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Why insurers question fibromyalgia disability claims

On Behalf of | Nov 2, 2023 | Long Term Disability Claim Denial

If your doctor diagnosed you with fibromyalgia and it is preventing you from working, you may consider filing for disability benefits. However, many cases are denied.

In fact, there is often a high rate of denials in cases of fibromyalgia. Learn why insurers question fibromyalgia disability claims and how this information may help your strengthen your case. 

Diagnosis difficulties

One of the most common reasons why insurers are skeptical about fibromyalgia disability claims is the difficulty associated with diagnosing the condition accurately. Unlike many other diseases that can be verified through objective tests like X-rays or blood tests, fibromyalgia is primarily diagnosed based on a patient’s reported symptoms. This lack of definitive diagnostic criteria makes it easier for fraudulent claims to be filed. This results in insurers being extra cautious when evaluating such cases.

Lack of medical consensus

Another factor contributing to the skepticism surrounding fibromyalgia claims is the lack of medical consensus on the condition. The medical community is divided on what constitutes fibromyalgia, its causes and its treatment options. 

Insurers, therefore, find it challenging to establish a standardized approach for assessing these claims. Without clear guidelines, the room for subjectivity grows, making it easier for insurers to question or deny claims.

The subjectivity of pain

Pain, fatigue and discomfort are primary symptoms of fibromyalgia, but these are inherently subjective experiences that vary from person to person. Insurers often use ‘objective’ measures to assess disability, such as the ability to perform specific tasks. With fibromyalgia, however, there’s no way to measure an individual’s pain level, causing further complications in the claims process.

The skepticism surrounding fibromyalgia disability claims can be attributed to various factors, including diagnostic challenges, a lack of medical consensus and the subjective nature of the symptoms. As a result, those filing disability claims for fibromyalgia may find themselves under increased scrutiny and should be prepared for a rigorous evaluation process.