Fibromyalgia and Long Term Disability Benefits: Proving Disability  

Fibromyalgia is a neurologic condition that causes pain and tenderness all over the body, along with fatigue and other symptoms. About 2 percent of adults suffer from it, according to the Centers for Disease Control, and the pain can be severe and unrelenting, impairing the sufferer’s ability to work and live a normal life. 

When people with long term care disability insurance are unable to work because of a disabling condition like fibromyalgia, they are entitled to their benefits. But long term disability insurance companies often dispute and deny claims involving fibromyalgia pain and fatigue. The companies typically say the claimant has not proven that their symptoms are disabling, or that their claim is not supported by objective medical evidence. Below we explain how to discover if you have fibromyalgia and what to do to prove it’s disabling you. 

Who Gets Fibromyalgia and Why

Fibromyalgia is characterized by wide-spread pain and tenderness, fatigue, depression and anxiety, sleep problems, memory and concentration problems, and headaches, including migraines. Less common symptoms include tingling or numbness in the hands and feet, TMJ (temporomandibular joint syndrome), and digestive issues. The cause of fibromyalgia is unclear, but there are risk factors associated with it. It typically happens in middle age or later and is more common in women and individuals who also suffer from lupus, rheumatoid arthritis or other rheumatic diseases. 

How Fibromyalgia is Diagnosed and Treated

A diagnosis of fibromyalgia is typically made by a rheumatologist and is, in part, a diagnosis of exclusion, meaning the patient will have to undergo a series of tests, including blood tests and X-rays, among other things, to rule out other diseases with similar symptoms. Fibromyalgia pain is widespread in nature, so the rheumatologist examines you to determine the location and severity of your pain. A test performed on 18 specific points on the body to identify pain may also support a fibromyalgia diagnosis. According to the American College of Rheumatology, at least three months of symptoms at a similar level is required for the diagnosis. There is no cure for fibromyalgia, but many patients see improvement with medication and certain non-drug therapies.

Proving Your Disability

Insurance companies employ a number of tactics to bolster their case that the claimant’s fibromyalgia is not severe enough to prevent the claimant from working. To combat these tactics, a claimant needs to collect medical, functional capacity, and testimonial evidence of how the condition is disabling and prevents the claimant from earning a living. This includes getting a diagnosis from a licensed physician who is familiar with the criteria needed to diagnose fibromyalgia. Give your doctor complete and comprehensive details about your pain and other symptoms and how they affect you, and make sure the doctor takes accurate notes. Your doctor can provide a professional opinion regarding your ability to do things like sit, stand and bend as well as maintain punctuality and attendance at work.

Doctors can also order a functional capacity evaluation, which is an extensive exam to measure the effect of the condition on your ability to live and work, and is often conducted by a physical or occupational therapist. After diagnosis, follow up regularly with your physician to explore different treatment options, taking care to follow instructions and take any prescribed medications. The insurance company will check to see if you have filled your prescriptions.

Keep a daily journal detailing your pain and other symptoms and how they impact your ability to do your work and perform activities like walking, housework and chores outside the home. Include in your pain diary whether you took medication, did recommended exercises or made other attempts to mitigate the pain each day. Identify family members, friends and co-workers who can make written statements describing your abilities before and after the onset of your disabling condition. Also, if you had a long, successful work history prior to disability, collect evidence, such as the details of your attendance record and any promotions, raises or awards, to support your case. 

We Can Help

If your long-term disability claim has been denied, terminated, or is being challenged, give us a call. We understand the debilitating nature of fibromyalgia and how to overcome the tactics insurance companies use to wrongfully challenge these claims. 


Evan S. Schwartz
Founder of Schwartz, Conroy & Hack