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Fibromyalgia and Disability Insurance


By Karen Lee Richards*

Many people with fibromyalgia are able to continue working either full or part time.  Others find that the chronic pain and fatigue are so severe, continuing to work is impossible.  When that happens, it may be necessary to consider applying for disability.

Social Security Disability Insurance

If you are no longer able to continue working, you may qualify for Social Security Disability benefits. Going through the process of applying for SSD is generally not a simple task.

Therefore, it’s important to learn all you can about the process before you begin in order to maximize your chances of being approved.

The following information and especially the suggested articles can help you navigate the system as smoothly as possible.

There are two types of disability benefits available through the Social Security Administration (SSA):

  • Social Security Disability Insurance (SSDI) – Pays benefits if you have worked long enough and have paid Social Security taxes within the past five years.
  • Supplemental Security Income (SSI) – Pays benefits based on your financial need.

If you’re unsure which program best fits your situation, use the Benefits Eligibility Screening Tool to see which you may be eligible for. The information here applies only to SSDI. For more information about applying for SSI, see: Supplemental Security Income Home Page

In determining whether or not you are disabled, SSA asks five questions:

  1. Are you working? If you are working and earning an average of more than $980 a month, they do not consider you disabled.
  2. Is your condition “severe”? Your condition must interfere with basic work-related activities.
  3. Is your condition found in the list of disabling conditions? The SSA has a list of conditions they consider so severe, they automatically mean you are disabled. If your condition is not on the list, they have to decide if it is equal in severity to another condition on the list. To check the SSA list of disabling conditions, see: Listing of Impairments. If your condition is not on the list or equal in severity, they then move to question 4.
  4. Can you do the work you did previously? If the SSA determines that your condition does not interfere with the work you previously did, your claim will be denied. If it does interfere, they then proceed to question 5.
  5. Can you do any other type of work? It’s not enough just to be unable to do your previous job. They also look at your medical conditions, age, education, past work experience and transferable skills to determine if you could adjust to doing other types of jobs.

For answers to frequently asked questions about how the SSA determines the answers to questions four and five, see: Work and Education Information the SSA Needs

These articles will provide you with additional in-depth information about applying for SSDI, particularly in relation to fibromyalgia:

Applying for Social Security Disability (A step-by-step overview of the process)

How Social Security Evaluates Fibromyalgia for Disability

Tips for Winning a Fibromyalgia or Chronic Fatigue Syndrome Disability Case – and – What Actually Happens at a Social Security Disability Hearing?

The Interplay Between Fibromyalgia and Social Security Disability

Fibromyalgia Disability Application Issues: How to Be Your Own Expert Medical Witness

Long-Term Disability Insurance

If you have long-term disability insurance through your employer, you may be able to receive benefits – at least for a period of time – when you are no longer able to work due to fibromyalgia. Be aware, though, that you will likely meet with resistance from your insurance company.

According to disability attorney, Aaron Hotfelder, on the legal network Nolo.com,

Long-term disability (LTD) insurance companies routinely deny or limit claims for long-term disability benefits based on fibromyalgia… Because there is no objective test for fibromyalgia and diagnosis is based largely on self-reported symptoms, many insurers specifically exclude fibromyalgia from coverage. Other carriers consider fibromyalgia primarily a mental disorder and will limit payments to 12 or 24 months.

Read your policy carefully to understand whether and for how long you can receive benefits based on fibromyalgia. The following language limiting eligibility is fairly typical.

Benefits will be terminated after 24 months for those with disabilities which are based primarily on self-reported symptoms, and disabilities due to alcoholism, drug abuse, or mental illness. Self-reported symptoms include manifestations of your condition that are not able to be verified using tests, procedures, or examinations commonly accepted in the practice of medicine, including headaches, pain, fatigue, soreness, numbness, dizziness, ringing in the ears, and loss of energy.

Even if your policy doesn’t specifically mention fibromyalgia as being excluded or limited, you should expect to meet substantial resistance if you file for LTD benefits based on fibromyalgia.

These articles will provide you with additional in-depth information about applying for LDI, particularly in relation to fibromyalgia:

Disability Insurance Q&A – Attorney Team Answers Your Questions

Fibromyalgia Disability Application Issues: How to Be Your Own Expert Medical Witness

Disability Attorneys See Signs of Evolution in Fibromyalgia Coverage

VIDEO: Top 5 Reasons for Long-Term Disability Insurance Denials

The Evolution of Denying Fibromyalgia and Chronic Fatigue Syndrome Claims in Group Long-Term Disability Policies

When You Can’t Manage a Full Workload – Partial Disability May Be an Option

* Karen Lee Richards is ProHealth’s Editor-in-Chief. A fibromyalgia patient herself, she co-founded the nonprofit organization now known as the National Fibromyalgia Association (NFA) and served as its vice-president for eight years. She was also the executive editor of Fibromyalgia AWARE, the very first full-color, glossy magazine devoted to FM and other invisible illnesses.  After leaving the NFA, Karen served as the Guide to Fibromyalgia and Chronic Fatigue Syndrome for the New York Times website About.com, and then for eight years as the Chronic Pain Health Guide for The HealthCentral Network.

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