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How To Support Your Disability Claim For Fibromyalgia


Although the courts have accepted fibromyalgia as a medically disabling condition, it can be challenging to collect disability insurance benefits for the disorder. Here is how you can support your disability insurance claim for a fibromyalgia diagnosis.

Why insurance companies challenge fibromyalgia claims

Fibromyalgia is a chronic disorder symptomized by widespread musculoskeletal pain, fatigue, sleep problems, and even psychological distress. The disorder affects an estimated 5 million Americans aged 18 or older.

The American College of Rheumatology established two criteria for diagnosis:

  • Widespread pain that lasts at least three months
  • At least 11 of 18 positive tender points on the tender point type test

Disability insurance companies fight fibromyalgia claims because the condition, which has no identifiable cause, is considered subjective. There is no testing available that can objectively confirm the diagnosis, like an x-ray or a blood test. Since the measurement of pain is subjective, it is often more difficult to prove disability by an insurance company’s standards.

How to support your diagnosis and strengthen your claim

Record everything.
Pain may be subjective, but keeping a daily pain journal to record the frequency, severity, and intensity of symptoms can strengthen your claim for benefits. Note all of your symptoms, no matter how big or small, in detailed entries that include dates, times, and what activity increased or decreased the pain.

A detailed record of your symptoms may support the information in your medical records and fill in any gaps. If your treating physician includes a review of your entries in their patient evaluation, your journal may be considered objective evidence. Since insurance companies seek often objective evidence of your diagnosis, this may be crucial to strengthening your disability claim.

Make sure your doctor is familiar with fibromyalgia.
Your regular treating doctor should understand fibromyalgia and how it affects your ability to function and how disabled you are. If the doctor is not experienced in diagnosing and treating the condition, as well as filling out monthly attending physician statements certifying disability, find a specialist who is.

A doctor who can properly identify and describe the restrictions and limitations caused by fibromyalgia is crucial to supporting your disability claim.

Gather supporting documentation.

You already have a pain journal, medical records from all treating providers and the results of your 18-point tender point test – do you really need more documentation?

The more written evidence you provide in support of your disability claim, the better. Seek further documentation such as witness statements (before the disability and after), letters, and functional capacity certification from your doctors.

Make sure your activities while not working are consistent with the restrictions and limitations your doctor has in place. Carriers love to do surveillance on claimants, as activities inconsistent with your restrictions/limitations are cause for a denial of benefits.

Functional capacity evaluations that are carefully administered can also objectify the fibromyalgia claim. Learn more about what to expect during a FCE.

Seek legal help.
A disability insurance attorney experienced in handling fibromyalgia cases can help you gather the necessary documentation, file a properly completed claim, strengthen any subsequent appeals and/or file a lawsuit if your claim is wrongfully delay or denied. Learn more about why legal advice is essential to successfully completing your disability claim forms:

Do you have questions about your claim? Schedule a free consultation.

DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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