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Patients with chronic pain often face LTD claim denials


Patients suffering from such conditions as fibromyalgia often face uphill battles with insurance companies who claim there is no “objective evidence” of a disability, Ottawa personal injury lawyer Najma Rashid .

“It’s very common,” says Rashid, partner with Howard Yegendorf & Associates. “And many of them also say that the extent of the disability does not correspond with the symptoms reported. It’s almost like they’re challenging the client’s credibility and questioning whether or not they have an illness that’s actually based on conventional medicine.”

Rashid specializes in long-term disability claims, and has worked with many clients with chronic pain illnesses who have been denied claims.

The skepticism among insurance companies likely dates back to a time when fibromyalgia — a chronic disorder characterized by widespread pain, fatigue, and tenderness — was not universally accepted as a condition in the medical community, Rashid says.

However, for the bulk of the past 16 years she has been practising law, fibromyalgia has been an accepted medical diagnosis.

“It’s not the type of thing that you can verify by a blood test or by an X-ray or a CT scan. So I think the insurance industries still look at it with some disbelief,” she says.

The claims are often denied on the basis of there being “no objective evidence” of a medical illness, Rashid says, despite the fact that every long-term disability policy she has read does not include that criteria.

The problem is, there doesn’t appear to be a way to objectively measure chronic pain conditions, she says.

“I’ve never had an insurance company actually tell me what is acceptable objective medical evidence,” she says.

Chronic pain is often diagnosed by a patient’s own reporting of symptoms.

“In terms of a physician managing a client for chronic pain, their management of the patient will often be based on what the client is reporting as opposed to an objective medical test,” she says.

In cases involving fibromyalgia or chronic pain, or even psychological conditions, that’s often the basis upon which their claims are denied, she says, leaving patients to consult a lawyer.

But she says there are many more people who “just quietly go away” after a claim denial and don’t seek legal advice.

“So the insurance companies do save money. That’s a reality.”