire independent medical testing to validate the consequences of the pain – even if the pain isn't quantifiable, its consequences may be. The claimant may have neurocognitive deficits from the medications or from the pain alone. These, in and of themselves, can be disabling.
- Focus on the limits in the ADLs (activities of daily living) – has the claimant surrendered their license? Does the claimant spend all day in bed? Does someone else do the housework?
- Look for the secondary diagnoses – chronic pain is almost always accompanied by fatigue (caused by enduring pain) and depression. These can be, themselves, disabling. They are also dangerous to claim as disabling, as most policies have mental illness limitations. This must be done carefully, or you risk your claim.
There are many other things an attorney can do to help you keep, or regain, your benefits.