Tips for Successful Disability Applications

Thursday, March 18, 2004

By: Glenn R. Kantor

Reprinted from FMOnline


It’s no secret that for years, insurance companies have made a regular practice of refusing to pay fibromyalgia sufferers their disability benefits. They might have denied your claim by stating there was no objective evidence causing your symptoms. They might have attempted to limit your benefits to 24 months by claiming that your inability to work was the result of a mental or nervous condition and not fibromyalgia. They might even have gone so far as to help you get Social Security Disability Benefits, then turn around and refuse to provide any additional benefits.

Successfully Applying for Long-Term Disability Benefits
If applying for long-term disability benefits becomes a necessity, you want to do everything you can to ensure that your claim is approved. It is up to you to provide evidence supporting your claim for benefits. Many people believe that a diagnosis of fibromyalgia will by itself guarantee the approval of a claim. Unfortunately, that is not the case. Typically, you need to demonstrate that as a result of the symptoms of your illness, you have restrictions and limitations that would prevent you from performing the material duties of your occupation with reasonable continuity.

Insurance companies reviewing disability claims, particularly group claims governed by ERISA, need to be persuaded that you meet the policy definition of disability.


There are two stages to the claim process:

1) Make sure you have documented the existence of your increasing limitations before you go out on disability;

2) When you make your claim, provide the insurance company with all of the evidence supporting your claim.
>Preparing to submit your claim
You cannot be a martyr, keeping your symptoms to yourself, until the day you decide you are no longer able to work. In your visits to your doctor, make sure he documents all of your symptoms, and tell him about your work difficulties. Don’t hide your condition from your employer, either. If you are terminated, and you first submit a claim for disability, asserting that your termination was due to your inability to perform your job duties, the lack of documentation in your personnel records will make proving your claim more difficult. While it is understandable that you don’t want to constantly complain to friends about your condition, letting close friends know what you are going through, and asking for assistance when you need it will help you when it is time to make your claim. Joining a support group in advance of leaving work would also be beneficial, as would conferring with your priest, minister, or rabbi about your symptoms and work difficulties.
>Submitting your claim
Now that you have determined it is time to submit a claim, the advanced preparation must be followed up by providing the insurance company with reasons to approve your claim. In addition to providing the company with all of your medical records (hopefully fully documented), get a letter from your doctor about your ongoing work difficulties, and have him explain your restrictions and limitations. You should submit a letter from your employer and/or co-workers, having them relay to the insurance company their observations as to your inability to perform your job duties. Letters from a social worker, friends and/or spiritual advisors speaking to your ongoing problems are also beneficial. Statements from spouses, parents, and children describing your condition from their perspective are also helpful.

In summary, long-term disability benefits are something you and your family may need for financial survival. Make sure you give the insurance company every possible reason to approve, rather than deny, your claim.

Glenn R. Kantor is the partner of Kantor & Kantor, which has recovered in excess of $100,000,000 on behalf of their clients settling cases against UnumProvident, Prudential, Metlife, Cigna, CAN, Liberty Mutual, The Guardian, Hartford, Standard, Aetna, Allstate, and many more. Kantor & Kantor works on a 100% contingency fee basis. For more information, call (877) 783-UNUM or go to http://www.deniedbyunum.com/.