Our firm regularly represents individuals who have been denied short or long term disability insurance (STDI or LTDI) benefits. Some individuals have debilitating physical injuries, which clearly prevent them from performing their jobs. More often, individuals come to us because they have a condition such as fibromyalgia, which has no identifiable cause and is accompanied by a host of symptoms. These clients face unique challenges in proving their disability, but with guidance and the proper evidence, they too can recover the benefits they deserve.
Insurance Companies Frequently Deny Benefits to People with Fibromyalgia
Since many fibromyalgia symptoms are subjective, insurance companies commonly deny these claims. Among other things, an insurance company might say:
• You do not have fibromyalgia
• Your fibromyalgia does not make you functionally impaired
• You are not getting proper treatment for your fibromyalgia
• A vocational consultant identified jobs you can perform despite the fibromyalgia
• A physician determined your restrictions and limitations are not supported
It is YOUR Burden to Prove Fibromyalgia Limits Your Ability to Work
When you appeal an insurance claim denial, it is your job to prove the insurance company’s assertions are wrong. It also is your responsibility to provide evidence to support your condition and the reasons you cannot work.
Five Ways to Increase Your Chance of Success on Appeal
At minimum, consider the following 5 tips to support your claim that fibromyalgia prevents you from working:
1. Find a Doctor Familiar with Fibromyalgia
Your doctor must be your advocate in terms of describing (in medical terms) your condition, symptoms, limitations and treatment. Thus, it is imperative you choose a doctor who understands the fibromyalgia diagnosis and how the condition affects your functioning. The doctor should have a global treatment plan, which may include pain medications, antidepressants, sleep aids, physical therapy, exercise, massage, counseling, and adjustments in diet, among other things. Your doctor should review your medical history to determine which treatments will be effective in your individual case. If your doctor does not actually believe you suffer from fibromyalgia, or if he is uncertain how to treat it, consider getting a second opinion from someone who specializes in the disorder.
2. Get Objective Testing
While fibromyalgia involves subjective reports of symptoms such as widespread pain and fatigue, the insurance company will look for objective evidence of your condition. Courts generally have recognized the 18-point tender point test as objective medical evidence of fibromyalgia. Even if the insurance company recognizes the fibromyalgia diagnosis, it may still assert your condition is not severe enough to prevent you from working. You will need to provide objective evidence of functional impairment. This will require meticulous documentation from medical providers, friends, family members and you about your activity level and restrictions and limitations. It may also require further testing, such as a functional capacity evaluation.
3. Gather Supporting Documentation
The more written evidence you can provide in support of your disability, the better. Certainly, you will need to submit medical records from all treating providers. You also will need to go out and collect additional evidence as to why you cannot work as a result of your fibromyalgia. This may include witness statements, letters and questionnaires from doctors, a vocational report and/or a functional capacity evaluation.
4. Apply for Social Security Disability Insurance
There is no cure for fibromyalgia, so your disability may be long-term. If you believe you will not be able to work for a year or more, consider applying for Social Security Disability Insurance (SSDI) benefits. Most long-term disability insurance policies require you to apply for SSDI benefits. Moreover, the Social Security Administration (SSA) recognizes fibromyalgia as a disability. Your case for LTDI benefits will be stronger if the SSA determines that you are disabled.
5. Hire Competent Counsel Experienced with Fibromyalgia Diagnoses
Attorneys specializing in LTDI claims will gather the evidence necessary to put together a solid appeal. Experienced attorneys have had other clients with fibromyalgia, and they will work with you and your doctors to get all the information necessary to prove your claim. Further, they understand how insurance companies, such as Unum, MetLife, CIGNA, Prudential and others operate. They will make sure to gather and present the best evidence to the insurance carrier. By doing much of the leg work for you, they can alleviate some stress so you can focus on your health.
Despite the special challenges for fibromyalgia clients, the disability attorneys at Hawks Quindel have convinced insurance companies to reverse their decisions and reinstate LTDI benefits. Our attorneys handle claims for short and long term disability as well as Social Security. Contact us if you would like to discuss the denial of your disability benefits claim.
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