Fibromyalgia Disability Canada: Benefits, Claim Denial & More

I wrote The Ultimate Guide to Fibromyalgia Disability Benefits for people who need to win or maintain disability benefits for fibromyalgia. This guide is based on my 25 years of experience as a former occupational therapist and now disability/fibromyalgia lawyer. This article is meant to answer questions like: is fibromyalgia a disability in Canada? What disability benefits can I get for fibromyalgia? And more!

Because you are reading this article, I know you are on the right path. Educating yourself is the most important thing you can do to improve your chances of success with any disability claim.

If you have questions about this guide or any disability claim issue, call our support team toll-free at (888) 732-0470.

Keep on learning, and I wish you all the best with your journey.

— David Brannen, disability lawyer & founder of Resolute Legal

What is fibromyalgia?

Fibromyalgia is a medical condition that causes widespread pain throughout the body. People who suffer from the condition are typically more sensitive to pain. This is referred to as abnormal pain perception processing.

The condition is also associated with other symptoms, such as sleep difficulties, fatigue, memory and concentration issues, mood swings, gastrointestinal problems, and more. The cause of fibromyalgia is unknown. However, in some cases, it can be managed with medication and self-management strategies.

It is estimated that fibromyalgia affects 900,000 Canadians, approximately 3% of the national population. Fibromyalgia is also a leading cause of disability in Canada. A 2014 Statistics Canada study that surveyed people who were permanently unable to work due to a chronic health issue found that fibromyalgia was the second most common condition behind COP. In other words, fibromyalgia accounted for 22.8% of people who were unable to work due to a medical condition.

Fibromyalgia symptoms

Fibromyalgia looks different for everyone. However, widespread pain throughout the body is the hallmark symptom associated with the condition. This widespread pain is most often experienced in the arms, legs, head, chest, abdomen, and back and is typically described as “a constant dull ache,” according to the Fibromyalgia Association of Canada.

Other common symptoms of fibromyalgia include the following:

• Stiffness
• Difficulty sleeping 
• Fatigue 
• headaches and migraines 
• Depression and anxiety
• Numbness or tingling

On top of that, fibromyalgia often co-exists with other chronic conditions such as:

• Irritable bowel syndrome
• Chronic fatigue syndrome
• Migraine and other types of headaches
• Interstitial cystitis or painful bladder syndrome
• Temporomandibular joint disorders
• Anxiety
• Depression
• Postural tachycardia syndrome

No symptom is necessarily rare with fibromyalgia, as people tend to experience a wide array of symptoms. However, the following are some of the less common symptoms.

Rare fibromyalgia symptoms:

• excess sweating
• sensitivity to noise, light, or temperature
• jaw pain
• chest pain
• bladder pain
• an urgent need to urinate

Many people want to know what are the worst symptoms associated with fibromyalgia. Similar to what we discussed above, symptoms and their severity are likely different for everyone. However, one study suggests that fibromyalgia symptoms tend to be worse in females, citing that women had higher tender points during diagnosis than men. Furthermore, other research suggests women have different symptoms than men. 

The following are common fibromyalgia symptoms in females:

• fatigue in the morning
• pain all over the body
• symptoms related to irritable bowel syndrome (IBS)
• more severe symptoms during menstruation and pregnancy 

Need a fibromyalgia lawyer?

As the Founder and Managing Lawyer of Resolute Legal, I constantly get asked what makes us unique. While there are many things that set our firm apart from others, such as our fair guarantee, education-first approach, and more, one of the key things that make us unique is that I was an occupational therapist before becoming a full-time disability lawyer. I worked throughout Canada and the United States for several years before returning to law school. My experience as an occupational therapist is a large reason why I started Resolute Legal. I wanted to help people with chronic conditions such as fibromyalgia. 

So, if you’d like to work with a disability lawyer who understands your condition and the challenges you have faced along the way, call our disability support team today at (888) 732-0470 to get started on winning back the benefits you paid for! You can also book a free case evaluation. Resolute Legal’s team of experienced disability lawyers is here for you!

Fibromyalgia treatment Canada

While there is no cure for fibromyalgia, there are several treatment options. For starters, many self-management techniques have proved effective in fibromyalgia sufferers, including but not limited to

• learning about chronic pain and how it affects your body;
• staying active every day, whether that be through walking or stretching;
• Utilizing relaxation techniques; 
• Prioritizing sleep;
• Taking it easy during daily activities to reduce the risk of flare-ups;
• Paying close attention to your body can help you discover the most effective treatments and prevent flare-ups
• Talking to family and friends 
• Seeing your doctor regularly and communicating how you are feeling as well as what treatments are helping/ hindering your progress

Along with that, both active and passive physiotherapy are also used to treat people with fibromyalgia. Active physiotherapy refers to treatments that require a patient’s active participation, such as stretching, breathwork, and more. On the other hand, passive physiotherapy doesn’t require the patient’s active participation. Instead, it utilizes procedures that are done to the patient, such as massage, therapeutic ultrasound, TENS machine and more. 

Therapy and counselling are other tools that fibromyalgia sufferers can utilize. As you probably already know, pain doesn’t just affect the body; it also deeply impacts the mind. Many people with fibromyalgia experience depression, anxiety, and feelings of hopelessness due to their constant pain. So, to help deal with the psychological component of the condition, therapies such as Cognitive Behavioural Therapy, Mindfulness-Based Stress Reduction, and Acceptance and Commitment Therapy can be beneficial. 

Alternative medicines and therapies can also be effective for some when used in combination with other therapies. For instance, some research suggests that acupuncture and Chinese herbal medicine have shown positive effects on people suffering from fibromyalgia. However, other research contradicts this.  

Medication for fibromyalgia in Canada

Although non-pharmacological treatments can work well for certain individuals, the majority tend to achieve the best treatment outcomes by combining self-care management strategies with medication. Various medications are used to treat the condition, and new research emerges every day. However, the most widely used and most effective medications used to treat fibromyalgia in Canada include the following:

• Pain relievers: Over-the-counter pain relievers such as Ibuprofen, Advil, Aleeve and more. Opioids are typically not recommended as the side-effects can cause more pain down the road
• Antidepressants Duloxetine (Cymbalta) and milnacipran (Savella) are often diagnosed in people with fibromyalgia. These medications can help with the pain and fatigue associated with the condition
• Anti-seizure drugs: Medications designed to treat epilepsy have been found to be effective in treating certain forms of pain. Gabapentin, marketed as Neurontin, may offer relief from fibromyalgia symptoms, and pregabalin, known as Lyrica, secured the distinction of being the initial drug endorsed by the Food and Drug Administration for fibromyalgia treatment.

Keep in mind, however, that Health Canada has only approved two prescription medications for fibromyalgia: Duloxetine (Cymbalta) and Pregabalin (Lyrica). To learn more, check out fibromyalgia medication Canada.

Is fibromyalgia a disability in Canada?

Is fibromyalgia considered a disability in Canada? Yes. All disability benefits providers in Canada recognize fibromyalgia as a condition that can qualify a person for benefits. However, a diagnosis on its own will not qualify you. Providers pay benefits to people who can prove their condition prevents them from working.

When reviewing claims for fibromyalgia, providers focus on the seriousness of your symptoms. They will consider the medical treatment you have had and future treatment plans. They look at how your symptoms affect your work and how hard you try to keep working.

For more information on what conditions qualify for benefits, check out our list of disabilities in Canada that qualify for disability benefits.

Fibromyalgia disability 2023 Canada employment rights

Many people worry about losing their jobs because of fibromyalgia. As a general rule, employers can fire anyone — as long as they give proper notice and do not do it for a discriminatory reason.

However, most employers will not fire employees who take sick leave. Under Canada’s human rights laws, employers have a duty to help employees with medical conditions that affect their work. Allowing sick leave is a reasonable accommodation that employers should give.

So, what are the Fibromyalgia Canada guidelines for working? You need to provide a doctor’s note if you want to go on sick leave. It should confirm that you are unable to work and need the leave. You will need to bring these notes often — every three to six months — to confirm that you still can’t work.

If your application gets denied, you can stay on sick leave while you appeal. Most employers will not give you a hard time — as long as you have a doctor’s note.

If your employer attempts to fire you while you are on sick leave, you may have legal rights to severance pay. You might even be able to get the termination overturned if you are fired because of your condition. However, these situations are complicated. You should always seek out legal advice.

Fibromyalgia disability Canada 2023

If fibromyalgia prevents you from working, you have a few options. You might be eligible for disability benefits from the government, your employer, or your insurer.

This list covers the possible fibromyalgia disability benefits in Canada:

• Disability tax credit (DTC)
• Long-term disability insurance
• CPP disability
• Short-term disability insurance
• Employment Insurance (EI) sickness benefits
• Workers Compensation
• Veterans Affairs Canada
• Provincial disability benefits

Let’s go over each. So you know whether you qualify or not. And then, we will explain how to apply and appeal a denial.

Fibromyalgia disability tax credit

Does fibromyalgia qualify for disability tax credit in Canada? Yes, in Canada, people with Fibromyalgia can qualify for the disability tax credit.To qualify, you must have a severe and prolonged impairment. But, this program has a higher standard than others.

Qualifying for this credit can get some of your previous taxes refunded. It depends on the timeline of your condition. You apply by filling out a T2201 form and sending it to Revenue Canada.

If Revenue Canada denies your claim, you can request an internal appeal. If that appeal fails, then you must go to the Tax Court of Canada to appeal again.

Fibromyalgia long term disability

As you may guess, long term disability (LTD) benefits pay for a longer period of time. If you win a claim for LTD, the payments can last for many years. A policy will specify that the benefits last a number of years — 2, 5, or 10, for example. Or, they last until you reach a certain age — usually 65.

LTD payments often cover 50-67% of your monthly salary. You receive payments once a month rather than every two weeks. Like STD benefits, most LTD benefits come from group plans or private policies.

If your company offers a group medical plan, you should check to see if it includes LTD benefits. If you’re in a union, your medical plan will likely have coverage for LTD.

You can also get LTD through private insurance policies if you are self-employed or underinsured. With private policies, the payment is usually a fixed amount — but sometimes it’s a percentage of your earnings.

You apply for LTD by filling out forms and sending them to the insurer. Once again, you’ll probably have three forms. There should be one for you, your employer, and your doctor. And again, it’s your job to submit them. You won’t get a decision until the insurer receives all the forms.

You can appeal a denial. Your LTD plan may allow you to do two to three internal appeals. After, you would need to do an LTD appeal hearing with an outside judge (external appeal).

Fibromyalgia Canada pension plan disability (CPP)

Can I get CPP disability benefits for fibromyalgia? Yes, people with fibromyalgia can win CPP disability benefits. However, you would still have to meet the program’s definition of disability. If you qualify, then you can get paid until age 65. The payment ranges for 2022 are $524.64 to $1,457.45 per month. The amount you receive is based on how much you paid into the program. The more you contribute, the more you’ll get back. Similar to EI, if you had a job with a paycheque, you paid into CPP. 

To qualify for CPP disability, you must have the right amount of credits. You can get credits by credit splitting with a former spouse or paying into another country’s pension plan. Or, you can qualify for credits if you leave work to raise a child.

You can get LTD and CPP at the same time. However, the LTD insurer usually has the right to offset your payments by the same amount. For example, if you get $900 from CPP disability, your insurer can reduce its payment by $900 for the same month. 

Even with enough credits, you still need to prove that your disability is “severe and prolonged.” A severe disability prevents you from regularly working a paying job. A prolonged disability has little hope for improvement.

You apply for CPP disability by filling out the CPP disability application form(s). Your doctor or nurse practitioner will have to fill out the medical report. Then, you send your application to a designated Service Canada office for your province.

If Service Canada denies your claim, you can appeal on two levels. The first is a reconsideration appeal. You must request this appeal within 90 days of denial. If denied again, then you appeal to the Social Security Tribunal. The deadline is 90 days as well. At the tribunal, a judge or a three-person panel will decide your claim. You can attend the hearing to give evidence and answer questions.

Once you get to the appeal stage, we highly recommend speaking to a CPP disability lawyer. Fibromyalgia claims are extremely complicated, so for the majority of people, working with an experienced lawyer will give them the best chance at success. Give us a call today at (888) 732-0470 to see if Resolute Legal is the right fit for you. 

Fibromyalgia short term disability

Short term disability (STD) benefits are another temporary disability payment. They pay 50-67% of your regular salary. You can usually get them for 15 to 17 weeks, but sometimes longer. You typically receive payments every two weeks. Employers offer these benefits either through the company or a group insurance policy. In both cases, employers hire an outside agency to run the program on their behalf.

You only qualify if you have a plan through your job. Not all employers offer this to their employees. If your employer does not, you might be able to get EI sickness. If you qualify for short term disability Canada, you will not qualify for EI. People who can get STD payments have to apply for those instead of EI.

You can start the application process for STD by asking for the required forms from your employer or the insurance company. The application includes three forms: one for you, one for your doctor, and one for your employer. It’s up to you to get all the forms back to the insurer.

If your application gets denied, you can ask for a review. This is called an internal appeal. During the appeal, your claim gets reviewed by someone else in the company. You usually have three or four of these appeals. After that, you may have to appeal to an outside judge or file with the courts. Your options will depend on your situation. Our short term disability lawyers at Resolute Legal can help at this stage. Call us today at (888) 732-0470 to schedule a free case evaluation. To learn more about why this happens, check out our article: reasons short-term disability can be denied.

Fibromyalgia Employment Insurance (EI) sickness benefits

People with fibromyalgia may be eligible for EI sickness. It is a temporary disability benefit paid by the federal government’s employment insurance (EI) program. EI covers 55% of your salary for 15 weeks.

To qualify, you must have paid into the EI program recently. You pay through deductions from your paycheque. These are automatic. So, if you got an official paycheque, you paid into the EI program.

You apply for EI benefits online through Service Canada. You can apply from home or at any Service Canada office. Your doctor needs to fill out a form to confirm that you cannot work for the 15 weeks that EI covers. And finally, your employer will need to issue a Record of Employment (ROE) to confirm your sick leave.

Please note: If you qualify for short-term disability, you can’t claim EI benefits simultaneously.

Fibromyalgia Canada Disability Benefit (CDB)

The new Canada Disability Benefit has yet to be released, so as of right now (October 3, 2023), we aren’t sure who will qualify. There also isn’t any information on the application or appeals process. However, if you’d like to learn more about the benefit and what we can expect when it is released, check out our article: New Canada Disability Benefit. 

Fibromyalgia Worker’s Compensation

Workers Compensation Canada pays short- and long-term benefits to people injured on the job. Each province has its own compensation program. To qualify, you must suffer a workplace injury or illness and work for a covered employer. That’s right, not all employers are covered.

It’s 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 or illness 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 (or all) of your CPP disability as well as the worker’s compensation.

If workers’ compensation denies your claim, you need to follow your province’s appeal procedures. 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 (WCAT).

VA disability for fibromyalgia

If you’re a member or former member of the Canadian Forces, you may qualify for short- or long-term disability benefits from Veterans Affairs Canada (VAC). 

To make a fibromyalgia VA claim, you must prove that a “service-related injury” caused or worsened your fibromyalgia. You’ll also need a doctor to confirm it.

You can apply for VAC disability either online or with a paper form. The VAC will review your service medical records and request more information if necessary.

The VAC follows a familiar pattern for appealing denials: internal reconsideration, then the Veteran’s Review and Appeal Tribunal.

Provincial government assistance for fibromyalgia Canada

Each province in Canada pays income support benefits to people unable to work because of a disability. If you qualify, you can receive fixed payments for life.

You can qualify for provincial benefits even if you have never worked. However, they only apply if your total family income falls below a certain amount. That amount differs from province to province, however. Family income does not affect the approval process for other types of disability benefits either.

You apply for provincial disability benefits by applying through your provincial agency or program. As usual, your doctor will need to provide a report or certificate that confirms you can’t work because of your condition.

You can appeal internally within the agency or program if you get denied. In some provinces, you can also appeal to an outside tribunal for a final decision. Check with your province for the proper procedures.

The following is an overview of each province’s provincial disability benefit program (excluding Quebec and the territories):

Ontario: Ontario Disability Support Program (ODSP)

ODSP, which stands for the Ontario Disability Support Program, serves as a financial aid and benefits initiative designed to assist residents of Ontario who are 18 years or older, have a disability, and require support for covering their living costs. The administration of this program falls under the jurisdiction of the Ontario Ministry of Community and Social Services.

Those who are approved for ODSP will receive a monthly payment of up to $1,308 in 2023. The amount you receive depends on your living situation. Additionally, if you rent or own your home, your payment will include two parts: basic needs and shelter allowance. 

To qualify for the program, you must be 18 years or older, be an Ontario resident, have assets no greater than the limits set out by the program, be in financial need, and meet the program’s definition of disability or be a member of the prescribed class.

So, can you get ODSP for fibromyalgia? Yes, people with fibromyalgia can qualify for the program. ODSP doesn’t approve applicants based on their medical condition. Instead, they approve claims for people who qualify for the program. 

Alberta: Assured Income for the Severely Handicapped (AISH)

The administration of Assured Income for the Severely Handicapped (AISH) falls under the jurisdiction of the Alberta government. To be eligible for this program, you need to meet several criteria. First, you must be at least 18 years old but not old enough to qualify for Old Age Security pension benefits. Additionally, you must reside in Alberta and hold Canadian citizenship or permanent residency status. Qualification hinges on your inability to work due to a permanent and disabling medical condition. Moreover, there are specific financial eligibility requirements, meaning your income and assets must not exceed a certain threshold. Lastly, you may also be asked to apply for other assistance programs such as CPP-D, EI, or WCB.

Nova Scotia: Disability support program (DSP)

The Disability Support Program, also known as DSP, is another option for individuals seeking long-term disability benefits. DSP is a provincial initiative designed to offer assistance to individuals of all age groups, including children, youth, and adults, who are living with disabilities. This assistance is provided through both residential and at-home support programs.

To qualify for DSP, individuals must have one of the following disabilities:

1. Intellectual disability
2. Persistent mental illness
3. Physical disability

Eligible participants receive monthly financial support tailored to their specific needs, covering expenses such as housing and personal costs. The amount is determined based on the program’s Standard Household rate and the composition of the household.

New Brunswick: Disability Support Program (DSP)

The province of New Brunswick administers a disability support program aimed at providing financial assistance for specific disability-related expenses within the region. While Canada boasts a comprehensive public health system, there are certain benefits not covered by it. The disability support program steps in to assist with costs associated with home support workers, respite care, supervision in residential facilities, transportation aid, and assistive devices.

To be eligible for the DSP in New Brunswick, you need to meet specific criteria. You must be a resident of New Brunswick, aged between 19 and 64, and have a long-term disability. Additionally, the program requires that your disability would benefit from community involvement, specialized benefits, and other forms of support to enhance your quality of life.

British Columbia: Disability Assistance (PWD)

In British Columbia, Disability Assistance represents a long-term disability benefit program administered by the provincial government. This program extends both financial aid and healthcare support to Persons with Disabilities (PWD). To qualify, you need to meet specific criteria:

1. You must be at least 18 years old.
2. You must have a severe physical or mental impairment expected to persist for more than two years.
3. Your capacity to carry out daily living activities should be significantly limited.

Furthermore, you must require assistance with daily living tasks, which can come from a person, assistive device, or animal. Unlike some other benefits, financial eligibility criteria are also taken into consideration, meaning your income and assets must fall within certain thresholds.

If you are already receiving CPP disability benefits, the application process becomes more straightforward.

Manitoba: Employment and Income Assistance Program (EIA)

The Employment and Income Assistance Program (EIA) offers financial assistance to residents of Manitoba who lack alternative means to sustain themselves or their families. EIA extends support to individuals capable of employment by providing resources to facilitate their return to the workforce. Additionally, EIA recipients receive assistance with their housing and utility expenses through Rent Assist if necessary.

To qualify for the EIA as a person with a disability, you must meet the following requirements:

• Live in Manitoba
• Be 18 years or older
• Have a disability that is likely to last more than 90 days, and this disability keeps you from earning enough money to pay for your or your family’s basic needs.
• You are in financial need

Saskatchewan: Saskatchewan Assured Income for Disability (SAID)

The Saskatchewan Assured Income for Disability (SAID) program serves as an income support initiative tailored for individuals facing substantial and persistent disabilities.

SAID ensures these individuals have access to sustained financial assistance, enhances their options for services, and facilitates their active involvement in their community.

The program’s primary focus is on addressing the everyday living and disability-related requirements of participants, offering supplemental benefits tailored to each individual’s unique needs. SAID benefits are individually determined and encompass various aspects, such as living expenses, disability-related support, and shelter costs, with no fixed maximum monthly benefit amount.

To qualify for the program, you must meet the following requirements:

• are a Canadian Citizen, permanent resident, or have refugee status or are in Canada under the Canada-Ukraine authorization for emergency travel;
• are living in Saskatchewan;
• are 18 years or older;
• lack financial resources to provide for your basic needs and
• have a significant and enduring disability that is of a permanent nature, substantially impacts daily living activities, and results in a person requiring assistance in the form of an assistive device, assistance of another person, a service animal or other accommodation.

PEI: AccessAbility Supports

Prince Edward Island’s Disability Support Program, now called AccessAbility Supports, is designed to support Islanders living with disabilities.

To be eligible for the program, you must meet the following criteria:

• Be under the age of 65
• Be a resident of PEI
• Have a disability that is diagnosed by a verified professional
• Have unmet disability needs (i.e., respite, one-to-one worker, etc.)

Once you’re approved, the program will come up with a plan that will best support your needs. This plan can include a variety of supports, including but not limited to personal daily living support, housing support, community and caregiver support, financial aid, and more. 

How can I get disability for fibromyalgia?

Because fibromyalgia is an invisible illness, doctors can’t verify the seriousness of your symptoms. You will likely have trouble getting approved for benefits.

No one but you can understand how serious your condition is. So, insurance companies may view your claim with skepticism. After all, you could exaggerate or lie to appear more disabled than you are.

Many people with fibromyalgia can manage their symptoms and continue working. So, you need to prove your case is different. Let’s go over how to do that.

Appropriate medical diagnosis

While an official diagnosis alone is not enough, you still need to have that diagnosis.

You must have a detailed clinical history. It should show the steps taken to rule out other possible conditions. Unfortunately, some doctors will diagnose fibromyalgia without following the proper steps. When this happens, the insurance company will dispute the diagnosis or question the treatment.

Fibromyalgia often occurs with other medical conditions, such as irritable bowel syndrome, depression, or chronic fatigue syndrome. Having these other conditions diagnosed can help because it shifts the focus beyond your fibromyalgia.

Objective medical testing

The FM/a ® blood test can confirm a diagnosis of fibromyalgia. While the FM/a test Canada is not required, it can save the time you spend ruling out other possibilities. However, remember that it can’t show the seriousness of your condition. It only confirms that you have it.

Appropriate treatment

When considering your claim, the disability benefits providers will look to see if you received appropriate treatment. Not getting appropriate treatment is one of the most common reasons for a denial.

This requirement covers all other conditions as well. For example, if you also have a mood disorder or depression, along with fibromyalgia, you must get treatment for each condition. This can include medications, consultations with psychiatrists, or psychological treatments. Multidisciplinary pain clinics now count as appropriate treatment centres as well.

Not getting proper treatment can happen for two reasons: either your doctor didn’t follow accepted standards for treatment, or you refused treatment. Even if you and your doctor believe that alternative methods may work better, you must try the standard treatments to qualify for disability benefits. Otherwise, you leave the door open for someone to say that you could work if you had the right treatment.

Medications and side effects

Serious medications make serious medical conditions more believable. So, you must try all the recommended medications even if you fear the side effects.

If you have a bad reaction to your medications, your medical records must report that in detail. And, if your doctor recommends against a medication, you must have it documented that the side effects are worse than the condition. Again, you run the risk of getting denied if you stray from standard treatments without a good reason.

Evidence of work-related limitations

With an invisible illness like fibromyalgia, disability benefits providers place great emphasis on how hard you try to stay at work.

“You didn’t try” is the most common reason for a denial. It is a difficult one to beat.

You need to go beyond saying you can’t do your job. You need to show that you asked for help from your employer to stay at work. This could include asking for fewer hours, easier duties, or changing jobs within the company. If your job was medium or heavy work, you should try an easier job with light or sedentary duties before going off on disability.

You need evidence to show how hard you tried to stay at work.

This evidence can include the following:

• Medical records discussing your work attempts
• Employment records showing the places you tried to work and all accommodations made
• A written statement from you that details your work efforts
• Signed written statements from your employer or co-workers describing how they observed your struggle to work

If you have strong evidence showing you tried to stay in the workforce, you have a good chance of winning benefits. On the other hand, if you have little evidence of your efforts to stay at work or evidence that you made no effort, then you have little chance of gaining approval. 

Credibility

Medical and employment documents will give you some of the best support for your claim, but the decision-makers need to believe you, too. In legal settings, credibility refers to a person’s trustworthiness or believability.

A decision-maker who finds you trustworthy may rule in your favour — even if you have weak evidence for your claim. And a decision-maker who doesn’t trust you won’t give you the benefit of the doubt in uncertain areas, even with good evidence. Credibility gives you an invisible edge that many people overlook.

The following is an overview of things that can boost and worsen your credibility:

Credibility killers

• Contradicting medical records or earlier statements
• Making excuses or blaming others for problems
• Criticizing other parties in the claim (even if they deserve it)
• Filing complaints against professionals you see as negative, biased, or unprofessional
• Using aggressive, sarcastic, or confrontational tones in your claim or testimony
• Blocking or stalling reasonable requests for information
• Fighting with doctors over your diagnosis instead of focusing on the disability
• Acting like a medical expert

Credibility boosters

• Making sure what you say matches the medical records
• Taking responsibility for errors or problems with your claim (not blaming others)
• Being cooperative and respectful of everyone in the claim
• Accepting expert advice and opinions
• Making good faith efforts to try all reasonable advice, even if you disagree with it
• Obvious efforts to keep working

Reasons for insurance claim denial for fibromyalgia Canada

The following are the most common reasons an insurance company will deny disability benefits for fibromyalgia.

Insufficient objective evidence of disability

Although insurers often cite “insufficient objective evidence of disability” to deny claims, this reason doesn’t work with fibromyalgia. Modern medicine has yet to find objective evidence of disability for fibromyalgia.

If you receive this as a reason, you should address it in your appeal letter. Fortunately, objective evidence is not a requirement under plans and programs.

Your letter should then focus on how your doctor followed best practices for diagnosis and treatment. Mention how you stuck to the recommended treatment. And emphasize all the things you’ve done to keep working. These aspects can make up for the lack of objective evidence.

Incorrect treatment

If you got the right treatment, then you would not be disabled, right? This reason for denial shifts the blame to you or your doctor. It supposes either your doctor offered the wrong treatment or you refused the right treatment. This is the most common reason for the denial of disability benefits for fibromyalgia.

The insurer may argue that your symptoms come from misdiagnosed and untreated depression rather than fibromyalgia. By that logic, of course, your treatment would not work for you.

Some insurers may say that you have not received treatment for multidisciplinary pain. Therefore, they argue that your disability is not permanent. Make sure you have ways to shut down this argument.

Insufficient work effort

Another common reason for denial is you can’t do your job, but maybe you could do an easier one. This reason often arises when your job requires medium to heavy duties, and you didn’t try a job with light or sedentary duties.

The best way to fight this is to try easier jobs. Until you do, the disability benefits providers will always doubt you. You might also show that while your job had medium duties on paper, you got accommodations that made your work qualify as light duty.

Disability lawyers specializing in fibromyalgia insurance claim denial

Winning fibromyalgia disability benefits is difficult but not impossible. You’ll face challenges because you can’t prove beyond the shadow of a doubt how serious your condition is. To maximize your chances of success, make sure your doctor follows all best practices for a fibromyalgia diagnosis and treatment. Cooperate with all treatment recommendations and do your best to keep working. 

With that said, even if you follow all best practices, there is still a large chance your claim will get denied. If that is the case, we are here for you. Prior to becoming a disability lawyer, I was an occupational therapist. I understand how insurance companies view conditions like fibromyalgia, and I know how to convince them that you’re claim is legitimate. 

Give our support team a call today at (888) 732-0470 to get started on winning back the benefits YOU paid for! And if you don’t have time to talk right now, you can book a free case evaluation. 

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