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Self-Reported Disabilities – Fibromyalgia and Chronic Pain

Medicine has come a long way in recent years. Researchers continue to find the previously elusive, unknown roots of Huntington’s disease, Alzheimer’s, and alopecia.

Doctors, however, cannot clinically diagnose every disabling condition. Conditions like fibromyalgia and chronic fatigue are hard to clinically confirm because they lack genetic and blood markers and do not appear on imaging tests. Instead, information about the pain, exhaustion, weakness, and mental suffering associated with these chronic disorders comes directly from the patients. This is why fibromyalgia, chronic fatigue, and migraines are considered self-reported disabilities.

While insurers recognize fibromyalgia, chronic pain disorders and migraines as legitimate medical conditions that may prevent you from working, it’s also subject to self-reporting limitations present in most individual and group long-term disability policies.

Make sure to consult an award-winning individual disability attorney or nationally acclaimed ERISA lawyer at DarrasLaw if you need assistance. We provide a free disability policy analysis and free claim consultation. DarrasLaw’s top-rated disability lawyers and award winning ERISA attorneys can help you answer the tricky questions on your disability claim application. We understand valid fibromyalgia, chronic fatigue, and migraine disability insurance claims and can help you and your treating doctors present the proper and most persuasive evidence to your disability carrier.

Individual or Group Long-Term Disability Benefits and Self-Reported Conditions

Whether you have an individual or group long-term disability insurance policy, you’ll likely find a benefit limitations clause applicable to certain self-reported mental health or substance abuse conditions. These may include:

  • Depressive disorders
  • Chronic fatigue
  • Fibromyalgia
  • Anxiety
  • Paranoia and delusional disorders
  • Anorexia and bulimia
  • Psychosomatic pain
  • Migraines
  • Mental illnesses
  • Drug and alcohol abuse and addiction

While insurers generally recognize these as legitimate disabling conditions, they try to deny most valid claims for individual or group disability benefits based on self-reported conditions and strictly limit the terms and limitations of your coverage.

For example, if fibromyalgia leaves you unable to perform the important duties of your occupation, it’s not enough to write as much on your claim application. Instead, your long-term disability insurer will look for pharmacy records, treatment records, and chart notes from your treating physician to confirm the legitimacy of your condition. However, only you know whether your condition truly prevents you from working reliably in your normal occupation.

The Facts About Fibromyalgia

According to the National Fibromyalgia Association, nearly 10 million people in the United States suffer from fibromyalgia. Women constitute between 75 percent and 90 percent of fibromyalgia cases. It’s one of the most common chronic fatigue and pain conditions in the world.

The Mayo Clinic says that fibromyalgia manifests with

  • Whole body pain
  • Chronic fatigue
  • Sleep disturbances
  • Memory loss
  • Mood disorders

However, it’s also associated with temporomandibular joint dysfunction (TMJ), depression, anxiety, irritable bowel syndrome (IBS), and tension headaches.

Although fibromyalgia can develop with time and without a triggering event, many legitimate cases of fibromyalgia arise after:

  • Physical trauma, such as a car accident
  • Surgery
  • Infection
  • Extreme mental and psychological stress

A fibromyalgia diagnosis requires a dull, aching pain throughout your whole body lasting for at least three months. It also requires true, “whole body” pain, on both your right and left side and above and below your waistline.

Long-lasting, whole body pain is the primary symptom of fibromyalgia, though this pain manifests in a variety of other conditions. Even if you sleep through the night, the pain may cause restless, light sleep and cognitive problems, resulting in chronic fatigue. This fatigue in turn causes you to lose your ability to focus, pay attention, and concentrate at work.

Diagnosing Fibromyalgia

Ultimately, a fibromyalgia diagnosis means that your brain isn’t processing pain signals in the right way, which then causes pain throughout your body. This is a difficult disorder to both diagnose and treat, and no known cure exists for fibromyalgia.

To successfully claim long-term individual or group disability benefits as a result of fibromyalgia, you must suffer from the condition throughout your policy elimination period and beyond to collect. Furthermore, clinical office visits with tender point testing documentation must back it up.

In the past, healthcare professionals diagnosed fibromyalgia with the 18 point test. This isn’t always a prerequisite to a fibromyalgia diagnosis, but your disability insurer may look for those test results. Because fibromyalgia is only diagnosed when you suffer from pain throughout your whole body, if you only experience chronic lower back pain, your disability carrier may argue you likely don’t have fibromyalgia.

During the 18-point test, your treating doctor will apply pressure to the following fibromyalgia-specific trigger points and ask you to rate your pain:

  • Left and right front of your neck
  • Left and right hips and buttocks where the muscles curve and join the thighs
  • Central lower back, right at the top of your buttock
  • The inside of the left and right knees
  • The left and right upper back where the back and shoulder muscles meet
  • Between your shoulders and your neck on the left and right side
  • The left and right side of your sternum near the second rib

Although a positive 18-point test will aid in a fibromyalgia diagnosis, the test itself is subjective. There is no way to measure the patient’s level of pain or determine whether the patient experiences pain at all. In the end, you self-report both your level of pain and whether you’re experiencing pain at every trigger point. This makes chronic pain and fatigue conditions such as fibromyalgia, although real illnesses, easier to fake than conditions diagnosable with genetic or blood testing.

Your long-term individual or group disability insurer will also look for negative testing, such as blood tests that rule out other clinical conditions that may cause your pain. These tests include, but are not limited to:

  • CBC (complete blood count)
  • Rheumatoid factor test
  • Erythrocyte sedimentation rate
  • Thyroid testing
  • The cyclic citrullinated peptide antibody test

Certain types of cancers, arthritic conditions, and thyroid disorders can combine to cause chronic fatigue, whole body pain, and cognitive fog. Your treating doctor will likely try to rule out all possible clinically diagnosable conditions before considering a diagnosis of fibromyalgia and conducting a trigger point exam. Your insurance company will look to see if your treating physicians were diligent in their diagnosis and that their chart notes accurately document and reflect all of your complaints, in office testing and treatments. This is especially true if you are male, as American men are far less susceptible to the disorder.

Don’t apply for individual or group disability benefits with a self-reported condition like fibromyalgia without real legal help. Instead, call the award-winning individual and nationally renowned group ERISA long-term disability attorneys at DarrasLaw today to schedule your free disability policy analysis and free claim consultation. Our litigation savvy long-term disability attorneys and top-rated ERISA lawyers understand fibromyalgia and other chronic self-reporting conditions. We know what long-term disability insurers want to see on your application and in your chart notes, and we can help you make your case. Call our office today at 800-898-7299 or contact us online.

Fibromyalgia and Your Occupation

While fibromyalgia produces chronic pain, it may not always be constant. Some days the pain may prevent you from getting out of bed, while other days you’ll only experience slight muscle aches. This can make it hard to determine when and if you should file a claim for long-term individual or group disability benefits.

Fibromyalgia can slowly progress. As your pain increases and persists, you’ll begin to lose sleep. As you begin to lose sleep, you’ll begin to find yourself irritable and unable to concentrate at work. Eventually, this will begin to damage your ability to reliably perform and function in a professional environment.

Don’t risk losing your job due to poor performance as the result of fibromyalgia, migraines, and chronic fatigue. If you’re afraid or unsure about claiming individual or group long-term disability benefits, call DarrasLaw’s top-rated fibromyalgia long-term disability lawyers and nationally acclaimed ERISA attorneys today at 800-898-7299. If you wait too long to take care of yourself and seek the rest and help you need, you may risk your career.

The National Fibromyalgia Association specifically recommends that patients diagnosed with fibromyalgia refrain from making important decisions when suffering from painful flair-ups. This disorder can cause cognitive fog, and it’s not just physical. You may find yourself unable to wake up in time to prepare for work, causing you to show up late. Your inability to concentrate may make focusing on complex tasks difficult, and you may find yourself needing to take more breaks throughout the day to stretch or take medications or to nap.

These factors can combine to hurt not just your ability to do the important duties of your occupation, but also your ability to do them correctly and safely. If you find arriving to work on time, completing your daily duties at a high quality pace, or pleasantly interacting with your co-workers is difficult, don’t wait. Apply for individual or group long-term disability benefits. Take the time to properly recover—don’t risk your professional reputation or your job.

Treating Fibromyalgia and Chronic Pain Disorders

While fibromyalgia has no cure, reducing your stress levels and working to get a better night’s sleep can make a huge impact on the severity of your condition. While out of work on disability, you’ll hopefully get the opportunity to do both.

Individual or group long-term disability benefits aren’t just necessary because of your fibromyalgia, they’re necessary to help treat it. Fibromyalgia treatments consists of:

  • Physical therapy
  • Antidepressants
  • Anti-inflammatory medications
  • Pain medication and injections
  • Rest
  • Stress reduction
  • Meditation
  • Exercise
  • Hot and cold compresses

Those suffering from fibromyalgia have a lower pain tolerance, meaning treatments may progress at a slower rate. Your body may also swell and feel painful to the touch, further slowing any physical rehabilitation.

How We Can Help

Applying for individual or group disability benefits as the result of fibromyalgia, migraines, and other chronic pain disorders, such as lower back pain and sciatica, chronic fatigue syndrome, chronic pain syndrome, and chronic neck pain can prove extremely difficult.

Your private long-term individual or group disability insurer may deny a valid claim for individual or group disability benefits based only on fibromyalgia. However, this does not mean you don’t have a disability under the specific terms and limitations of your long-term disability policy. It’s simply something you’ll have to work harder to prove, which the experienced, top long-term disability attorneys and ERISA lawyers at DarrasLaw can help you with.

Even with the help of a stellar individual or group long-term disability attorney at DarrasLaw, fibromyalgia claims can be hard to prove. However, conditions commonly associated with fibromyalgia aren’t. For example, memory loss, irritable bowel syndrome, and TMJ all lend themselves to a clinical diagnosis. If these disabling conditions prevent you from performing the important duties of your occupation, you may successfully base your valid claim for individual or group benefits on them.

The award-winning long-term disability attorneys and experienced ERISA attorneys at DarrasLaw can discuss both your long-term disability policy and medical records while conducting a complimentary disability case analysis. We may help you find the best way to claim individual or group long-term disability insurance benefits.

Call America’s Premier Disability Lawyers for Chronic Pain at DarrasLaw

You don’t have to fight your chronic pain alone. You know better than anyone that, as your pain progresses, so does the nature and severity of your symptoms. Depression, anxiety, IBS, TMJ, high blood pressure, and persistent headaches may all manifest as the result of fibromyalgia and individually qualify you for long-term individual or disability benefits. To discuss your case with top-rated fibromyalgia and chronic pain disability lawyers or the award winning ERISA attorneys, call DarrasLaw at 800-898-7299 or write us online. Frank N. Darras and his firms have recovered nearly $1 billion in wrongfully denied, delayed, and terminated insurance benefits. DarrasLaw can try to help you properly frame your self-reported claim so you can get timely paid.

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