For millions of Americans, filing for Fibromyalgia disability benefits can be an intimidating process. Fibromyalgia (FM) is a medical condition which causes physical impairment, pain, discomfort, and fatigue. Individuals with FM may experience depression as a result of dealing with persistent pain.
Managing FM may leave you unable to work and in need of long-term benefits. If this describes your situation, there are things you need to know before you file a claim for disability benefits due to FM.
Women between the ages of 25 and 60 are more likely to develop Fibromyalgia. Men are diagnosed with FM, but women are diagnosed at a rate ten times as high as men. As many as two percent of the population, or 6.5 million people, suffer from the pain and discomfort of Fibromyalgia.
The primary symptom associated with FM is extreme pain often in joints and muscles throughout the body. It may be painful even touch certain parts of the body, and the pain may be accompanied by redness and swelling. The neck, shoulders, hips, and back are the areas commonly affected by FM.
Also, individuals suffering from FM may have a lower pain tolerance than others due to the nature of the condition. Dealing with constant pain can impact a patients quality of life and lead to depression and anxiety.
If you have Fibromyalgia, you may decide to file a claim for disability benefits. The first thing you need to understand is that insurance companies tend to deny Fibromyalgia disability claims because it is a self-reported disease. The fact that you cannot prove FM with test results, such as X-rays, CT-scans, or an MRI, can make it more difficult to receive approval for benefits. However, there are ways to strengthen your claim.
As you know, diagnosis of FM is typically made by your physician who reviews your medical history, conducts tests excluding other diseases, and performs a comprehensive physical examination. Most physicians determine an FM diagnosis if symptoms have persisted for at least three months.
Because you are the one requesting Fibromyalgia disability benefits, the burden of proof rests upon you. A diagnosis of Fibromyalgia from your physician is not enough to qualify you for benefits, mainly because your determination is based on self-reported symptoms. As noted above, the inability to confirm your symptoms with medical tests is the basis under which most insurance claims are denied. Reviewing the following factors will help you strengthen your claims case.
Medical reports and treatment from a rheumatologist or orthopedist will carry more weight than treatment from your primary care physician or a general practitioner.
Insurance companies are likely to reject Fibromyalgia disability benefits claims because diagnosis relies on self-reported symptoms. The clause under which insurance companies deny long-term Fibromyalgia claims is referred to as the “self-reported symptoms limitation clause” or the “non-verifiable condition limitation.”
Based on the limitation clause, most insurance companies limit benefits to a maximum of 24 months. Symptoms considered non-verifiable include headaches, fatigue, stiffness, pain and soreness, dizziness, ringing in the ears, dizziness and so forth. Similar conditions subject to this clause are mental illness, alcoholism, and drug abuse.
Again, insurance companies consider these symptoms non-verifiable because they are self-reported. Another reason for this is that your doctor cannot conduct medical tests typically associated with disease diagnosis.
Carefully read the conditions of benefits coverage for Fibromyalgia disability benefits or similar self-reported or non-verifiable medical conditions. If you are familiar with the requirements, or limitations, of your insurance company, you will be in a better position when you file your disability claim.
Your insurance policy may not name Fibromyalgia specifically as a disease under the non-verifiable classification. But it’s wise to prepare yourself for resistance from your insurance provider.
It is common for your first Fibromyalgia disability benefits claim to be denied. But, there is an appeals process you can follow. Many individuals who take advantage of the appeals process are able to obtain benefits.
It’s likely you suffer from other symptoms of Fibromyalgia such as swelling, numbness, irritable bowel syndrome (IBS), and difficulty sleeping. Cognitive problems may also occur, often referred to as “fibro fog,” which may increase your stress and anxiety levels.
An accurate record, including dates, may help legitimize your fibromyalgia benefits claim.
At CJ Henry Law Firm, we have experience handling long term disability claims. Contact us today regarding your Fibromyalgia disability benefits claim or appeal.
