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Well-recognized, sometimes disputed: myofascial pain syndrome

| Dec 8, 2020 | Long Term Disability Claim Denial

Insurance companies routinely look for ways to delay or deny long-term disability claims or to terminate existing benefits.

We underscore that at the established national disability legal offices of the ERISA Law Center. We stress on our website that, “There are a variety of reasons an insurer might deny your long-term disability claim.” Here are just a few:

  • Reassessment of benefits via an internal review
  • Claim that a condition doesn’t meet (or no longer meets) policy definitions
  • Insurer’s finding that claimant should be able to engage in work
  • Symptoms claimed to be vague or not tying back to a distinct illness or condition

Why myofascial pain syndrome can face insurer blowback

Myofascial pain syndrome (denoted MPS hereafter) causes chronic pain for a sufferer that links to so-called “trigger points.” Those are sensitive muscle areas, often those that are especially affected by repetitive motion. The Mayo Clinic states that while muscle pain generally abates over time in most instances, that is not the case with MPS. The discomfort – often disabling pain – for victims of this malady often worsens and does not go away.

And there is this, too, which can bring insurance challenges for afflicted persons: The Mayo Clinic points to trigger-point pain that sometimes occurs “in seemingly unrelated parts of the body.”

That can lead to an insurer’s argument that a claim is ambiguous (not precisely identified and even subjective) and should be denied. That lack of precision in a diagnosis and absence of a clear medical explanation/basis relevant to a particular pain source can make an MPS diagnosis problematic from a long-term disability standpoint.

An insurer’s obstinacy or outright claim challenge should never be passively tolerated by a disabled person. Claimants can take strong action in the wake of delay, denial or termination by securing help from a proven disability legal team.