Cathy, who suffers from fibromyalgia, was denied disability from her health insurance provider because her doctor did not provide enough information on her condition. Cathy then applied for benefits from Social Security, which recently ruled that fibromyalgia is a medically determinable impairment.
It should be just a matter of time for independent insurers to also see it that way. Fibromyalgia is one of the most common wrongly denied disability claims, and if it continues to be denied, given the Social Security ruling and new medical evidence, an insurer could be acting in bad faith.
“While I am waiting for a decision from Social Security I am also looking into appealing my insurer’s decision,” says Cathy. “I was denied short term disability benefits last October and if I don’t get assistance soon I have no choice but to go back to work. I already exhausted my twelve weeks of FMLA benefits that I am entitled to for the year. Fibromyalgia is very painful and very debilitating and it keeps me from performing my job well so I am in panic mod--I’m sure that my employer will fire me. I know my pains will increase due to the long hours I have to work in the same position and not being able to move around.”
Fortunately for Cathy, fibromyalgia is now recognized as a disability unto itself. The Social Security Administration (SSA) published a ruling last July 2012 that provides guidance to disability claims examiners and administrative law judges on how to assess fibromyalgia cases. Despite this ruling, as evidenced by Cathy’s denial, some insurers still won’t recognize fibromyalgia as a disability. The good news is that most claimants who are initially denied, win disability benefits after they file an appeal.
Historically disability examiners have denied this condition because of its subjective nature, meaning that symptoms cannot be a “proven” impairment such as rheumatoid arthritis or degenerative disc disease, both of which can be diagnosed through testing. And it is only recently that physicians have recognized the disease as a legitimate disability. In the past it has been referred to as a “catchall” condition and doctors give a “catchall diagnosis”, which doesn’t bode well with disability examiners. Cathy’s family doctor may have hindered her claim.
When doctors haven’t been able to find specific reasons for their patients’ pain, fibromyalgia was often diagnosed, for lack of anything better. And independent medical examiner--those employed by the insurance compan--saw these diagnoses all too frequently. If Cathy’s doctor sent her to an orthopedist or rheumatologist and they diagnosed fibromyalgia, she would likely qualify for social security benefits because the SSA sees this condition as a medically determinable impairment . And a diagnosis from a specialist would likely help her appeal.
(A "medically determinable impairment” is an impairment that has been established by medical evidence and it must be established by medical evidence such as x-rays and lab tests. An impairment cannot be established on symptoms alone, so complaining about pain and fatigue, which are the typical symptoms of fibromyalgia, is not enough. Rather, the SSA needs to see medical signs of an impairment that could reasonably be expected to produce your symptoms.)
Despite the new SSA ruling, many claims examiners may not be up to speed and it will likely take some time to change the initial application approvals. In the meantime, the appeals process and an experienced disability attorney should be able to help Cathy.
If you or a loved one have suffered losses in this case, please click the link below and your complaint will be sent to an insurance lawyer who may evaluate your Denied Disability Insurance claim at no cost or obligation.
Posted by Connie
Cindi - I am also 52, have also been working since I was 15 and am all alone with no family to help me. I'd been sick for years now but kept ignoring it and treating the symptoms separately even though I watched my mother suffer 15 years before her death. By the time the CFS syndrome kicked in, I finally realized how sick I was. By then I couldn't even get out of bed and lost my small biz. They tell me I can go to a homeless shelter or live in the projects. This isn't an acceptable quality of life for me. You're not alone. God help us both.
Posted by cyndi
I was denied two times, i have fibro, arthritis, stenosis, nerve impment
IBS..migraines...depression..anxiety..bilateral carpal tun.i ve tested positive ANA three times..i have extream low vitamin D..and B12 and often lukopenia (low white blood) .. I am progressively becomimg worst. Im 52yrs old worked since i was 16 ..i just cant believe that i was denied..by time this is over i will have had lost everything. our savings..my retirement..and my home.. God help me.
Posted by Carolina Aitken
It took me 15 years to get my disability. I was diagnosed with fibromyalgia along with bone on bone on both knees, three places in my spine,one place in my neck and both shoulders.
At the last hearing the judge didn't even see me, he stated to my attorney; "if I agreed to take back payments of only 5 years he would grant my case". I was so desperate, I agreed. Long story short they ripped me off for over one hundred thousand dollars and fifteen years of medical benefits. So, my advice to anyone applying don't give up, but don't hold your breath either!
Posted by Richard Hudon
In Ottawa, Ontario, Canada, I was diagnosed with fibromyalgia using a pain trigger point detection protocol system developed by Canadian Rheumatologists.
It is now accepted in Ontario, that generalized and/or whole body pain lasting more than 6 months as detected by any treating physician qualifies as Fibromyalgia and this is accepted by all insurers of Canadian patients.
Posted by Claudine Fourie
THANKS FOR THIS NEWS.
IN 2005 I MANAGED WITH DIFFICULTY AND MY COLLECTED RESEARCH I HAD DONE AFTER BEING DIAGNOSED BY ONE OF VERY FEW DECENT SPECIALIST RHEUMATOLOGIST IN LONDON IN 2004, HAVING BEEN AFFECTED BY TOXIC ENVIRONMENTAL AND A STINT OF HEAVY AND REPETITIVE, LIFTING & STANDING WORK AND I THEN CONVINCED THE BRITISH AUTHORITIES WHILE I WAS IN IMMENSE PAIN AND MENTAL FATIGUE HEREOF.
Posted by Florence Leon-Paul
Dear Martina my name is Florence and I have Fibromyalgia also and I understand the pain you are going through by walking to the store and by parking too far the best thing i will recommend is going to the motor vehicle and asking receptionist for a disability form bring it to your primary care or your pain management doctor have them fill it out for you and bring it back to the motor vehicle hopefully that will work for you.
Posted by Tina M Barrett
I have Fibromyalgia, My Rheumatologist works at a very well known hospital Fibromyalgia is definitively diagnosed through a blood test This test checks what is called c3 and c4 if either one is high, then this is a measure of your bodies autoimmune response. both c3 and c4 were high for me. I am also a nurse and long hours on your feet and stress in itself will cause a flare up what upsets me however, is those people who claim to have this yet do not I would not wish this on anyone your memory begins to fade thus making nursing unsafe for my patients and a law suit for myself
Posted by Deah
I was diagnosed with RSD, then the Doctor retired and the next Doctor said I had MCTD (which I believe is a better diagnoses for my symptoms), then that Doctor passed away. Now my new Doctor feels I have Fibromyalgia. It is my belief from my own research on my symptoms and changes I made in my life is that Fibromyalgia is a condition we get from the foods we eat. Food allergies and the chemicals that we ingest through our food. Four months ago I purchase a Nutri Bullet and started drinking green drinks. Spinach, Chard, Kale, grapes, apples, pears, pomeganate seeds, mango, blackberries, strawberries, raspberrys, cherries (fruits purchased frozen at a local Dollar establishment). I mixed different fruits with my greens and sometimes as a few walnuts, almonds, goji berries, raw sunflower seeds, raw pumpkins seeds and what ever else I can afford. In four months I have lost 15 pounds and my joints feel better and most of my painful areas have improved 30-50%. I also am wearing those copper infused leggings and tops that seem to help too. the porblem with hiring an atorney is that they get almost a third of your settlement! And most people can't afford to not work for two years while they are waiting for appeals. Most people who file give up and force themselves to go back to work because they would be homeless and go hungry. I think our Government needs to look into what is being put into our foods ie., chemicals, fake sweetners and things like cellulose, which is tree bark. Cellulose is in just about everything and with all the children and adults with plant and tree allergies this is totally unacceptable. In my case all the Doctors would do is push pain medications or send me to physical therapy where the PH cause further damage to herniated discs and fractures. I don't llike the feeling of being drugged or my head in a cloud or the fact that we now are forced to go to the Doctor every three months to get our pain medications. When I have to pay for these appointments I can't afford to go to the Doctor when I am really sick. If you have been injured and in pain for 25 years and never asked for more pain medications, never lost your pain medications and never had any other drug in your systems when tested, it is a waste of my money and now the Governments money to force me to go to the Doctor when I am not "sick". It would be more cost effective for people like me to be checked on a yearly basis at the same time that I go in for illness or injury. This is a ridiculous requirement to see a doctor to get a med refill, then have to be seen 5 days later for your injury or illness when it could havebeen handled all in one visit.
I agree with Jennifer though, that without a viable test for Fibromyalgia there will be those people who fake the symptoms so they don't have to go to work and can play and vacation the rest of their lives. This is a discredit to those of us who are symptomatic and scientists need to got on the stick to find a test for diagnosising and a cure.
I would rather be working with a $4,000.00 per month Administrative Assitant income than trying to live off $800.00 per month.
Good luck to us all. At least I have found some relief through drinking green and eating a healthier and on the most part gluten free meals.
Posted by barbara hill
it is a shame fibromyalgia hurts so bad,i cant hardly get out of bed,or put on my clothes,i filed for disability .it took me two years to recieve my disability.i almost took.my life.my husband worked as a mechanic for 33 years.he has carpal tunnel ruptures disk pinch nerve,knees grinding bone and bone,knees going out and he falling down,high blood pressure,chronic fat in his spine,cant hear.been denied disability twice,wating on a hearing now.its a shame u put ur money up and when u get sick u cant draw ur money.lord help us please.
Posted by Pam
I've had fibromyalgia for quite some time because I MAKE myself get up and go to work. And, afterward I am glad I I'd because the movement makes me feel better than curled up in a blanket all day. I know one thing,it hurts. I'm an advanced practice RN, a clinical nurse specialist, and have dealt with all kids of patients in patients having pain.
My own is something I have to consciously make a choice for it not to consume me.
If you get nothing else from this discussion.......
Ian is right on the money. Its show me the data type thing.
However, there are data, if documented accordingly, a differential diagnosis can be made as to number of tender points, etc., and then there is data, albeit subjective, yet, substantiated by the MD, there is ,little room to guess or wonder anymore.
The government is the government. Social security is the government.
They are bland, and do not care what you say or how its said. They simply want the information, the data, or signatures.
So, consider the source. Logical end? The attorney you've seen who has a good track record, and one you can trust as your advocate.
You need an advocate. Youre dealing with courts and magistrates so you need an attorney, which may also charge you fees.
That's dependent on the individual attorney.
Get what you deserve.
Go to work and keep at it because the initial increased pain fades a bit more with each time youre exposed to that stressor. Before you know it, itmay not be as bad as it was in the beginning.
But if you can't work, and I've been in that situation too, but was blessed with three years of support from my employer, then you have no choice but to navigate the legal system.
I've really fallen through the cracks. I was let go for a stupid reason and haven't worked in 6 months looking for a good job. I did staff nursing. Its time to either teach nursing or return to staff development departments in hospitals. I was denied unemployment because they accused me of not following policy. However, I was the highest paid, and most degreed. The place was sold and the consensus is they were threatened by me. And now, they've given out 2 very important references, which one said they simply didn't believe!!! I would think this is against the law. It sent me into a downward spiral.
But, I got a gift from all this. I've decid d to go back into doctoral studies to get my PhD. So, I'm not allowing them to define who I really am.
I am showing who I really am, despite the fact I'm not perfect.
No one ever said we had to all be the same or be perfect.
This is life. What's the alternative? Been there too. Not good. Dark.
So turn around and be thankful you lived another day.
Your beliefs become your thoughts. Your thoughts become your actions
Do what you can, and give the rest to God..
My husband left me then destroyed my relationship with someone I really loved. Then he turned around and married a physician...for her money.
5 years later, I am still alone. After 30 years of marriage & 4 kids. Kids.....my kids have been my refuge. Theyre all close in age & are best friends with each other me and best friends with me. They have been my haven. But they're also burdensome and I worry a lot.
I have constant panic attacks. I don't know how to live alone but I've managed to for the last two years in a houseive leased. I thought I might buy it but the owner showed up and is waiting for me to move in the next three months. I hate moving. Plus, I had fixed this house up & personalized it so much. Now, I don't know where I'm going to be working , nor where I am going to be living.....My security... my basic primal need, that I'm so insecure about, is crumbling all around me.
But in have faith. Something is about tho turn things around.
We all must have hope. Faith in things unseen...like fibromyalgia.
Its there, you just can't always see it.
Hope is faith in things unseen.
I hope the rapture comes soon & there won't be asny more pain.
In the meantime......massage, hot tubs, avoiding triggers, like cold weather....ouch!!!! Do what you can & give the rest to God and your attorney!
I love attorneys. They are some of my best friends for advice about my security. There are people out there that care. It may not necessarily be your family that does. Seek professionals that can help you, not family or friends that get frustrated because they front know how to. And that's the essence of what can threaten relationships.
Be realistic. But don't expect pity parties or a lot of sympathy.
Others think, Wow...they look good. They don't look sick.
If they only knew the knots ....tight ones.....all over my body.
Then they could understand. People dont understand what they cannot see.
Don't be a victim. Don't choose defeat. Persevere.
Stay well. Don't get this flu going around. I bet that isn't good at all.
I hope what I've said helps. That's my only intention....that it helps.
Nothing personal....except to say I have read about what Ian wrote on diagnostic testing.
Its all so complicated!!! I like the attitude......No worries. Be Happy.
Posted by Jennifer
This is good news, I know a few people who have been in debilitating pain from Fibromyalgia and have not been able to pay bills or buy good food becuase they can't work.
The problem is I also know somone who got Disability due to Fibromyalgia and doesn't really have it. She knows the symptoms well and has lied to the Doctors about her condition. She works. She plays softball and was even the softball manager for the Time Out Tavern softball team. Goes bowling, rides in mechanical bull contests and is out in bars 6 nights a week playing pool and singing karaoke, drinking and stripping naked in public. It is people like this who make it hard for people who "really do" have Fibromyalgia and other autoimmune disorders to be taking seriously by the Social Security Administration and other agencies.
Hopefully someday, they will come up with a blood test that will confirm diagnosis, so people who are really truly ill can be diagnosed earlier.
Posted by Saul Register
I truley understand what you'all are saying. I was diagnois with fibro when no one new what it was. I would hurt so bad and couldn't find relief any where. The other doctors thought I was crazy. I had already had cancer when I was 20 and survise it, according to doctor I would live only 6 months and SSI denied me help then too. After having cancer I would get sick ruffly ever 3 to 6 months and no one new why. Then when I got into my middle 30s I started hving seveer pain for no reason, so I went to an orthopedia and he diagnosis with fibro, and he gave me trazdone for years and it help. Then other medicialy problem pop up over and over. I didn't know what to do, I was working and thanks to GOD, I had a great boss in the early years, but good things don't always last. I got new bosses and they gave me hell, but I held on I worked 23 years and finally couldn't make another day and thanks GOD, I work under pension and had enough medicialy records to get me my pension. It is about time we fibro get the needed help.
Posted by Bonita
I have spent most of my life with chronic fatigue & chronic pain, diagnoised with fibromyalgia, rh,Lupus, copd, nueropathey,depression, hypro thyroid, nodules on my thyroid, hyeniel hernia, peptic ulcers, weight gain, abused because they thought I was lazy. I left home at 16 married had a baby a yr later made it worse. I knew what needed to be done but I hurt so bad and was so tired I couldn't do it. I have suffered with uncontrollable crying & panic attacks, hemmoraged 9 mon had to have a hysterectomy & blood, gallbladder taken out, knee surgery, mood swings, at 18 almost had a nervous breakdown couldn't understand what was wrong with me. I have had doctors tell me it was in my head, at one point the doctors had me on around 37 are 39 meds some taken 4x a day. I had them I had to take nasal, rectal and by mouth some just to be able to take the others. I was in a back brace, leg brace, both hands & wrist & on a walker. I applied for disability & SSDI and was denied, I appealed was denied again. I lost everything no insurance no treatment. The SS Board told me at one point it was in my Head as well. I wanted to die at that point just from the thought they thought I was crazy. I even ask them at one point how they could give SSI to people that chose not to go to school and couldn't read but deny me when I had no choice in anything that I had, they said nothing. I finally refused to take all the meds because I chose to have a quality of life rather then a quanity. I had children to raise and needed a clear head to do it, so again I was denied benefits. So I continued to try to work getting worse all the time, I would go to work and my boss would get so upset seeing me because I would have to almost crawl to the house I would be in tears and shaking from pain and barely could get out of the car. I'm 54 now and I finally got my SSI last year but only back pay for I believe 19mon. I have struggled my whole life been basically called a nut, accused of being on drugs at 16 because I passed out, and test showed I wasn't. And for the last several months I have been almost totally down in the bed both knees went out & my lower lumbar as well. When I go to the Doctor I'm in so much pain when he says anything I start crying, & no matter how hard I try not I do, & he will always make a remark like stop being a baby, are why you crying which makes it worse because I'm trying so hard not to. My life has been miserable behind all of this & if it weren't for the love I have for my kids & God I would have ended it long ago just to stop the pain & the feeling of be worthless because of how I feel. Doctors want to diagnose you with depression but if they lived in my shoes they would be depressed too. I have to stay home most of the time because I get sick if I get around anyone who is sick. So I started taking in rescue animals because as long as I had them they have to be fed & I knew I would force myself to get out of bed that way & not give into the pain. I had took in foster children for yrs & done senior care for as long as I could then I got pneumonia & had it 11 1/2 months before I could get rid of it. Then at that point I could no longer work at all I had to beg for indigent care finally and I got it after 9months with pneumonia. I filed again for SSI & 3 doctors again confirmed it & with a attorney I finally got it. I finally got a house that is in need of repairs but I lost one hm in a fire & another to the hurricane was promised a house thru a grant program But never recieved it and have been living in a small fema unit for several yrs and a friend told me of one gonna be torn down & I begged the man before he tore it down if I could get it moved would he let me have it & he did. Then I had to find someone to move it that took about 2months and I used the back lil bit back pay I got for that. And managed to get some repairs done then ran out of money and now just a little bit at a time gets done when my ck comes in every month & it will probably be a year are so now before I can even get in it. What is so bad I have worked so hard and in so much pain just to be able to have a nice home & now I don't know if I will be able to even walk in it by the time it is finished if it even gets finished. But living in a trailer the size of this one you can pretty much count on being alone there is no room. I am telling you this as God is my witness it's all true. So that you that do have it don't give up. All I wanted was to be able to give are even leave my children & grandchildren something but at this point I'm not sure if it will be what I envisioned and I struggle from month to month but I give it everything I got to make it. So hang in there do what you have to do,and families be supportive you have no Idea of just what your love one is going thru. I have know one but God & me to help me & God does the bigger part. God bless you all & Good Luck and my prayers go with you.
Posted by Judy Bush
It seems the more pro active solution would be to to get training in something that can be done at home or part time bases rather than giving up on life and getting SSDI. I have 2 close friends with this disease who are both active and work. I know there is medication out there to help and both of my friends use a infrared sauna which really seems to help. As to Marianne's statement of so many have been wrongfully denied is it not true that so many have been abusing SSDI? Sherry stated she had received a full scholar ship to collage, she certainly could take classes from home using her computer.
Posted by Sherry Vaught
I have applied for disability several times in my life. My parents even did so when I was five. I have been sick my whole life at the age of 16 I missed half my senior year due to back problems. I have never been able to work for very long because of my illness' . Recently I was told that I had. Genetic disease called Ehlers Danlos since I was a child, which explained a lot for me. I have fibromyalgia, degenerative disc disease, herniated disc in my thoracic spine, hemangioma on my spine(blood tumors), chronic fatigue syndrome, TMJ, mitral valve prolapse, rapid and irregular heartbeat, hypoglycemia, chronic pain syndrome, chronic chostochondritis, arthritis. At this point in my life I have had 3 shoulder surgeries, 2 knee surgeries, lap gastric bypass, gall bladder, and breast reduction with the hopes of relieving some of my shoulder pain. My pain level gets worse every year, my families finances are destroyed. I have been to more doctors than I can count. I don't want to be medicated with pain medication until I am a zombie and then I can't enjoy life with my family. I want someone who will maybe finally connect the dots, put all the symptoms together and get a real treatment. Not someone that treats each one individually. One doctor has even suggest Reflex Sympathetic Dystrophy and also Muscular Dystrophy. I also suffer for sever migraines more than 25 per month, for the last 9 months they have been daily. I am on a beta blocker and 2 preventatives, plus the doctor is trying to put me n an abortive called Maxalt as a daily pill, my insurance refuses to give me the 31 pills, they will only give me 12. I have a mysterious pain in my left side for 10 years no one knows what it is, the pain get so intense that I vomit. If you split me in half the entire left upper quadrant front and back are in severe pain, all day every day, and the pain management doctor has me taking Vicodin four times a day and flexeril two times a day, along with Savella twice daily. I suffered from Endometriosis so bad, that I ended up having a hysterectomy at age 32, upon which time they told me my uterus was like shredded wheat, no one ever gave me a reason why it was necrotic. My son was born in 1996, so how long was it like that and why? I read recently that if you had applied for disability as a child and you had a parent who was current on SS disability it might be possible to get it. Both my parents are. I am told I do not have enough work credits, well I wouldn't since I always been sick. The only reason I have any is because my first husband left me because he was sick and tired of me being sick and tired and found someone else. I had to call in sick many times, and I had to take an extended leave of absense do to knee surgery. I had a good boss. I had to quit college due to my health, had a full scholarship.
Everytime I try to go back to work I have to quit because the pain is crippling, over and of again since as long as I can remember. I have bone sitting on top of bone in my lumbar spine, and cervical spine. They(disability board) says my husband makes too much money so I can't get it as long as I am married to him. I don't want to be married to him, but I have nowhere to go, no insurance, no home. I am 45 years old with a 17 year old son, my son who he adopted because his dad walked away. Why can't I qualify under the statute of reg SS since my parents filed for me as a child. I did not know I should have filed before a certain age. I have filed at least 4 times. Can you help me?
Posted by Ian Hodgson PhD
The real problem in fibromyalgia and ME/CFS is political.
If you take anyone with FM or ME/CFS and test for upregulation of immunological markers you will always find that the patient must be suffering. The markers are not definitive for FM or ME/CFS but they still tell you "this person has a disease". For example, you will see:
consistently increased IFN-alpha and gamma
low natural killer cell function
increased titers of RNase-L
various other cytokine abnormalities
Oxygen uptake dysfunction.
Taken together they spell a disease.
Insurers take advantage of the unwillingness to test the patient to this degree because it is expensive to do so.
Posted by eleen a backman
thanks for sharing this article cathy i aslo suffer from this and people think im crazy cause i dont looks sick it just hurt all the time i hate this diease but now have hope thank you
Posted by Wayne Robbins
I was denied for Fibromyalgia thru SSDI and a large insurance carrier years back. Do I have the legal right to or chance to receive compensation.
Posted by Cathy Boyes
I just filed for disability for my fibromyalgia that I have had for 9 years and I also have rheumatoid arthritis and some other medical problems. I am more hopeful now since I read this article. Thank you so much, Cathy
Posted by Lori Devine
I have Fibro,also it is the most painful thing that has to be in this world...My thing is were did it come from??Your nerve switch,you can't move ,even pick up a glass of water.And if you work one day it is over for you body the next 3 days or so.Help
Posted by Marianne Stanton
I would like to use this article on my blog
SO many people have been wrongfully denied Social Security Disability Income benefits.
The purpose of my blog is to assist people obtaining their benefits and what to do and where to go when they've been denied.
Posted by Martina Donnelly
I was delighted to receive and read the above email. I was just wondering if you have any idea how long it will take for this condition to be recognised in Europe.? I am not even entitled to a parking permit which means I have to park further away from my church, pharmacy, grocers and library than the spaces that are kept for a mother and child. I find it so hard to travel now. Two letters I wrote to the airport authority were ignored. All I wanted was help queueing. I'm afraid of getting worse and it would be nice to know there is some sort of hope on the horizon. Many thanks, Martina (Dublin)
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