Disability insurance carriers do include fibromyalgia in the list of disabilities they cover for both short- and long-term disability. So, yes, you may be able to get disability for fibromyalgia in Canada. According to the Arthritis Society, fibromyalgia affects about two percent of people in Canada.
However, your medical records need to prove the severity of your condition and show that it prevents you from working to be awarded disability benefits. If you received a denial on your fibromyalgia-related disability claim, you may be able to challenge the denial through an internal or external appeal.
How a Disability Case Is Evaluated
Not all workers with a fibromyalgia diagnosis may qualify for disability benefits. The insurance provider may examine the claimant’s medical records and other documentation to determine if they meet the standards set in their policy. They may consider:
- The severity of symptoms
- The frequency of symptoms
- The occupation and how symptoms affect the work
- The previous and ongoing medical treatment
- Other factors
If you file a claim for disability benefits based on fibromyalgia, you may want to have specific evidence that speaks to these factors in your medical records.
Documenting Fibromyalgia for a Disability Claim
Fibromyalgia may be challenging to diagnose and even harder to document and prove to your disability insurance carrier. Not only does fibromyalgia pain differ from person to person, but it may vary in location and intensity in the same person throughout the day.
Pain is difficult to quantify, but there are also other symptoms of fibromyalgia that are not as abstract. Your doctor should document these in your medical records if you report them. They include:
- Extreme sensitivity to touch, pressure, and temperature
- Lethargy and weakness
- Irregular sleep patterns
- “Fibro fog,” a symptom related to memory and concentration
- Gastrointestinal issues
- Changes to normal bladder function
Some people with fibromyalgia also have another co-occurring condition, such as:
- Ankylosing spondylitis (AS)
- Rheumatoid arthritis (RA)
In some cases, it may be easier to prove your claim based on one of these diagnoses than it is to document your fibromyalgia symptoms.
Still, a pain journal documenting the frequency and intensity of your fibromyalgia-related pain may be used as evidence. You may also gather statements from colleagues or family who have witnessed your fibromyalgia-related pain and may attest to how it has limited your ability to work.
Ways to Challenge a Denial Based on Your Fibromyalgia Claim
If your insurance carrier denied your fibromyalgia-based disability benefits claim, you have options for fighting the denial, which includes:
Filing an Internal Appeal
Insurance carriers provide an opportunity to file an internal appeal following a denial. This appeal is simply a reconsideration of your claim and supporting information by the insurance company. Unless there is an easy-to-fix technicality in the denial letter, a disability lawyer may determine that an internal appeal is unlikely to change the insurance company’s mind.
Our lawyers may be able to help you decide if this is a necessary step or if we need to pursue another option on your behalf.
Filing an External Appeal (a Lawsuit)
An external appeal may be more effective than an internal appeal because it allows a third party, the court system, to interpret your eligibility for benefits.
After gathering evidence to support your fibromyalgia-based disability claim, your lawyer may be able to negotiate an out-of-court settlement with the insurance carrier.
If the insurance carrier refuses to make a settlement, your lawyer may be able to defend your rights in court. The court may award you compensation if it determines the insurance carrier denied you unfairly.
Take Action to Challenge a Denial of Disability Benefits
If your insurance carrier denied your application for fibromyalgia-based disability benefits, it is important that you act quickly. There are strict time limits for filing a denial-of-benefits lawsuit.
Under Ontario’s Limitations Act, we only have two years from the date the insurance carrier originally denied you for benefits to take legal action. In some cases, this limit may only be one year. If we do not take legal action by this deadline, you may give up your right to recover compensation via a lawsuit.
Talk to a Legal Team About Your Benefits Denial
You may be able to get disability for fibromyalgia in Canada. If your application for fibromyalgia-based disability benefits was denied, Preszler Injury Lawyers may be able to help. Our Ontario team serves Toronto and all other areas throughout Ontario.
Call Preszler Injury Lawyers now at 1-800-JUSTICE to learn more. Initial consultation calls are always free.