Chronic pain and fibromyalgia claims are among the hardest disability claims to get paid, and the reason has very little to do with how disabled the person actually is. It is that the condition does not show up on an X-ray.
Why insurers dispute these claims
Insurers rely heavily on objective findings. Chronic pain conditions, by their nature, do not produce them. There is no blood test and no scan that proves fibromyalgia, which means the claim rests on the clinical picture, on function, and on consistency over time.
- “No objective evidence of disability.” This is the standard line, and it confuses the absence of a test with the absence of a condition.
- A file review by a consultant who never examined you. Pain is not assessable from paper.
- Mental health treatment used against you. Many people with chronic pain are also depressed, which is unsurprising, and that gets recast as the real problem.
- Activity used as proof of capacity. Being able to do something once, on a good day, is not being able to do it reliably for a working week.
What actually helps
- A functional capacity evaluation, which measures what you can do and for how long rather than what you have.
- A consistent treatment record with a family doctor who knows you, ideally over years.
- A pain and activity diary kept as you go. Good days and bad days, written down at the time, are far more persuasive than a recollection.
- Evidence from the people around you about what changed. Spouses, employers and co-workers see the gap between what you used to do and what you manage now.
- An occupational therapy assessment of your home and work, which turns a symptom into a measurable limitation.
A word about being believed
People with chronic pain often tell me the hardest part is not the condition. It is being treated as though they are exaggerating. That is a reason to document carefully, not a reason to give up. The policy asks whether you can work. It does not ask whether your condition is visible on a scan.
Read more
- Long term disability: the main page
- Your claim was denied: what to do first
- The change to the any occupation test
Speak to a lawyer about a chronic pain or fibromyalgia claim
Initial consultations are free. Our fee schedule is published in full, by stage of the case, on our Fair Fees page. Call 905-409-2438, send a text, message us on WhatsApp, or use the contact form.
Steven Polak is licensed as a lawyer in Ontario and practises with Lerners LLP at 123 Athol Street, Whitby.