Fibromyalgia and Long-Term Disability Benefits in Canada

Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties. It can significantly impact an individual’s ability to carry out daily activities, including work responsibilities. The Arthritis Society of Canada explains that fibromyalgia is a relatively common condition, which affects 2% of Canadians.

For individuals with fibromyalgia whose symptoms hinder their capacity to work, pursuing long-term disability (LTD) benefits becomes essential. However, securing these benefits can be challenging due to common denials and misunderstandings surrounding fibromyalgia. This article aims to shed light on fibromyalgia, its impact on employment, considerations for LTD coverage, common reasons for benefit denials, and steps to address denials effectively in Canada.

Understanding Fibromyalgia

Though fibromyalgia and chronic fatigue syndrome are very similar, they are subtle differences. In fibromyalgia, widespread body pain and tenderness are the dominant symptoms. In chronic fatigue syndrome, fatigue is the dominant symptom.

Fibromyalgia is a complex condition characterized by:

Chronic Pain:

Widespread pain affecting muscles, ligaments, and tendons throughout the body.

Fatigue:

Persistent, often debilitating fatigue that is not relieved by rest.

Sleep Disturbances:

Non-restorative sleep, sleep apnea, insomnia, and other sleep disorders are common among individuals with fibromyalgia.

Cognitive Issues:

“Fibro fog” or cognitive difficulties, including problems with memory, concentration, and mental clarity.

Other Symptoms:

Headaches, irritable bowel syndrome (IBS), mood disturbances, sensitivity to stimuli (light, sound, temperature), and joint stiffness.

Fibromyalgia and Long-Term Disability

The symptoms of fibromyalgia can significantly impact an individual’s ability to work. Chronic pain, fatigue, cognitive challenges, and associated symptoms can lead to reduced productivity, increased absenteeism, and difficulty performing job duties consistently. LTD benefits can provide crucial financial support for individuals whose fibromyalgia-related disabilities prevent them from engaging in substantial gainful employment.

Is Fibromyalgia Covered by my LTD Policy?

Whether fibromyalgia is covered by your LTD policy depends on the specific terms, definitions, and criteria outlined in your insurance contract. Most LTD policies cover disabilities that prevent individuals from performing the material duties of their occupation or any gainful occupation for which they are reasonably suited based on education, training, and experience.

Fibromyalgia Disability Benefits

To support your fibromyalgia disability claim, you will typically need:

Medical Documentation:

Detailed medical records, diagnosis confirmation, treatment history, specialist reports, and functional assessments outlining the severity of symptoms, functional limitations, and impact on work capacity.

Functional Assessments:

Assessments from healthcare providers or vocational experts detailing how fibromyalgia symptoms impair your ability to perform work-related tasks, concentrate, and maintain productivity.

Supporting Statements:

Statements from treating physicians or specialists describing the nature and extent of your disability, treatment modalities, and recommendations for accommodations or restrictions at work.

Can My Disability Benefits Be Denied?

Despite the disabling effects of fibromyalgia, LTD benefit denials are not uncommon. In fact, because its symptoms are hard to test for, and shift depending on the day, people with fibromyalgia may look fine, but could be experiencing tremendous pain. Medical advances are making it much easier to diagnose than before, though it can still be challenging when dealing with an insurance company over long-term benefits.

Common reasons for denials include:

Insufficient Medical Evidence:

Lack of detailed documentation regarding symptom severity, functional impairments, treatment history, and ongoing limitations.

Occupational Definitions:

Interpretation differences between “own occupation” and “any occupation” definitions in LTD policies.

Independent Medical Examinations (IMEs):

Insurers may request IMEs to assess disability claims. IME reports that contradict treating physicians’ opinions or downplay symptom impacts can lead to denials.

Policy Limitations:

Some policies may exclude certain conditions, have waiting periods, or impose limits on coverage based on specific criteria.

What To Do If My LTD Benefits Have Been Denied?

If your LTD benefits for fibromyalgia have been denied:

Review Your Policy:

Understand your LTD policy terms, appeal procedures, and timelines.

Gather Strong Supporting Documentation:

Compile comprehensive medical records, functional assessments, supporting statements, and any correspondence related to your claim.

Appeal with Thorough Support:

Submit a thorough appeal with robust medical and vocational evidence supporting your disability claim. Address concerns raised in the denial letter and provide additional context or explanations as needed.

Seek Legal Assistance:

Consult with an LTD disability lawyer experienced in fibromyalgia-related claims. A lawyer can review your case, provide legal guidance, advocate during the appeals process, and escalate the case if necessary.

Contact a Disability Lawyer About Your LTD Denial Today

Seeking legal assistance is crucial in challenging LTD benefit denials for fibromyalgia. A disability lawyer at Preszler Injury Lawyers can assess your case, navigate complex legal processes, and advocate for your rights to obtain the benefits you deserve. Contact our law firm today to discuss your situation and take proactive steps towards securing your LTD benefits.