Hi. I’m Nick Ortiz. I’m a board-certified disability insurance attorney.
Today, I’m here to talk to you about fibromyalgia and long-term disability claims.
You’re probably here today because an insurance company has denied you benefits for your fibromyalgia disability. You’re probably wondering what it is that you need to prove in order to receive your LTD benefits.
First, I want to go over some of the reasons why an insurance company may deny a claim for fibromyalgia.
One of the common reasons that they cite in their denial letter is that there is insufficient objective medical evidence to support the disability. What does that mean? At the end of the day, most insurance companies are looking for objective findings of an underlying medical condition. For example, if someone has a broken leg and they have an X-ray, the X-ray is an objective test to show the existence of a broken leg, but the problem is, there really is no such objective test to prove fibromyalgia because if you have the condition, you know that it is primarily muscular in nature, which means you can’t take a picture of it with an X-ray.
In fact, most testing to establish the existence of fibromyalgia is generally what we call subjective in nature, and that’s because one of the most common test that’s used is what’s called the pressure point test. Again, if you have this condition, you’ve probably undergone a pressure point test where the doctor, there are multiple pressure points along the body. The doctor presses these different pressure points, and if you have severe pain in that location, then you have a positive pressure point. If you have so many pressure points that are positive, then you’re diagnosed with fibromyalgia.
The primary problem with the pressure point test is that the results are predicated on the patient’s responses. The patient could be manipulating the results. Put it in another way, the patient, at the end of the day, may be controlling the outcome of the testing. They could be saying that something hurts, when in reality, it really isn’t hurting or isn’t hurting that badly, but the patient is incentivized in a way to say that it hurts because they’re looking for that positive outcome.
Again – to compare that to objective test – in an X-ray, you can’t fake a broken bone. An X-ray will show whether or not the bone is broken. That is the primary difference between objective testing and this pressure point subjective testing. That’s why in a fibromyalgia case, it’s particularly important to have other evidence to support the claim.
For example, if you’re taking a lot of medications that cause significant side effects, then that’s another type of evidence that you want to go to support case, or if you’re undergoing a lot of pain management for the condition, then the reality is that there are not a lot of people who are going to undergo significant testing and pain management, which may involve shots and things like that, without the existence of an significant underlying condition like fibromyalgia. That is additional what we call collateral evidence that can be used to support the existence of fibromyalgia condition and the severity of the condition.
Those are just a couple of the types of evidence that our firm uses to bolster a fibromyalgia claim. If you like additional information and you want to work with an attorney that’s experienced in handling fibromyalgia cases and long-term disability claims, then I encourage you to give our office a call at 850-898-9904.
I’m also making available a free copy of a book that I wrote called The Top 10 Mistakes That Will Destroy Your Long-Term Disability Claim. You can download a free copy at www.freeltdbook.com. Thanks for listening. We look forward to hearing from you.