Ms. R. was an executive of a large corporation for over 12 years. She was on track to take over the eastern division of her company. Ms. R. began noticing that during the day, she felt fatigued; however, it was not a normal feeling of being tired. It felt more like a weight draped over her body and mind. She assumed that she was just run down and needed a vacation. On the weekends, she stayed in and rested. However, this did not help. She was struggling to stay awake at work and focus during telephone calls and meetings. Ms. R. also began suffering from severe joint pain and body aches. At first, she assumed that this was just a product of her exhaustion - her body and mind were overworked. Before Ms. R. took over the eastern division, she decided to go on a two week vacation. She hoped that the time off would rejuvenate her. Unfortunately, the pain and fatigue did not go away with rest. In fact, she never felt worse. Despite this, Ms. R. returned from her vacation and started in her new position. However, as time went on, Ms. R.'s severe pain and fatigue only increased. She was struggling to get through each day. She was taking naps in her office, leaving work early, and forgetting important meetings. Ms. R.'s co-workers began to notice a change in her work product. At this point, Ms. R. knew something was wrong and began the long and frustrating process of trying to find a medical reason for her concerning symptoms.
Another district court has found that Liberty Life failed to give a claimant a full and fair review of her claim for long-term disability benefits. Ruth Ann Hare suffered from fibromyalgia, forcing her to leave her physically demanding job and request disability benefits. While she received Short Term Disability benefits for some time, Liberty Life denied her request for Long-Term Disability benefits at the application and administrative appeals stages based on the assertion that Ms. Hare failed to provide objective evidence of her condition. Accordingly, Ms. Hare sued Liberty Life seeking payment of the denied benefits.
As those who suffer from medical conditions such as fibromyalgia and chronic fatigue syndrome know, these illnesses can incapacitate an individual physically and mentally. No current treatment has proven totally effective against these infirmities and in many cases the illness becomes worse over time. Many clients come to us at DI Law Group complaining that despite having provided their insurance company with medical evidence proving that they are no longer able to work, the insurance carrier has either failed to make a decision and is "surveillance" the claim or has unfairly denied benefits claiming there is insufficient evidence upon which to grant benefits. One such client, "Ms. Doe", a professional who truly enjoyed her occupation and worked as long as physically possible, contacted us after her claim for benefits had been unfairly denied by Prudential. Included with her application were medical records with examination findings confirming her medical diagnoses and detailing her physical limitations and decline. During its investigation of the claim, Prudential put her under surveillance, sent her ongoing requests for information, had one of their own "independent" physicians review her medical records and the surveillance tape, and misrepresented her occupation and limitations to the vocational specialist assigned to review her claim. Not surprisingly, Prudential's physician determined that there was no medical evidence to substantiate her reported complaints of pain, fatigue, and limitations and thus found that she could return to her job on a full time basis.
Those suffering from a severe case of Fibromyalgia know that it can cause widespread, debilitating pain, cognitive problems such as memory loss or difficulty with concentration, and overwhelming fatigue. Unfortunately, the cause of fibromyalgia remains unclear and there are no definitive diagnostic tests (such as X-rays or blood tests) that can be used to confirm the diagnosis or its severity. Additionally, because there is little in the way of "objective" evidence to confirm a diagnosis of fibromyalgia, it is often evaluated as a psychiatric condition by many insurance companies (all in the insured's head) and not considered a truly disabling illness. Moreover, insurance companies realize that some people experience only mild symptoms and can work despite their symptoms. However, what many insurance claims examiners fail to recognize is that for some people, the pain is quite severe and often prevents them from doing simple things like going for a walk, household chores, and going to work. If you have fibromyalgia and are unable to work, navigating the disability process can be difficult and frustrating.