Monday, June 11, 2012

Fibro, CFS and Disability Insurance

Note: This is a press release from a law firm. The key graph is this:
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. 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.

Fibromyalgia/Chronic Fatigue: Diagnosis Difficult, Benefits Often Denied
Large insurance companies often deny disability claims based on
fibromyalgia and chronic fatigue syndrome.

    June 10, 2012 /24-7PressRelease/ -- Fibromyalgia and chronic
fatigue syndrome are two frequently misunderstood medical conditions.
According to the National Institutes of Health people often think they
developed overnight and exist only within a person's mind. The truth
is that these diseases have been around for centuries, although they
were 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.

Basics of Fibromyalgia and Chronic Fatigue Syndrome and Treatment by Insurers

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.

2 comments:

Bravada Jones said...

Could you please provide the name and the state/jurisdiction of the case you mentioned toward the end of your entry?

Much appreciated,
B. Jones

CFS Facts said...

"This is a press release from a law firm", so I have no information other than what is posted.