Why are fibromyalgia Long Term Disability claims often denied by insurance companies? An experienced LTD attorney can help you navigate the claims process and increase your chances of receiving the benefits you are entitled to.
Fibromyalgia is a medical condition that causes chronic pain, fatigue, and cognitive challenges, making it difficult or impossible for many to maintain steady employment.
Unfortunately, proving fibromyalgia as a qualifying condition for Long Term Disability (LTD) benefits can be one of the most challenging hurdles claimants face. Insurance companies often question the validity of symptoms due to the lack of specific diagnostic tests.
Understanding how to gather the necessary evidence and present a compelling case is essential to securing the benefits you deserve.
Why Fibromyalgia is Difficult to Prove in Long Term Disability Claims
Fibromyalgia is a complex medical condition with no known cure and no specific diagnostic test. Doctors generally diagnose it based on patient-reported symptoms and physical examinations. Unlike other medical conditions like cancer, arthritis, or multiple sclerosis, fibromyalgia is difficult to diagnose and even more difficult to prove.
The National Institutes of Health notes that fibromyalgia is suspected to result from abnormal pain processing in the brain, and while it affects both genders, women are disproportionately impacted.
The symptoms of fibromyalgia can be pervasive and debilitating, including:
- Chronic pain affecting various parts of the body.
- Stiffness in joints and muscles.
- Numbness or tingling in extremities.
- Severe fatigue and cognitive impairments often called “fibro fog.”
Despite these symptoms, insurance companies frequently deny LTD claims for fibromyalgia, citing insufficient medical evidence or inconsistencies in documentation.
The Importance of Medical Evidence for Fibromyalgia Long Term Disability Claims
Insurance providers demand thorough and detailed medical evidence to approve LTD claims. For fibromyalgia, this often includes:
- Medical Records: Comprehensive records from your primary care doctor, specialists, and other healthcare providers.
- Diagnostic Documentation: While fibromyalgia lacks definitive tests, blood work, imaging, and other tests ruling out similar conditions can strengthen your claim.
- Physician Statements: Detailed letters from your doctor affirming your diagnosis and explaining how your condition prevents you from working.
- Symptom Journals: Personal logs that document the severity and frequency of your symptoms, how they affect your daily life, and their progression over time.
- Treatment Records: Lists of medications, therapies, and treatments you have pursued, even if they provided limited relief.
Collecting and organizing evidence can be tough, especially when dealing with the physical and emotional effects of fibromyalgia. However, this step is crucial in providing the documentation needed for a strong LTD claim.
Why Insurers Frequently Deny Fibromyalgia Claims
Long Term Disability insurance providers often reject fibromyalgia claims because the condition lacks definitive testing. Common reasons for denial include:
- Insufficient Medical Documentation: Claims without comprehensive evidence may be dismissed outright.
- Failure to Meet Policy Definitions: Many LTD policies require claimants to prove that they cannot perform “any occupation” or their “own occupation,” and fibromyalgia symptoms can be subjective and fluctuating.
- Bias Against Subjective Symptoms: Pain, fatigue, and cognitive impairments are difficult to quantify, making insurers more likely to deny such claims.
How We Can Help
At Herbert M. Hill, P.A., we understand the uphill battle of proving fibromyalgia in Long Term Disability claims. Our experienced legal team works tirelessly to ensure that our clients’ claims are supported by robust evidence and prepared to counter the common objections raised by insurance companies.
Here is how we can assist:
- Comprehensive Evidence Gathering: We help clients compile medical records, secure physician statements, and organize personal documentation to create a compelling case.
- Appealing Denied Claims: If your LTD claim for fibromyalgia has been denied, we meticulously analyze the insurer’s reasoning and build a detailed appeal to address their concerns.
- Guidance Through the Claims Process: From the initial claim to the appeals process, we provide personalized support to navigate every step of your LTD case.
Take the First Step Toward Securing Your Benefits
If you are struggling with fibromyalgia and wondering how to prove your eligibility for benefits, our Long Term Disability lawyers for fibromyalgia are here to help. Our team has extensive experience handling complex LTD cases and fighting for clients facing denials.
Do not let the challenges of the fibromyalgia Long Term Disability claims process stop you from getting the support you need. Contact us today to discuss your case, and let us help you pursue the financial stability you deserve.
