“Be your own advocate.” When it comes to our health care system, this is sage advice. We may not all be medical experts, but we can become active participants in our care by asking questions of our doctors, understanding our medical conditions, treatment options and insurance coverage.
But what if the medical professional you consult is skeptical or dismissive when you present yourself for diagnosis? What if your insurance provider denies your claim by questioning the severity, or even the existence, of your condition? Many of my clients who have been denied their short or long-term disability benefits suffer from fibromyalgia and chronic pain syndrome and have encountered these situations all too often.
According to the Mayo Clinic[1], fibromyalgia is a disorder characterized by widespread musculoskeletal and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way our brain processes pain signals.
Symptoms of and Treatment for Fibromyalgia/Chronic Pain Syndrome
According to the Mayo Clinic,[2] people with fibromyalgia often have wide-ranging symptoms, including:
- Widespread pain (on both sides of the body and above and below the waist) for at least three months. The pain is often described as a dull ache.
- Fatigue, even when sleep is not disturbed. However, pain may disrupt sleep.
- Cognitive difficulties in terms of concentrating and remembering.
- Many other problems, such as cramping in the lower abdomen, tenderness in the face and jaw, stiffness, sensitivity to certain stimuli, depression, anxiety, and headaches
Fibromyalgia symptoms can range from mild to severe and wax and wane over time or due to particular stresses on the body, and many people must dramatically limit their activities, including work, as a result of symptoms.
Treatment is varied and usually employs some combination of patient education, aerobic exercise, cognitive behaviourial therapy and pharmacological options.
Diagnosis, Disability and Believability
The National Fibromyalgia & Chronic Pain Association[3] notes that fibromyalgia is fairly common as three to six per cent of the world population likely lives with the condition. Although it can affect people of all ages, it is about four times more likely to occur in women.
When diagnosing fibromyalgia, healthcare providers often use laboratory tests to rule out or co-existing conditions. Although many health care providers are sensitive to patients’ descriptions of pain and symptoms, others may be less than sympathetic, skeptical or simply frustrated if they cannot determine the cause of the pain.
Moreover, when fibromyalgia symptoms result in a disability that requires obtaining disability insurance, some sufferers will find insurance companies use diagnostic difficulties or the non-specificity of symptoms to deny claims.
The Law and Chronic Pain
With such costs in the balance, some insurance providers have sought out researchers[4] or doctors in the field to contradict plaintiffs who challenge denial of claims in court. These experts tend to base their diagnosis on unreasonably high thresholds and may frame their findings in ways to attempt to distinguish pain from physical impairment and psychological “illness behavior” from disability.
This is where self-advocates for healthcare can benefit from a form of supportive legal advocacy. Canada’s Supreme Court has noted the chronic pain cannot always be objectively verified through current diagnostic practices. However, “despite this lack of objective findings, there is no doubt that chronic pain patients are suffering and in distress, and that the disability they experience is real.”
For more information about fibromyalgia/chronic pain syndrome or to speak about a denial of short or long term disability, please contact Brad Moscato at 416-646-7655 or bmoscato@hshlawyers.com.
[1] http://www.mayoclinic.org/diseases-conditions/fibromyalgia/basics/symptoms/con-20019243
[2] http://www.mayoclinic.org/diseases-conditions/fibromyalgia/basics/symptoms/con-20019243
[3] http://www.fmcpaware.org/aboutfibromyalgia.html
[4] http://www.hshlawyers.com/articles/chronic-pain-an-invisible-injury/
