Can I Get Long-Term Disability Benefits for Fibromyalgia?

One of the most common questions we get is “Do I qualify for long-term disability benefits if I have fibromyalgia?”

Fibromyalgia (FM), also known as fibromyositis and fibrositis, is a disease of the central nervous system that causes chronic, widespread pain and fatigue and can have a significant impact on a person’s employment and daily life. Therefore, fibromyalgia can qualify for long-term disability benefits – provided it is not excluded by your insurance policy wording.

Has your claim for disability benefits been denied? Has the insurance company denied your appeal? Were you receiving benefits and the insurance company terminated those benefits?

The experienced team at Ertl Lawyers can help.

We’ll work with you and your physician to help challenge the insurance company’s denial or discontinuance of your long-term disability benefits.

Where necessary, we will engage other trusted professionals to support your case including specialists, functional capacity evaluators, and vocational evaluators to help credibly explain why your disability symptoms are preventing you from doing your “own occupation” or “any occupation”.

Ertl Lawyers offers:

• A free case assessment
• Fair, flexible rates, including contingency fees (i.e. only pay if you win)
• Service across all of Ontario

If you are looking for long-term disability lawyers in Toronto that care about your well-being, you’ve found us.

Our help can make all the difference.

Fibromyalgia: Overview

Fibromyalgia is a neurologic chronic health condition that causes pain all over the body and other symptoms, especially fatigue and cognitive impairment.

Fibromyalgia is not an autoimmune or inflammation-based illness, but research suggests the nervous system is involved.

In some people the disease appears after a traumatic experience like an accident, overwork, emotional trauma, hormonal changes, sexual or physical abuse during childhood, or a viral disease. In some people, fibromyalgia presents with no apparent cause.

Intensity of the symptoms is extremely variable from person to person. Some individuals are almost completely disabled, while others are only mildly so. 

Though there is no cure, medications can reduce symptoms in some patients.

Fibromyalgia often co-exists with other painful conditions, such as:

• irritable bowel syndrome
• migraines and other types of headaches
• interstitial cystitis or painful bladder syndrome
• temporomandibular joint disorders/jaw pain
• rheumatoid arthritis

See: Arthritis Society and Canadian Rheumatology Association

Most Common Symptoms of Fibromyalgia:

Fibromyalgia is mainly associated with:

• Pain: the pain generally consists of burning, aching and soreness that is typically more severe in parts of the body that are used the most (such as the feet, causing difficulty walking or standing). 
• Fatigue: the fatigue is usually strong, often to the point of exhaustion, resulting in decreased endurance and a limited ability to function physically and mentally. 
• Cognitive difficulties: Memory, concentration, and attention are impaired, particularly when exhaustion is most intense.

Other symptoms can include:

• muscle stiffness, especially in the morning
• unrefreshing sleep (waking up tired even after a full night’s sleep)
• headaches / migraines 
• jaw pain
• dizziness or lightheadedness
• nausea, diarrhea, constipation, gas, or bloating
• bladder spasms
• difficulty controlling body temperature
• sensitivity to bright lights or sounds
• weight gain or loss
• feeling anxious or emotionally numb
• painful menstrual periods (women only)

Important: Many people with fibromyalgia become discouraged, which can lead to depression and anxiety. 

Criteria for a Diagnosis of Fibromyalgia

There is no single test to confirm if you have fibromyalgia. Doctors (usually rheumatologists) have to rule out other conditions to make a diagnosis, but there are now Canadian guidelines – endorsed by the Canadian Pain Society and the Canadian Rheumatology Association – to identify and manage the condition.[1]

The main diagnostic criteria using the Canadian guidelines are:

• history of widespread pain in all four body quadrants for a minimum of three months
• pain in 11 of 18 specified tender points when they are pressed
• other clinical symptoms including fatigue, sleep disturbance, neurocognitive manifestations and/or neurological manifestations.

Because a fibromyalgia diagnosis is based, to a large extent, on self-reported symptoms, long-term disability insurers often deny these claims.

Treatment for Fibromyalgia

There is no cure for fibromyalgia, however symptoms can be treated with both medication-based and therapy-based treatments.

Medication

Medications (e.g. painkillers, antidepressants, SSRI’s, sleeping aid medications) will likely be required for most patients but can be expected to provide only modest symptom relief. 

Therapy

As each case of fibromyalgia is difference from another, therapies such as the following may or may not help any particular person with fibromyalgia:

• cognitive behavioural therapy
• psychotherapy
• massage therapy
• acupuncture 
• biofeedback
• chiropractic
• homeopathy
• hypnotherapy
• mental imaging
• naturopathy
• osteopathy

Fibromyalgia and Workplace Discrimination

It is unlawful to discriminate against someone in the area of employment based on their physical disability: Ontario’s Human Rights Code and the Canadian Human Rights Act.

If you are suffering from fibromyalgia, you might face discrimination in a variety of ways:

• You experience employment termination because you have fibromyalgia
• You are denied accommodation because of your fibromyalgia. 
• After returning from a disability leave, your employer places you in a lower, part-time position at a lower rate of pay
• Someone makes unwelcome remarks or jokes about your disability.
• Someone offends or humiliates you physically or verbally threatens or intimidates you because of your disability.
• Retaliating against you for filing a human rights complaint. 

See our video: “Disability Discrimination”

Ertl Lawyers are experts in Employment and Disability Law. If you have been discriminated against, our disability and employment lawyers in Toronto can help, including:

• Having your employer comply with their duty to accommodate you.
• Having your employer stop all forms of discriminatory conduct.
• Representing you in wrongful dismissal in Ontario, constructive dismissal, and human rights matters.
• Ensuring that your employer complies with its statutory obligations, including its obligations under the Employment Standards Act.
• Negotiation severance packages (including continuation of benefits).

What Are Some Steps You Should Take Before You Apply for Long-Term Disability Benefits for Fibromyalgia?

Review Your Policy Carefully

Your entitlement to disability benefits for fibromyalgia depends on the specific wording of your disability policy. 

As noted, some policies outright exclude fibromyalgia coverage or else consider it a “mental disorder” (and seek to limit the amount of benefits).

It is important that you understand how the insurance company defines things like “totally disabled,” “occupation,” “mental disorder, “self-reported condition” – and whether any exclusions apply (particularly for pre-existing conditions).

Bottom line: You need to know what your policy says before you apply for benefits.

Gather Medical Evidence

To be entitled to disability benefits for fibromyalgia, every insurer requires you to provide medical evidence documenting your diagnosis and that your illness or injury causes restrictions or lack of ability, such that you are prevented from performing the essential duties of your occupation. 

It is recommended that you get treated by a medical professional (particularly a rheumatologist) who will diagnose your condition using established criteria.

It is also recommended that you provide to the insurer results of any Functional Capacity Evaluation or cognitive testing that objectively documents your physical and (if applicable) mental limitations.

Gather Evidence of Workplace Limitations

Because your entitlement to long-term disability benefits for fibromyalgia depends on the strength of your evidence, you should get a copy of your employee file from work. It may show that your fibromyalgia has negatively impacted your work performance. Your work performance may have been affected by your pain, fatigue, cognitive impairment, or other symptoms.

Create a List of the Physical Duties of Your Job

You should get a copy of your job description. Based on that job description, you should write out a detailed list of the physical (and mental) duties associated with your job description – and explain how your fibromyalgia limits or prevents you from performing you own occupation.

Follow Your Doctor’s Treatment Plan

Your entitlement to long-term disability benefits also requires you to be receiving regular, ongoing care and treatment for your fibromyalgia. In other words, don’t skip appointments, and always follow your doctor’s treatment plans.

Keep a Pain Diary

On your end, it is important to keep a pain diary. A pain diary is a written record that helps you keep track of when you have pain, how bad it is, and whether your treatment is helping. 

What Other Benefits Might I Be Entitled to for Fibromyalgia?

Other than short-term and long-term disability benefits through a group or individual insurance plan, people suffering from fibromyalgia might be entitled to one or more of the following benefits:

• Employment Insurance (EI) Sickness Benefits;
• Ontario Disability Support Plan (ODSP);
• Disability Tax Credit (DTC);
• Disability Creditor Insurance (under your mortgage or credit cards);
• Trillium (extended health benefits);
• Canada Pension Plan Disability (CPP-D); and
• Disability Pension (employer).

Organizations / Associations / Colleges

• Arthritis Society
• Canadian Rheumatology Association
• Canadian Pain Society
• American College of Rheumatology
• National Fibromyalgia and Chronic Pain Association 
• Arthritis Foundation

Disclaimer: The content on this web site is provided for general information purposes only and does not constitute legal, medical, or other professional advice or an opinion of any kind. Users of this web site are advised to seek specific legal advice by contacting members of Ertl Lawyers (or their own legal counsel) regarding any specific legal issues. Ertl Lawyers does not warrant or guarantee the quality, accuracy or completeness of any information on this web site

Endnotes:

1. Jain AK and Carruthers BM, co-editors. van de Sande MI, Barron SR, Donaldson CCS, Dunne JV, Gingrich E, Heffez DS, Leung F Y-K, Malone DG, Romano TJ, Russell IJ, Saul D, Seibel DG. Fibromyalgia Syndrome: Canadian Clinical Working Case Definition, Diagnostic and Treatment Protocols. A Consensus Document. (2003) Journal of Musculoskeletal Pain 11(4). Retrieved from: https://fmguidelines.ca/
2. Burckhardt, Carol & Liedberg, Gunilla & Henriksson, Chris & Kendall, Sally. (2010). The Impact of Fibromyalgia on Employment Status of Newly-Diagnosed Young Women: A Pilot Study. Journal of Musculoskeletal Pain. 13. 31-41. 10.1300/J094v13n02_05. Retrieved from: https://www.researchgate.net/publication/232046163_The_Impact_of_Fibromyalgia_on_Employment_Status_of_Newly-Diagnosed_Young_Women_A_Pilot_Study