Private Disability Insurance Claims

First, Fibromyalgia and Chronic Fatigue Syndrome are Genuine Medical Conditions — Not Imaginary

Fibromyalgia and chronic fatigue syndrome are two frequently misunderstood medical conditions. According to the National Institutes of Health many people often think these serious conditions are “fad-like” and symptoms exist only within a person’s mind. The truth is that these diseases have been around for centuries, although they were once commonly believed to be a single condition known as muscular rheumatism.

With technological advances, physicians and medical researchers have been able to specifically categorize these two unique diseases. The recent ability to diagnose these ailments allows patients an increased chance of managing the disorder and returning to their daily routines.

A diagnosis is often achieved using an 18-point test. The challenge for people with these diseases is that even with a positive diagnosis the level of pain and fatigue resulting from these diseases cannot be quantified. As a result, many large insurance companies frequently deny disability insurance claims.

The companies argue that the patient is not truly disabled and support this statement with the fact that it is very difficult for doctors to objectively list the level of pain and fatigue suffered by the patient.

 

Fibromyalgia and Chronic Fatigue Syndrome Compared

Fibromyalgia is a disorder that causes pain in the victim’s muscles and includes symptoms of fatigue, anxiety, depression and headaches.

Chronic fatigue syndrome is a complicated disorder that shares many similarities with fibromyalgia. Symptoms include fatigue, loss of memory, unexplained muscle pain, poor sleep and extreme exhaustion lasting more than 24 hours.

 

Insurers Employ Sneaky Tactics to Avoid Paying Fibromyalgia Claims

Unfortunately for both of these diseases the symptoms are subjective. There are no tests to determine the exact level of patients’ pain or fatigue. Many insurers attempt to circumvent coverage of these diseases by requiring objective tests. This technique is often successful, because it is near impossible to objectively prove that a person suffering from either of these disorders is in pain.

Recently, a court decision reviewing a denied disability claim for a fibromyalgia sufferer took a step towards holding large insurance companies accountable for fully evaluating claimants seeking disability compensation. In the case, a large insurance provider denied a policy holder disability benefits without conducting an independent medical examination. Instead, they based the denial on an investigation carried out by one of the company’s employees.

The court ultimately found the insurance company’s denial was unreasonable. They did not hold that fibromyalgia and chronic fatigue syndrome should receive coverage, but that insurance companies owe their policy holders a duty to conduct a full, independent investigation.

Although the holding works in the policy holder’s favor, the road to approval of a disability insurance claim is still long and complicated. If you or a loved one is suffering from one of these ailments and is attempting to or have already been denied benefit, you should speak with an experienced California insurance claims attorney to better ensure your legal rights are protected.