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Getting Long-Term Disability (LTD) for Fibromyalgia

Getting Long-Term Disability (LTD) Benefits for Fibromyalgia

It can be discouraging when your insurer has denied your long-term disability (LTD) claim for fibromyalgia, but a denied claim is not the end of the road for your claim.  Our team understands how frustrating it can be to receive a denial, especially for a condition such as fibromyalgia.

Those suffering from this condition may find it renders them unable to work.  When this occurs, they may turn to their LTD insurance coverage.  If you receive a denial from your insurer, then you have the right to appeal their decision.

Fighting an insurance company for disability benefits can be exhausting for anyone, especially for a person suffering from the chronic pain and fatigue often associated with fibromyalgia.  Our attorneys can help you navigate the complex long-term disability appeals process.

This is not a process you must do on your own, however.  Our long-term disability attorneys have over 30 years of handling LTD claims and can assist you wherever in the process you are.  Call CCK today at (800) 544-9144 for a free case evaluation.  We will analyze your fibromyalgia case and determine if we can help.

What Is Fibromyalgia?

Fibromyalgia is a chronic neurological condition that causes widespread musculoskeletal pain and tenderness that tends to come and go.  Researchers do not yet fully understand what causes the pain associated with the condition; however, theories suggest that the disorder may cause the “central nervous system” (CNS) to become overactive, which results in an amplified response to pain.  This amplified response is called “central sensitization.”

Some medical professionals believe that this overactivity may be attributed to chemical imbalances in the brain.  This overactivity results in changes to how pain signals are processed throughout the CNS.

It is estimated that over 5 million people in the United States suffer from fibromyalgia.  Of those affected, approximately 80 percent are women.  The average age of diagnosis ranges between 35 and 40 years old — though it can begin at any age.

What Causes Fibromyalgia?

Currently, there is no definitive medical explanation for what causes fibromyalgia.  Scientists have been able to rule out autoimmune, inflammatory, joint, and muscle disorders as possible causes.  Studies have been able to reveal that certain risk factors or triggers can make people more prone to developing the condition.

Some potential risk factors include:

  • Genetics: Individuals with a history of fibromyalgia in their family may be genetically predisposed to develop the disorder;
  • Gender: Women are about four times more likely to develop fibromyalgia than men; and
  • Other disorders: Those suffering from “rheumatoid arthritis” or “lupus” are more likely to develop fibromyalgia.

Likewise, some potential triggers that may lead to the onset of fibromyalgia include:

  • Traumatic physical injuries: Car accidents and other injuries may trigger fibromyalgia;
  • Emotional trauma/psychological stress: fibromyalgia has been linked to “post-traumatic stress disorder” (PTSD) in some patients; and
  • Illness and infection: Sometimes an illness or infection, such as “Lyme disease,” can cause the onset or worsening of symptoms.

Of course, it is possible to develop this condition without any apparent trigger.

Symptoms and Complications of Fibromyalgia

Chronic widespread pain that can migrate to all parts of the body is the most common symptom associated with fibromyalgia.  This pain is not the same in each patient.  Its intensity and location will vary from person to person.  Pain caused by fibromyalgia is classified as lasting for more than three months; this pain will be above and below the waist and on both sides of the body.  Widespread pain is not the only symptom of Fibromyalgia.

Definition of Disability in Long-Term Disability Policies Explained

Other symptoms include:

  • Extreme fatigue that does not improve with rest or sleep;
  • Cognitive and memory issues (sometimes referred to as “fibro fog”);
  • Difficulty sleeping;
  • Headaches or migraines;
  • Muscle fatigue that causes twitching or cramping;
  • Depression and anxiety;
  • Numbness or tingling in the hands or feet; and
  • Digestive issues, such as “irritable bowel syndrome” (IBS).

The effects of fibromyalgia can result in disability and a lower quality of life.  Some complications resulting from fibromyalgia can include the following:

  • Those with fibromyalgia are twice as likely to require frequent hospitalization than someone without the disorder;
  • Studies show that women with fibromyalgia may suffer a 40 percent reduction in physical function and a 67 percent impairment of mental health;
  • Adults with fibromyalgia are three times more likely to suffer from major depression than those without the condition; and
  • There is an increased likelihood that those with fibromyalgia will also be diagnosed with other disorders such as rheumatoid arthritis, and “systemic lupus erythematosus.”

As is evident, the symptoms and complications mentioned above can significantly impact a person’s ability to work.

Fibromyalgia Diagnosis and Testing

Currently, there is no objective medical test that can diagnose fibromyalgia.  Thus, diagnosing this condition can be difficult and, potentially, take years to diagnose correctly.  Blood tests and X-rays are conducted to rule out other conditions that cause similar symptoms.

The most currently accepted method for diagnosing fibromyalgia was set in place by the American College of Rheumatology in 2010.  This two-step process uses a “widespread pain index” (WPI) and “symptom severity” (SS) score.  The WPI measures how many of the 19 specified pain regions the patient is experiencing symptoms in; these areas include the legs, arms, back, and neck.  WPI scores range from 0 to 19.

Your doctor will also measure the severity of your symptoms using the SS scale.  The SS scale measures the severity of certain symptoms that a patient experienced within the previous week.  Your doctor will ask you to measure the following common symptoms:

  • Fatigue
  • Waking up tired
  • Cognitive problems

They will also ask you if you experienced other symptoms in the previous week; using the same scale — 3 meaning you had a lot of symptoms — you will give a score.  Your doctor will then add all four SS scores to get a final score that will range between 0 and 12.

Physicians combine the WPI and SS scores to establish a fibromyalgia diagnosis.  Patients matching or exceeding the following criteria will most likely receive a diagnosis:

  • WPI score greater than or equal to 7 and an SS greater than or equal to 5; or
  • WPI score between 3 and 6 and SS greater than or equal to 9; and
  • Have been experiencing symptoms at a similar level of severity for at least three months; and
  • Have not been diagnosed with another condition that may be causing reported symptoms.

Although no lab test can confirm a fibromyalgia diagnosis, patients exhibiting symptoms may have to undergo a variety of blood tests to rule out other conditions, such as:

  • An erythrocyte sedimentation rate
  • A complete blood count
  • Vitamin D levels
  • Thyroid function tests

Physical examinations of the muscles and joints, neurological exams, and sleep studies are often conducted in patients exhibiting signs of fibromyalgia, depending on the symptoms being experienced.

Treatment of Fibromyalgia

Treatment options for those with fibromyalgia can vary depending on which symptoms are most prevalent or severe in the patient.  According to the American College of Rheumatology, treatment regimens can include medication-based therapies as well as options not reliant on medication; combining both treatment options may yield the most favorable outcomes.

Non-drug therapies can include:

  • Physical exercise: This is thought to be an effective way of improving the quality of life in those with fibromyalgia.  Therapies such as yoga can serve as a low-impact exercise regimen that increases endorphin levels, which can reduce pain and help with depression.  Physical exercise is also an effective way of improving sleep quality.
  • Alternative therapies: Examples include meditation and breathing exercises.  These exercises can reduce stress, which is thought to trigger fibromyalgia pain.
  • Cognitive behavioral therapy (CBT):  This form of talk therapy is intended to encourage lifestyle changes (e.g. exercise and stress reduction) in addition to treating underlying depression.
  • Physical therapy: This is thought to reduce pain and stiffness in fibromyalgia patients by teaching pain-relieving stretches and helpful exercises.

The other form of treatment is medication.  Medication selection can vary on a case-by-case basis, depending on which symptoms are most affecting your life.  For example, one person may be suffering most from chronic fatigue, whereas another is suffering predominately from widespread pain.

Commonly prescribed FDA-approved medications for treating Fibromyalgia include:

  • Duloxetine (Cymbalta) and Milnacipran (Savella): These medications change serotonin and norepinephrine levels in the brain to help control pain.
  • Pregabalin (Lyrica) or gabapentin (Neurontin): These medications block the overactivity of nerve cells; They can also improve sleep.
  • Antidepressants: These medications increase serotonin levels, improve sleep, and relieve pain.  Doctors may increase the amount of this medication if the patient is also experiencing depression.

Other treatment options are available for more individualized symptoms, such as those also suffering from related conditions like IBS or migraine headaches.  Always consult your treating physician before beginning any new treatment regimens.

CCK Understands Fibromyalgia Disability Claims

Those living with fibromyalgia may experience a wide array of physical and cognitive impairments as a result of their condition.  Since pain caused by fibromyalgia can flare and resolve on its own, a person with the condition may be able to carry on their normal job duties one week, but not be able to leave their bed the next.  Severe and frequent pain caused by the condition can greatly impact a person’s ability to remain working, especially for those working in physically demanding jobs.

How ERISA Impacts Long-Term Disability Claims

Fibromyalgia can also lead to impaired cognitive function, such as trouble concentrating and memory loss.  The effects of this fibro fog can make administrative tasks much more difficult and can dramatically impact your ability to perform duties in the workplace as you once did.

Additionally, the fatigue caused by this condition sometimes does not improve, even with a full night of sleep. Regular full-time work can prove to be incredibly challenging to maintain when suffering cognitive deficiencies and severe fatigue.

If your long-term disability claim for fibromyalgia has been denied by the insurance company, consider consulting an experienced ERISA attorney as soon as possible.

How Can CCK Help You With Your Long-Term Disability Appeal?

Let the experienced LTD team at Chisholm Chisholm & Kilpatrick fight for your long-term disability benefits.  We take a comprehensive approach to preparing and filing your appeal so that you may focus on maintaining the best quality of life possible.

Our team can find insurance company errors.  To do this, we gather any and all insurance documents surrounding your LTD claim.  This includes your denial letter, policy documents, the insurance company’s claim file, and other plan-governing documents; these documents may hold the key to winning your appeal.

We will incorporate our knowledge of ERISA, U.S. Department of Labor laws, and insurance policies into your appeal to identify errors the insurance company may have made.

CCK can also act as a point of contact between you and your treating physicians.  Often, doctors can be so busy in their day-to-day medical practices that they do not adequately communicate the severity of your condition with the insurance company.  Therefore, we facilitate the flow of information between the two entities to ensure that all documents and necessary records are completed sufficiently and submitted on time.

Since effective communication is key throughout the appeals process, we will be sure that you know how to communicate with your doctor about your fibromyalgia and how it impacts your daily life.

Moreover, at CCK, our skilled attorneys know what evidence to collect in order to build the best evidence record possible for you.  Common forms of evidence we gather include:

  • Medical records
  • Test results
  • Reports from treating physicians
  • Expert opinions, including vocational evaluations
  • Witness statements from your family, friends, and co-workers

Preparing an exhaustive evidence record to file with your appeal is critical for winning your case.  Gathering all necessary documentation is especially important with ERISA-governed policies because the administrative appeal stage is often the final opportunity to submit substantive evidence to the record.

We make sure that the evidence we gather is submitted thoroughly and on time for our clients.  Our evidence-supported arguments will work to prove that you meet your policy’s definition of disability.

Call Chisholm Chisholm & Kilpatrick Today for Your Long-Term Disability Claim or Appeal

We understand how frustrating the long-term disability process is, especially if you suffer from a condition like fibromyalgia.  Luckily, this is not something you must handle on your own.  Call CCK today at (800) 544-9144 for a free case evaluation with a member of our team.  We will analyze your case and determine if we can assist you.