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Denied disability: US Social Security recognizes Fibromyalgia
Tuesday 8 January 2013
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.
The above, with comments, originally appeared here.
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