Fibromyalgia is one of perhaps ten medical impairments which drive disability insurers crazy. It is a syndrome of symptoms and complaints which open the door to multiple file review abuses leading to the non-payment of disability claims. In addition, unsuspecting claimants and insureds “buy-in” to the many, many Internet articles about fibromyalgia and disability claims, much of it being inaccurate.
While fibromyalgia really is a credible, disabling disease, quite often insureds make it seem less so by saying things to an insurance company that may lend to stereotype rather than a bona fide physical impairment which is preventing an individual from returning to work. If you are a client of ours, we help you manage your fibromyalgia claim and stay clear of most of what we describe below.
Here are five things a fibomyalgia patient should NEVER say to a disability insurer.
“I have brain fog or fibro fog.”
Unfortunately, the term “brain fog” is a stereotypical term used to describe the mental “spaciness, difficulty with short-term memory, and word finding and substitution that can occur with any number of diseases including Meniere’s disease as well as fibromyalgia. The term is used all over the Internet and some physicians actually use the term in describing symptoms in medical notes.
However, when dealing with disability claims specialists (who often laugh at the use of the term) it is far more beneficial if the insured avoids using the term “brain fog”, and describes the actual phenomenon in more detail instead.
For example, it is much better to say, “On occasion I have severe difficulty finding my words and frequently forget important things.” Unfortunately, using lingo like “brain fog” and “fibro fog” with an insurance company won’t get your claim paid.
“It hurts all over.”
Although it may seem so at times having fibromyalgia does NOT in fact hurt all over. There are 18 specific tender points, when touched with pressure that can hurt. A few years ago an insurance IME physician confided in me that as soon as an insured told him “It hurt all over”, he knew he/she didn’t have fibromyalgia.
When describing symptoms to an insurance company, be very specific. Say, “It hurts behind my shoulder blades, on my upper arms, and lower back when touched.” Look up the fibromyalgia chart on the Internet and become familiar with where these tender points are located and be prepared to describe EXACTLY where it hurts to the insurance specialist. Although admittedly, your body may seem to hurt all over when several tender points are positive, in fact, it DOES NOT hurt all over. Telling an insurance company “It hurts all over” won’t get your claim paid.
“I have good days and bad days.”
Telling an insurance company “you have good days and bad days” presumes healthy people have only good days. In reality, even extremely healthy people have both good and bad days. ALL people feel better more days than others, so the phenomenon doesn’t place fibromyalgia patients into a special “disabled” category – it just makes FMS patients a member of the human race.
The insured’s response is usually, “Yes, I walked around the Mall on Tuesday with my sister, but you should have seen me in bed for three days afterward. I pay for it all.” Unfortunately, an insured can tell this to an insurance company until they are blue in the face, but he/she will NOT be believed and the statement is not viewed as being credible by the disability insurer.
Instead of using the catch-all phrase “good days/ bad days”, instead say, “My doctor’s treatment plan recommends I stay active as best I can, and I try, but I sure do have a hard time functioning afterward.” This is why DCS, Inc. recommends keeping a journal where the insured documents physical activities and how he/she feels afterward on a daily basis.
“I sleep all the time, or I’m in bed all the time.”
Sometimes insureds do not “think” what they actually say to their disability insurer. This phrase is often used in conjuntion with “I have good days and bad days.” Logically, one CANNOT have good active days and then ALSO “sleep all the time.” This kind of description lends itself to insurance surveillance. The first time the insurance company finds you NOT sleeping, the disability claim is in trouble.
Insureds with fibromyalgia are in fact fatigued quite a bit. However, nearly all physicians include activity, exercise, pool therapy etc. as part of a credible treatment plan. Fibromyalgia patients should be actively engaged in, participating in, or at least attempting to do what the doc tells them to do. When asked it’s best to say something like the following, “Attempting the exercise plan recommended by my doctor is exhausting and physical activity often causes me to be fatigued.” Informing an insurance company you “sleep all the time” won’t get your claim paid but it will get you observed by the surveillance team.
Finally, “I’m taking herbs and treating with alternative medicine.”
Granted, quite a few doctors are heading in this direction, but for disability purposes “alternative” does not mean “instead of.” Regular and appropriate treatment for fibromyalgia includes taking Lyrica or another anti-depressant if recommended by your doctor. Herbs and other alternative medicines can also be recommended, but for disability purposes herbs and mushrooms are not viewed as conventional medicine by disability insurers. When asked you might say, ” My doctor and I have discussed conventional treatments but we decided the conservative approach for me will be included in my treatment plan along with some alternative recommendations.” Treating only with alternative herbs, mushrooms and other alternatives to conventional medicine will not get your claim paid.
I hope this information is helpful to our non-clients. DCS, Inc. manages fibromyalgia, chronic fatigue, MS, and RSD claims as a specialty. If you have any questions about this or any other information on the Blog please feel free to contact me for further information.
