Is Your Chronic Pain Covered By Your Policy?
If you have a long-term disability claim involving some type of chronic pain or pain syndrome, like fibromyalgia or another medical illness or disorder that is hard to diagnose or prove you need to be careful with your long term disability benefits appeal and presenting your case to the insurance company. Fibromyalgia, claims based on pain sometimes get extra scrutiny from disability insurers. Here is why, and what you can do about it.
Pain syndromes are relatively new medical diagnoses. Not much is known about many of them and some people, even doctors, don't even believe they exist (or think the person or treating physician is making them up, or can't figure out the real cause of the problem.
They are subjective, not objectively verifiable (you can see a broken arm on an x-ray)
There is no medical test that can definitively diagnose them (no x-ray, MRI or CT scan will show pain or fibromyalgia)
They often cannot be cured and can become permanently disabling
Insurance companies don’t want to set a precedent of paying such claims, and
Insurance companies may believe you can work even with pain, and that pain doesn't prevent you from working
So the typical situation is that disability insurance companies fight paying these claims. If your disability claim is based on fibromyalgia, chronic regional pain syndrome, trigeminal neuralgia, occipital neuralgia, or generalized pain, then you may be in for a fight.
But this doesn't mean you are not entitled to disability benefits. It just means you have to prepare for the fight to get your disability benefits. And you'll need thorough documentation (and a good attorney helps too - we formulate a plan for your appeal).
Here are steps to take or focus on in an ERISA case based primarily on pain:
Focus on a prescription history – narcotic pain management, nerve damage medications, etc. are evidence of pain.
Focus on the side effects of prescription medications – how do the side effects affect your ability to work full time?
Focus on personal statements – get testimonial letters from friends, family, and co-workers to describe the extent and severity of the pain from someone who sees you often or over time.
List the types of pain management therapies you've attempted, and anything you've tried that your doctor has recommended – any type of therapy, massage, acupuncture, anything that shows you're trying to deal with the pain.
Focus on how the pain affects your ability to work – get testimonial letters from supervisors and coworkers that show how you're limited in what you can do at work.
Focus on getting independent medical opinions and testing to validate the pain and the consequences of it
Focus on the limits in the ADLs (activities of daily living) – can you drive, take care of your lawn, clean the house? Do you need help getting in and out of a car, to the bathroom, getting dressed?
Document related diagnoses – chronic pain is almost always accompanied by fatigue and depression. These can be, themselves, disabling. But you have to be careful, because many disability policies have limitations for disability caused by mental illness.
There are many other things an attorney can do to help you get your disability benefits. Give us a call at 202-393-3320 to find out more about how we can help.