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Long Term Disability Claims & Fibromyalgia: Facts, Fiction & Fairness (Ontario)

Goldfinger Injury Lawyers has assisted countless long term disability clients with their denied LTD claims against large insurers in fibromyalgia, chronic pain and depression cases.

If you are reading this installment of the Toronto Injury Lawyer Blog Post, you likely have some questions about fibromyalgia, chronic pain, or Long Term Disability Cases in general.

If this entry does not answer the questions you may have, don’t hesitate to give us a call toll free across Ontario at 1-877-730-1777 or email Brian Goldfinger at or our law firm at Brian Goldfinger and our long term disability lawyers would be pleased to answer your questions, whatever they might be. All of our communication is confidential; and there is no charge; so don’t hesitate to ask away.

And with that pre-amble out of the way, it’s now on to demystifying fibromyalgia and chronic pain in the context of a long term disability claim in Ontario.

Chances are, you have long term disability insurance through your employer, or through an individual policy.

There aren’t that many long term disability insurers out there. So chances are you’re dealing with one of either Manulife, Sun Life, Great West Life, Industrial Alliance, Desjardins, SSQ, RBC Insurance, Empire Life, Co-Operators Insurance, La Capitale, Western Life just to name a few. There are certainly others, but that’s a pretty good list to start.

What all of these insurers have in common is that they are NOT CHARITIES. At the end of the day, they are in the business of making money.

The more money which a large long term disability insurer pays out to a claimant like you; the less money they get to retain in profit.

So, if your long term disability claim has been denied, don’t take it personally (easier said than done). In the vast majority of cases, it’s purely a business decision to deny your claim.  There are certainly exceptions where the adjuster is incompetent, or has a vendetta against the claimant; but those are the exceptions, not the rule.

It’s easy for a long term disability insurer to APPROVE a claim where there are objective findings on a CT Scan, X-Ray or MRI. Example: You have a bad car accident and you break your legs, sustain a brain injury and cannot walk or manage your normal day to day self care activities.

These objective findings ought to lead to a quick approval for long term disability benefits without the need for the intervention of a personal injury lawyer.

But fibromyalgia cases are different.

Fibromyalgia is completely misunderstood. Some doctors believe in it. Others simply do not and shrug it off.

Fibromylagia does NOT show up on any x-ray, CT Scan or MRI.

Most Judges, Juries and everyday people do not even know what fibromyalgia. So when a claimant bases their disability application on a diagnosis of fibromyalgia, the insurer is skeptical right off the bat. Because of its sometimes mystifying and subjective nature, fibromyalgia is an EASY denial at first instance for a long term disability insurer. But this does NOT mean that you should lose hope and give up the fight. Tough times don’t last, but tough people do….

So, let’s get some things straight when it comes to discussion fibromyalgia:

Fibromyalgia facts:

  • Fibromyalgia affects 2-3% of all Canadians
  • Most people with fibromyalgia are women (80 to 90%)
  • Fibromyalgia does not lead to permanent joint damage, deformity or broken bones
  • People with diseases such as rheumatoid arthritis, lupus ankylosing spondylitis can also have fibromyalgia
  • It’s not uncommon for people with fibromyalgia to also experience sadness, anxiety, depression and worse, suicidal ideations

What is Fibromyalgia?

Fibromyalgia is a medical condition that is believed to affect the central nervous system. The most common symptom of fibromyalgia is widespread pain, which can be experienced in one or more places throughout the body. The pain can vary from person to person, may move around the body from time to time and may change in intensity on a daily or even hourly basis. People with fibromyalgia may also experience other symptoms, such as fatigue, sleep difficulties, lack of concentration and memory, mood swings and gastrointestinal problems (such as constipation or diarrhea) and have a heightened sensitivity to touch and pressure.

What fibromyalgia does have in common with arthritis is that it can cause pain and fatigue and thus can have a significant impact on a person’s daily life.Goldfinger-logo-icon-300x300

Because the symptoms of fibromyalgia are hard to test for and may change throughout the day or week, it is often misunderstood and perceived as an “imaginary disease” or something that is “all in your head”. People with fibromyalgia may look well, but may in fact be experiencing a lot of pain. While more research is needed to fully understand this condition, doctors are now better able to diagnose it and recognize that multiple physiological factors are at play in producing the symptoms.

For many, the cause of their fibromyalgia cannot be identified. For many, the start of their fibromyalgia may be pinpointed to a triggering event, such as a severe illness, a traumatic incident or a stressful, emotional experience (such as a car accident or the death of a loved one).

There is currently no cure for fibromyalgia but medication, exercise, relaxation and stress-reduction measures, as well as other lifestyle changes, may help to reduce symptoms.

Regrettably, there is no single magical pill used to help cure fibromyalgia, although fairly recently (2007), Lyrica/Pregabalin became the first drug approved for treating fibromyalgia by the FDA in the United State (recognition is a step in the right direction).

To re-cap, fibromyalgia is an invisible impairment which has no cure which affects both mind and body which doesn’t show up on an X-ray, CT Scan or MRI which some people have heard of, and others have not, which some doctors believe in, and others do not, which is associated with all other sorts of factors like depression, GI problems, arthritis, lupus, etc. How’s that for a mouthful.

Given the complexity and lack of understanding of fibromyalgia, you can see how and why a long term disability insurer would make a denial for such a claim. But, as previously stated, this does not mean that you should give up. Stay strong and don’t let them knock you down. There is light at the end of the tunnel.

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