Fibromyalgia and Long-term Disability Claims

Fibromyalgia is a chronic condition that causes pain and tenderness throughout the body. It affects 2-8% of the population and is twice as common in women as in men. It can affect an individual’s ability to function in daily life. It can also cause fatigue, sleep, memory, and mood issues. If you have fibromyalgia, and it is disrupting your ability to work, you may need to get long-term disability benefits.

Read on to learn more, including how you can get the help you need if your long-term disability claim for fibromyalgia is denied in Canada.

JUMP TO…

Understanding Fibromyalgia

Fibromyalgia is a medical condition believed to affect the central nervous system in a way that increases sensitivity to nerve endings. The most common symptom is widespread pain throughout the body. Other symptoms include tingling all over the body or sensitive to pressure on the skin.

Some sufferers also report cognitive symptoms such as memory problems, problems concentrating, an inability to multi-task, reduced attention span, and problems with short- and long-term memory consolidation. This condition is known as ‘Fibro fog’. Separate mental health disorders such as anxiety, depression, and chronic fatigue syndrome can also present in individuals with fibromyalgia.

Is fibromyalgia a disability in Canada?

Yes, All insurance companies in Canada that provide disability benefits recognize fibromyalgia as a condition that can qualify a person for benefits when they can’t work.

Common reasons for denial of long-term disability claims for Fibromyalgia

Fibromyalgia is sometimes excluded from insurance coverage or comes with the condition of long-term disability benefits being limited to two years. Even if your policy does not exclude fibromyalgia from coverage, successfully accessing benefits may be difficult. However, it is possible to get benefits for fibromyalgia. Below are reasons why some people might experience a denial for benefits.

Not enough medical evidence or documentation to confirm your diagnoses

Fibromyalgia could be considered an invisible illness and is resistant to most objective medical testing. In addition, an FM/a blood test can test for low levels of cytokines – an indicator of fibromyalgia – it does not measure the severity of the condition. This can be a problem when relying on medical tests to prove a disability.

The applicant has not sought the appropriate medical attention

Not seeking or participating in appropriate treatment for a disability is one of the most common reasons for a denial. If you are not getting appropriate treatment, either your doctor is not following standard protocol for treatment, or you are not following up on your doctors treatment recommendations. Either situation is going to be a problem for your insurer. If you believe alternative therapies can help, it is important to follow your doctor’s primary suggestions first. Not doing so could leave you vulnerable to your benefits being denied. This is true for any medical condition you are seeking benefits for, not just fibromyalgia.

What you can do to improve your chances of getting your benefits approved

Seek a confirmed diagnosis with objective medical testing

As an invisible illness, the difficulty someone is experiencing with fibromyalgia can’t be proven with objective medical testing. However, your doctor can perform other blood tests that will rule out similar conditions, thus narrowing the diagnosis down to fibromyalgia. These tests include:

Thyroid function tests

• Celiac serology
• Vitamin D
• Rheumatoid factor
• Complete blood count
• Erythrocyte sedimentation test

Keep records of your illness, medical visits and treatment

Since there is no specific test to diagnose fibromyalgia, your doctor will follow a diagnostic protocol and issue several different kinds of medical tests. Keep a record of all the tests your doctor runs. If your doctor refers you to a specialist, make sure you keep all your appointments and document each one. You will need supporting documentation to prove that other conditions were ruled out first. Since fibromyalgia is often associated with other conditions, such as mental health issues, documenting the process of getting these other health issues addressed and treated can help support your claim.

Seek Appropriate Treatment

Whether you are seeing a specialist for pain, physiotherapy, or psychological counselling, it is important to follow your treatment plan to the letter. If your doctor has recommended that you pursue a method of treatment, following the advice of the experts will only lend credibility to you and your claim. Additionally, making an effort to try reasonable recommendations will also lend credibility. This is true even if you do not agree with your doctors suggestions. Obviously, if you have genuine objections or concerns about treatment options or the side effects of medications, be vocal about your concerns to your doctor. You do not have to explore medications or treatments that you are not comfortable with.

Keep a journal of changes you are experiencing

Fibromyalgia can present in many ways. Keeping track of your symptoms in a journal is a way to help articulate your condition to your treating physician, as well as to document to your insurance company that your physical symptoms are real. Because there is a component of the illness that affects mental health, track your mental health, mood changes, changes in patterns of sleep, and any cognitive changes or deficiencies that you are experiencing. As with medical records, keep a record of any medications taken and side effects you may be experiencing.

Provide evidence of limitations to work

Trying to continue working by finding accommodations will boost your credibility. You need to demonstrate that you made every effort to continue working. Some evidence that might prove this are: medical records documenting your attempts to work, requests to your employer for accommodations, or witness statements.

If you’ve asked your employer for accommodations at work, keep track your attempts to alter your work processes or environment to allow you to keep working with written agreements or statements (reducing shifts, fewer hours, or lighter duties) and why those accommodations were requested.

If you have to take a leave of absence, document the circumstances surrounding the absence. Other evidence might include a written statement by you detailing your experience working or record of your employment. Your employer or co-workers may also provide statements as witnesses if they have observed your attempts to continue working by altering your duties. Such statements will help advance your credibility and your claim by providing evidence of your inability to work.

Was your LTD Claim Denied?

The long-term disability claims process can be a complicated one that may feel overwhelming, especially while managing a disability. If you have fibromyalgia, cannot work, and have been denied or cut off from your long-term disability benefits, seek the help of the team of disability lawyers at Samfiru Tumarkin LLP. We know how this process works because our lawyers have past experience working for insurance companies. We know their weaknesses.

Don’t walk way from your rights. That is what the insurance company wants you to do. They may also encourage you to appeal the denial. Do not go through the insurance company’s appeals process! In most cases, your appeal will be unsuccessful, and your insurer will use this tactic to run out the clock on your time limit to file a claim for full compensation.

If your disability claim is denied in Canada, you need to contact the experienced long-term disability lawyers at Samfiru Tumarkin LLP immediately at 1-855-821-5900 for a FREE CONSULTATION. We will review the facts of your situation, tell you if you have a case, and take the fight to the insurance company on your behalf. Don’t let them walk away with the money that they owe you in your time of need.<p/P

Advice you need, compensation you deserve.

Additional Resources

• Arthritis Society (Canada)
• The Arthritis Foundation
• Canadian Women’s Health Network
• Chronic Pain Association of Canada
• Disabled World
• Toronto Area Fibromyalgia Support Group Resources
• MyHealth.Alberta – Managing Fibromyalgia
• HealthLinkBC