Chronic pain, fibromyalgia and depression are invisible.
That means that they don’t show up on any x-ray, CT Scan, MRI or other diagnostic test. It also means that nobody would know that you are suffering from chronic pain, fibromyalgia or depression simply by just looking at you. It also means that if you tells someone that you are suffering from chronic pain, fibromyalgia or depression; they might not understand; or worse yet; might not even believe that you are suffering. The world is more empathetic and understanding of someone who has a visible injury (like a cast on account of a broken arm) as opposed to someone who is suffering from chronic pain, fibromyalgia or depression.
All of these factors make living with chronic pain, fibromyalgia or depression even harder than it already is.
Adding insult to injury is when your doctor, employer, family members or long term disability insurer doesn’t seem to acknowledge or believe that you are disabled.
It’s an uphill battle. But don’t give up. Goldfinger Injury Lawyers is here to help as best we can.
So, what do you do if you have chronic pain, fibromyalgia or depression, and you have applied for Long Term Disability benefits and you have been denied?
For starters: lawyer up!
The insurance company does not want you to do this, but in the majority of cases, you have to. Long Term Disability benefits don’t just magically fall down from the sky. You have to fight for them once you have been denied.
Insurance companies are in the business of approving or denying long term disability claims. This is their profession. For the overwhelming majority of long term disability claimants, it’s their first time making such a claim. For all intents and purposes, the claimants are first timers. They are amateurs in the disability claims field. This is NOT their profession. They don’t know the first thing about the forms which need to be completed, the evidence which needs to be submitted; or how these claims are handled, assessed and adjudicated.
Don’t fight this battle alone, without experienced legal advice. If you are fighting the insurer on your own, you are fighting an unfair fight whereby the cards are stacked against the disability claimant in favour of the large, deep pocketed insurer who has loads of experience handling these claims.
Insurers want you to fight these claims on your own knowing that you will make a mistake somewhere down the line. Insurers don’t want you to lawyer up so that a limitation period lapses. That way, your claim will never stand a chance of winning, no matter the legal merits of the disability claim. If you miss a limitation period, then you’re out of luck regardless of the extent of your disability. Had you lawyered up in time, then your lawyer will take care of that looming limitation period and protect your rights.
See your doctor. If you don’t have a doctor, go to an Urgent Care Clinic, Walk In Clinic, or Hospital. Letting your pain lag without getting treatment for it creates large holes in your disability case.
Under most long term disability policies, there is a requirement for the disability claimant to be under the regular care of his/her family physician, or nurse practitioner. If you don’t have a family physician, or nurse practitioner, then it’s important to show that you are receiving regular care from a medical professional for your problems. If you haven’t seen a doctor in say a year; it’s going to be problematic to establish that you meet the disability test under your policy.
An insurer will argue that if you aren’t receiving regular care or treatment, then your problems can’t be that bad. After all. If they were bad, then you would be going to get care. Healthy people don’t regularly see their doctors because they don’t need to (as they are healthy). But disabled or injured people need to see their doctors regularly for their injury or disability. So, if there’s no regular patter of treatment; then the disability claimant can’t be that injured, or perhaps they are lying about the severity of their disability.
Don’t give up! Never, ever, ever give up on your claim.
I have handled countless long term disability cases over the years involving chronic pain, fibromyalgia and depression.
A common thread in all of these claims, apart from the insurer denying the claim; is that at some point during the claim/litigation process; the claimant wants to give up on the case/quit.
This is exactly what the long term disability insurers wants the claimant to do. They want to grind them down so that they quits the case.
The claimant needs to stay strong and to never give up hope.
Long Term Disability cases are not easy. If the claim was an easy and straight forward case, the claimant would have been approved for long term disability benefits in the first place! There is a reason that the claim was denied. Understanding that reason can be very difficult because a claimant never knows what goes on behind the scenes at an insurance company. It may be as simple as they don’t believe that the medical evidence supports the claim. It might be surveillance which was collected which showed a discrepancy between the claimant’s presentation and his/her medical records. Or it could be a variety of other factors. Whatever the reason, it’s not relevant. The only thing that matters is that the claim has been denied, and now the claimant needs to stay strong, stay the course and fight the claim.
This is easier said that done.
The cold, hard truth is that long term disability cases; much like all personal injury cases are marathons and not sprints. They take time to settle, or to get to trial. It’s not like on television where the case can open and close over the course of an hour long episode. Real life legal cases don’t work like we see on television. This concept of waiting and time are very difficult for people to accept; particularly when there are financial pressures and bills to pay. But, this is the reality which claimants need to understand in order to have a proper mindset when litigating a long term disability case.