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Fibromyalgia & Depression: Will the Insurance Company ever Believe You?

Some injuries are visible to the naked eye. Someone in a wheelchair with a broken limb. A bandage. A crutch. A walker. A cast or a cane. All of these things are plainly visible and send a strong message to the world that a person is hurt, injured and not at their best. These sort of visible injuries are easy to understand, plainly visible to people from all walks of life and from  diverse backgrounds. It doesn’t take a medical expert or a skilled personal injury lawyer to help a judge and jury understand that we have an injured party involved in the case at hand.

In contrast, the vast majority of injuries are invisible to the naked eye. You cannot see chronic pain. You cannot see fibromyalgia. You cannot see anxiety, depression, post traumatic stress disorder, suicidal ideation, or plain misery. Perhaps you can see an unhappy look on one’s face. But simply because someone appears to be unhappy does not necessarily mean that they are suffering from a serious personal injury or disability. Perhaps they are just having a bad day.

The purpose of this edition of the Toronto Injury Lawyer Blog is to focus on those invisible injuries which insurers love to deny, discount and minimize. In particular, we will focus on fibromyalgia and depression which often go hand in hand. And which are two injuries/disabilities which both auto insurers and long term disability insurers love to deny and discount.

If you are suffering from fibromyalgia or depression, don’t lose hope or give up! Stay strong. There is light at the end of the tunnel. Your injuries and disabilities are legitimate despite what the insurance company and their hired gun doctors might say. The insurance company wants you to become reclusive so that you don’t commence an action to get the compensation you deserve. If you do nothing, you will get nothing and the insurance company will win. But if you have the strength and courage to take the first step and to reach out to a personal injury lawyer; you are taking a step in the right direction. Don’t give up. Don’t lose hope.

Fibromyalgia and depression do not show up on any x-ray, CT scan, MRI or other digital tests. You cannot see fibromyalgia or depression on a microscope.

When you tell someone that you’ve been diagnosed with fibromyalgia, they likely have no idea what that is. In fact, some doctors don’t believe that fibromyalgia exists.

When you tell someone that you’ve been diagnosed with depression, they may not understand what that entails. They may think of it as simply having a bad day and give the advice for you to simply cheer up and everything will be alright. Unfortunately, it’s not that simple. If it were there wouldn’t be a need for psychiatrists to see depressed people, or anti-depressant medication. If only “cheering up” could be that simple then the problem of depression would wipe away like chalk to a blackboard.

A common thread we have seen with our clients who suffer from depression is either that they are not seeing doctors/counsellors on a regular basis; or they are seeing doctors/counsellors on a regular basis. There is no middle ground. Part of this comes to funding and availability of doctors. Some communities don’t have the same mental health resources as other communities. Counselling is often not covered by OHIP. That means that a patient may have to pay out of pocket for treatment if it’s not covered by OHIP or under a private insurance plan. Having to pay for mental health counselling to deal with depression can be very expensive. The reality is that when you don’t have to money to pay for treatment, you’re not going to get it. linkedin-2-300x300

Another reason why clients who are coping with depression may not see doctors or get regular treatment is because they are too depressed to get the help they need. They are simply drowning in depression and it has made them completely non-functional. This happens all too often and is hard for an insurer to comprehend.

Those clients who are receiving regular treatment or counselling often have it paid for by OHIP or by private insurance. So there are no financial barriers to getting treatment. In addition, since the COVID-19 Pandemic, doctors and service providers along with insurers have been more open to the idea of virtual counselling. This has helped to open accessibility for patients because they can get the care they need right from the comfort of their own home provided that they have good internet access.

We are certainly cognizant that not all people have internet access; or good internet access for that matter. It’s simply not enough to have access to internet. It needs to be strong enough to have meaningful and uninterrupted conversations so that the counselling means something. It can be very frustrating for patient and service provider to have their connection severed due to a weak internet connection. We see the same thing happen during Zoom Mediations, Zoom Pre-Trials and Examinations for Discovery conducted via virtually. If the internet connection is not a good one; the hearing won’t be a good one either.

A common thread that we see with our Fibromyalgia clients is that they are seeing a lot of doctors, from a wide spectrum of different specialties. They may see a family doctor, a rheumatologist, a physiatrist, a psychiatrist, a psychologist, a neurologist, a gastroenterologist and the list goes on. Some doctors believe in the patient’s pain and suffering and show great empathy. Others are dismissive because their injuries and pain are not appearing on their normal tests. This often drives patients to alternative methods of healing which fall outside the normal or accepted regime on Ontario. It was not too long ago that medicinal cannabis fell into this category (and for some slow to change insurers it still does!). Homeopathy, naturopathy. acupuncture or any other method which provides pain relief which falls outside of the OHIP system are viewed as these treatment alternatives. They are not covered by OHIP so that patient must pay out of pocket for treatment. Sometimes treatment is covered by private insurance. Other times it’s not. Either way, people suffering from Fibromyalgia will try anything to get better because living with the pain they do is very difficult.


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