Tuesday, December 5, 2023

Can You Claim Disability Benefit For Fibromyalgia

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What Medical Conditions Qualify For Disability Benefits

Fibromyalgia and Chronic Fatigue Disability Benefit Legal Update

Any medical condition can qualify for disability benefits. Generally speaking, most disability benefits programs in Canada do not give benefits based on a medical diagnosis. Rather, they provide benefits based on the level of disability caused by the medical condition. So the focus will always be on the level of disability caused by your medical condition, rather than only the name of your medical condition or diagnosis. To qualify for benefits, you must show that the level of disability from your medical condition meets the eligibility criteria of the disability benefits plan in question.

Following is a list of common medical conditions that qualify for disability benefits. For each of these conditions we discuss the unique challenges you will face.

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Does Fibromyalgia Qualify Me For Long

Fibromyalgia is a chronic condition that is quite common. It is characterized by a group of symptoms that exist simultaneously and need to be managed. Warning signs include fatigue, chronic pain, changes in mood and problems with memory. While painful, it is not life threatening nor does it lead to joint impairment.

At the early onset of a fibromyalgia disability, the condition often affects a certain area subtly. As time progresses, multiple areas of the joints, organs, and skin are affected. Although any part of the body can be distressed, the sites most affected by the condition are the legs, back, arms, shoulders and neck.

Fibromyalgia is considered a rheumatic condition, meaning it is marked by pain and inflammation in the muscles, joints, and fibrous tissue in the body though it causes no damage.

Approximately 900,000 Canadians are affected by the condition.

Take Action To Challenge A Denial Of Disability Benefits

If your insurance carrier denied your application for fibromyalgia-based disability benefits, it is important that you act quickly. There are strict time limits for filing a denial-of-benefits lawsuit.

Under Ontarios Limitations Act, we only have two years from the date the insurance carrier originally denied you for benefits to take legal action. In some cases, this limit may only be one year. If we do not take legal action by this deadline, you may give up your right to recover compensation via a lawsuit.

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Fibromyalgia And The Disability Tax Credit Faqs

I have Fibromyalgia. Am I eligible for the Disability Tax Credit? Yes. If you or someone you support suffers from Fibromyalgia you are eligible to apply for the DTC.

I was just diagnosed with Fibromyalgia. Can I apply for the Disability Tax Credit Right Away? In order to be eligible for the DTC your disability must have lasted or be expected to last at least 12 months. You may be eligible to apply for the DTC right after diagnosis provided your doctor is willing to attest to the above stipulation.

What constitutes Life Sustaining Therapy? The Disability Tax Credit defines Life Sustaining Therapy as that which is necessary to support a vital life function and is required to be performed no less than 3 times a week for no less than 14 hours per week. Where fibromyalgia is concerned there are two main types of therapy administered: Passive therapy in the form of massage and the like and Active therapy which includes things like flexibility and mobility exercises. Either or both can be considered life sustaining if they provide the support necessary for the conduct of a vital function.

How do I determine how much time is spent on Life Sustaining Therapy? Determining the amount of time you spend undergoing Life Sustaining Therapy to treat your fibromyalgia is not difficult. Simply keep track of the amount of time you spend engaged in different types of passive or active therapies and record the totals on form T2201.

Passive treatments may include:

What Disability Benefits Am I Entitled To With Fibromyalgia

Fibromyalgia Disability Benefits

If your application for SSDI is approved, your payment will begin six months from the date your disability began. The amount you receive will depend on your lifetime earnings and how many work credits you have accrued. You can use the SSAs online benefits calculator to find out how much you are entitled to claim.

Once you have been receiving disability benefits for two years, you will also be automatically enrolled in Medicare parts A and B. This will entitle you to help with paying for inpatient treatment, follow-up treatment, doctor fees and other medical services.

While hospital care and certain follow-up treatments could be provided free of charge, you will need to pay a monthly premium in order to cover other services.

While the exact cause of fibromyalgia is still unknown, scientists and researchers have discovered some possible fibromyalgia causes.

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How Social Security Administration Views Fibromyalgia

The Social Security Administration published a policy interpretation ruling, SSR 12-2p, in July 2012 that works as a guideline for how the SSA evaluates each fibromyalgia case. This ruling is also used to determine a medically determinable impairment.

To be established as a disability by the SSA, your fibromyalgia case must meet the following requirements:

  • Medical evidence from your physician showing that the fibromyalgia ruling is unanimous.
  • History of widespread pain throughout all parts of the body.
  • Evidence of tests conducted that ruled out any other diagnosis.
  • Must meet 11 out of the 18 tender points during physical examination. See image below for the 18 possible tender points used by the SSA.

If You Have Fibromyalgia Can You Get Disability

Receiving a Fibromyalgia diagnosis does not necessarily qualify you for disability. However, the symptoms linked to the disorder are often disabling. For example, the most common symptom of Fibromyalgia is chronic widespread pain. The pain is often unpredictable and can last for several months at a time; It can impact your sleeping, your concentration, and even your memory.

Are you currently experiencing chronic widespread pain and the other problems associated with Fibromyalgia? If so, then your Fibromyalgia disability may prevent you from performing the duties of your job. If you cannot do your job because of Fibromyalgia, our long term disability lawyers can help you file a disability claim or appeal a claim that was denied. We can make a compelling argument that you meet your policys definition of disabled.

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Request For Doctor Clarification

You may feel you have a legitimate claim and have supplied adequate verification of your fibromyalgia diagnosis to be approved for the Disability Tax Credit. However, the Canada Revenue Agency has stated that diagnosis alone whether for fibromyalgia or any other condition is not sufficient to qualify for DTC benefits. As a result the doctor or qualified medical practitioner must provide clarifying details relative to your impairment and how it affects your ability to perform at least 1 of the basic activities necessary for daily living.

How Fibromyalgia Affects Your Physical Capacity For Work

Does Fibromyalgia Qualify you for Disability Benefits?

Many of the symptoms of fibromyalgia can affect your ability to perform physical work. In the first place, sensitivities to light, sound, temperature changes, and odors significantly limit the types of work environments you can work in.

The pain that is associated with fibromyalgia can limit your ability to stand or sit for long periods of time. It can also affect your ability to lift, carry, push, pull, and grasp. Those who experience joint pain as a result of fibromyalgia may also have difficulty bending, lifting, walking, and performing other common actions required in physical work. The numbness and tingling which often accompanies fibromyalgia can make fine motor movements difficult, making even light physical work problematic.

Perhaps most significantly, the chronic fatigue which usually comes with fibromyalgia can make it extremely difficult to stay focused any task for an extended period of time, especially if it is combined with some of the psychiatric/neurological effects. Several of the other symptoms can also make physical work impractical for fibromyalgia sufferers.

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How To Prove Fibromyalgia Disability

The SSA will want to see objective proof of your disability in the form of a physicians letter. This could be from a medical doctor or osteopath, although you may stand a better chance of being approved if you see a specialized rheumatologist.

In addition to a confirmed diagnosis of fibromyalgia, you will need to provide your medical history for the previous 12 months. This should include records of physical examinations, lab tests, scans, prescribed medications and an assessment of whether your symptoms have improved, worsened or remained the same.

You should also include details of any psychiatric assessments or other treatments you have received. Your physician will need to fill in a Physical Residual Functional Capacity Assessment to prove that you are unable to work due to your disability.

In addition to doctors records, the SSA may request information from non-medical sources and this may include previous employers, teachers, neighbors, relatives or friends.

Fibromyalgia And Social Security Disability Benefits

If fibromyalgia disability keeps you from being able to work, you may well be entitled to Social Security Disability benefits. However, winning benefits under the Social Security Administration disability program can be difficult.

The SSA Blue Book lists the approved medical listings for specific impairments. It does not list fibromyalgia.

Since there is no medical listing, the Social Security examiner will attempt to equate your disability with an existing medical listing. They will also consider and give value to other impairments that may be involved, such as:

The determining factor in qualifying for Social Security Disability is whether fibromyalgia affects your ability to work. We have helped many patients win fibromyalgia disability benefits, even though their initial claims were denied.

As Board Certified Social Security Disability attorneys, we can ensure your case will have the best possible chance of success. We work with your doctors to get the medical evidence needed to win your claim. We work with experts to show the impact fibromyalgia has on your ability to work and do daily activities.

We will pursue your disability claim at every step of the process. We will represent you at the Social Security Disability hearing before the administrative law judge and throughout the appeals level.

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Your Diagnosis Is Key

Central to proving a claim for long term disability benefits based on fibromyalgia is convincing the insurer you have the correct diagnosis. Insurance companies are leery of primary care physicians who diagnose fibromyalgia simply because they cant find any other explanation for your symptoms.

Your chances of success are best if you see a rheumatologist who will follow the established criteria in diagnosing your condition. For fibromyalgia, your insurance company will want trigger point proof from your doctor for a diagnosis and will deny your claim if you dont provide it. While fibromyalgia cannot be objectively diagnosed at the present time, there are objective medical tests that are consistent with it. These tests should be obtained.

Social Security Disability Benefits For Fibromyalgia

Can You Get Long

The Social Security Administration does not include fibromyalgia in its published Listing of Impairments. Even so, you may still qualify for Social Security Disability Insurance . Social Security will evaluate your medical conditions to see if they meet or equal one of the listings. Even beyond that, you may qualify for disability benefits based on vocational standards.

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Winning Social Security Disability Benefits For Fibromyalgia Requires Specific Medical And Vocational Evidence

SSA will want to know whether you have a medically determinable impairment, and your condition so limits your functional abilities that it keeps you from working or as SSA calls it, performing any substantial gainful activity.

What evidence does the SSA need to find that fibromyalgia is disabling?

  • Objective, diagnostic medical evidence. In cases of fibromyalgia disability, SSA wants to establish the presence of a medically determinable impairment of fibromyalgia. SSA will consider either of the following two sets of criteria for diagnosing FM:
  • 1990 American College of Rheumatology Criteria for the Classification of Fibromyalgia.Criteria include history of widespread pain throughout your body for at least three months, the 18 tender points test, and evidence that other disorders that could cause the symptoms or signs are excluded. or
  • 2010 American College of Rheumatology Preliminary Diagnostic Criteria.Criteria include history of widespread pain throughout your body for at least three months, repeated manifestations of six or more FM symptoms, signs, or co-occurring conditions, and evidence that other disorders that could cause the symptoms or signs are excluded.
  • Diagnosis from a specialist. Because the symptoms are often self-reported, youll need a thorough medical history and treatment from a specialist such as a rheumatologist, who can be a pivotal factor in your case.
  • But It Can Be Very Hard To Prove That Your Fibromyalgia Is Disabling

    The symptoms of FM are notoriously difficult to diagnose. Symptoms resemble those of other diseases, and proper diagnostic testing for fibromyalgia is not always done. Self-reported, invisible conditions are sometimes viewed with suspicion and doubt by insurance companies and federal disability programs. ;

    We know FM is very real. At Marc Whitehead & Associates, we represent individuals who cant work due to fibromyalgia, helping them apply for and win their rightful disability benefits. If your claim has recently been denied, our attorneys can help you appeal the denial and pursue the benefits you deserve.;

    In all cases, you need to know how each disability program or insurance company views and determines claims based on fibromyalgia. And although obstacles may abound, they simply mean you need a strategy that will craft the most competent claim for your situation.

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    Fibromyalgia And Medical Complications

    Because fibromyalgia causes long-term pain throughout the body including muscles, tendons, and joints the medical complications can be severe. Some of these include:

    • Chronic tenderness
    • Irritable Bowel Syndrome
    • Migraine headaches

    However, because fibromyalgia doesn’t have an official recognized cause and is hard to diagnose, it may be difficult to be approved for SSD benefits. Often, the SSA will look for other diagnosed conditions in addition to fibromyalgia, including rheumatoid arthritis or degenerative disc disease.

    Before applying for SSD benefits, you should visit a specialist regularly. The physician can establish a history of fibromyalgia symptoms and perform an accurate manual tender point examination a procedure that helps to document the severity of fibromyalgia in patients.

    At our law firm, we understand the difficult diagnosis process associated with fibromyalgia. The odds are stacked against you but we know that your pain is very real.

    If you suffer from severe fibromyalgia but your SSD claim was denied, contact Edgar Snyder & Associates right away. Remember, you only have 60 days to file an appeal.

    We win the majority of claims we appeal for our clients. We can help you get the money you need. If we don’t win your appeal, you won’t owe us a penny. It’s that simple.

    Workers Compensation Benefits For Fibromyalgia

    Fibromyalgia Disability Insurance Claim Help & Information

    Workers compensation pays short- and long-term benefits to people injured on the job.

    Each province has its own compensation program. To qualify, you must have suffered a workplace injury and worked for a covered employer. Thats right, not all employers are covered.

    Its difficult but possible to prove a workplace injury caused or worsened your fibromyalgia. While no one knows the exact cause of fibromyalgia, doctors generally agree that a traumatic event can trigger or exacerbate it.

    To succeed in this claim, you need a medical doctor to support your belief that the workplace injury triggered the fibromyalgia or made it permanently worse.

    Workers compensation payments overlap with EI, CPP, and short- and long-term disability. This can get complicated, so you should seek legal advice for any concerns about payments. Depending on your province, you may keep some of your CPP disability as well as the workers comp.

    If workers compensation denies your claim, then you follow the appeal procedures for your province. These programs also have two levels of appeal, the internal reconsideration and the outside tribunal. In most provinces, this tribunal is called the Workers Compensation Appeals Tribunal .

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    Fighting Fibromyalgia Disability Benefit Denials

    Fibromyalgia is a chronic disorder that affects about 5 million Americans.

    Symptoms of fibromyalgia include intense pain and aching in the muscles and soft tissues throughout the body including specific tender points. Patients may also suffer chronic fatigue, cognitive dysfunction, irritable bowel syndrome, and depression or anxiety.

    The exact cause of fibromyalgia is not known. It may involve different factors that, when working together, affect the way the brain processes pain. Research suggests triggers for fibromyalgia may include:

    • Genetics
    • Physical trauma
    • Certain illnesses or infections

    While fibromyalgia does not damage the joints or organs, the constant pain and fatigue has a devastating impact on daily life. Although the chronic pain associated with fibromyalgia is real, there is no lab test or X-ray to diagnose it. Doctors diagnose fibromyalgia based on a patients symptoms and physical exam.

    Getting approved for fibromyalgia disability benefits can be tough. But with the right attorney to help, you can get the benefits you deserve.

    Is Fibromyalgia A Disability In Canada

    Yes. All disability benefits providers in Canada recognize it as a condition that can qualify a person for benefits.

    However, a diagnosis on its own wont qualify you.

    Providers pay benefits to people who can prove their condition keeps them from working. When reviewing claims for fibromyalgia, providers focus on the seriousness of your symptoms. They will consider the medical treatment youve had and future treatment plans. They look at how your symptoms affect your work and how hard you tried to keep working.

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    Disability Tax Credit Benefits Amounts

    For fiscal year 2016 the Disability Tax Credit limit is $40,000. This is the maximum benefit you may receive. The actual Disability Tax Credit amount you ultimately receive will depend on your taxable income as well as other factors. This does not mean however, that $40,000 is a lifetime cap on total benefits you may receive via the Disability Tax Credit, since once approved for the DTC you may be able to claim retroactive benefits for up to 10 years as well.

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