Fibromyitis and Long Term Disability Insurance Claims

What is Fibromyitis?

Fibromyitis is inflammation of the muscle and fibrous tissue, which is frequently followed by degeneration of the muscle fibers. Fibromyitis is generally an acute condition that is caused by injury or accidents. It can occur as part of a chronic condition, though it is not an underlying cause.

Diagnosing Fibromyitis

Fibromyitis is diagnosed through clinical assessment. A doctor will test range-of-motion, tenderness, and pain. He or she may also test muscle strength by asking the patient to resist pressure or lift their arms or legs. In order to rule out other conditions, other diagnostic tests may be ordered. Possible tests include imaging tests like MRIs, bloodwork, and electromyography (EMG).

Treating Fibromyitis

Fibromyitis generally responds well to conservative measures and self-care. Resting and allowing the area time to recover can relieve the pain. Over-the-counter pain relievers can help, and prescription pain relievers may be considered in severe cases. Physical therapy can both relief fibromyitis and prevent its reoccurrence. If part of a chronic condition, treating the underlying disorder may be key to relieving symptoms of fibromyitis.  

Disability Evaluation of Fibromyitis

Fibromyitis is not typically a disabling medical condition in and of itself, and generally the body heals on its own. However, some severe cases may limit people from working or engaging in normal life activities, and may be disabling in combination with other severe medical conditions. People who cannot work because of their fibromyitis may apply for Long Term Disability (LTD) benefits. The insurance company will review their claim to see if the claimant qualifies under the terms of the plan.

Definition of Disability

Most LTD plans consider a person disabled if they have a medical condition that causes them to 1) be unable to perform their work duties for the first two years of the policy and 2) be unable to work in almost any job for the following years. Each LTD plan defines disability as slightly different, so look over your plan policy to see how your plan determines “disabled.”

Evaluating A Disability Claim for Claimants With Fibromyitis

You must prove that your fibromyitis keeps you from doing your old job (if an “own occupation” definition of the term disability) or any other job (if an “any occupation” definition of the term disability).

The insurance company will review the claim to see if your symptoms – such as chronic pain – is disabling. Pain is evaluated on:

  • How your everyday life is affected
  • The location, frequency, intensity, and duration of your pain
  • What causes, worsens, or relieves your pain
  • Medications used to treat pain and their side effects
  • Any treatments you have used to alleviate your pain and their effectiveness
  • Any other factors that affect your pain

The insurance company will also look at the Residual Functional Capacity (RFC) form to determine the extent of your symptoms and how they may keep you from working. If your fibromyitis is caused by another condition, you may be awarded benefits based on the severity of the underlying condition.

What the Insurance Company Needs From You and Your Medical Providers

You should tell the insurance company about any doctors you may have seen for your fibromyitis. The insurance company will need to obtain all relevant medical records to get the full picture of your health. If for any reason they cannot get these records from your doctors, you should request them and provide them to the insurance company yourself. Important records to include are:

  • Physician notes
  • Bloodwork
  • Physical therapy notes
  • Diagnostic test results

You will need to provide proof of your diagnosis and your ongoing symptoms, as well as proof of how you are affected by your symptoms. If your doctor diagnosed you by clinical assessment, you may want to get additional diagnostic testing to help your case. Providing detailed documentation is key to a successful claim. Residual Functional Capacity (RFC) assessments determine how you are affected by the condition and what you can do despite your limitations. It is used to determine what jobs you may still be qualified to perform.

Working with a Disability Attorney

An experienced disability attorney will give you the best chance of getting the disability benefits you deserve for your fibromyitis. Even if you have been denied disability benefits, that does not mean you are out of options. It is not unusual to be denied the first time you apply. You have the right to file an appeal and try to get more information that may help your case. Getting expert help is often the difference between being denied and being approved for benefits.

While the process can be intimidating, your disability attorney is an expert on the process. Since they receive their payment from awarded funds, they do not get paid unless you win your case. You can seek help without worrying about upfront costs or unexpected bills.

The Ortiz law firm has successfully represented people in disability cases across the United States. If your LTD claim was wrongfully denied and terminated and you would like to talk to one of our experienced disability lawyers about your fibromyitis and its impact on your ability to work, call us at 850-308-7833. We would be happy to evaluate your case and to discuss how to help you through the appeal process.