Considering the Economic Factors Associated with Fibromyalgia

Those who suffer with fibromyalgia often find that this long-term medical condition creates an economic burden.  Besides the medical expenses, there may arrive a time when working full time may prove to be difficult, or you get to the point where you can’t work at all. This is often the case after a period of a few years.[1] The question then arises, “What to do?” The right answer depends on each individual case

Health Care Expenses

If you have fibromyalgia, it can be an expensive health problem. In fact, research indicates that the financial burden for those with this syndrome is substantial.[2] It’s impossible to calculate the true cost because so many people suffer years before they are even diagnosed. The medical expenses are normally for:

  • Doctor visits
  • Medications
  • Emergency room visits
  • Alternative treatments
  • Physical therapy
  • Behavioral therapy or related forms of social-psychological therapy

If you are fortunate enough to have good health insurance, the policy will pay a portion of the expenses. Yet, even then it’s possible to accumulate significant expenses not covered by insurance in the form of co-pays or non-covered charges.  As a result of the higher costs, it is important to consider possible options for managing or reducing the short and long term financial burden as soon as you are diagnosed with fibromyalgia.[3] You may be helped in this effort by your employer’s willingness to be flexible about work schedules.

The Part Time Option

If work becomes increasingly harder to perform, it may be necessary to reduce job duties or change position or jobs. You can talk to your employer and ask if you can work part time. This way you will be able to accomplish two goals – continue working for the income while maintaining the ability to enjoy life outside the office.[4] It provides you with some income, while allowing you more time to deal with the symptoms of fibromyalgia.

Yet, not all employers are able or willing to let people work part time just because they have fibromyalgia. In some cases, it’s an all-or-none proposition. A lot depends on company policies and the type of job involved. Some positions simply require full-time effort.

There may also come a point where you are unable to even work part-time. Painful flare-ups may become more frequent and increase in intensity or muscle stiffness prevents free movement. In this case, you may have to consider other options.

The Family and Medical Leave Act (FMLA)

One possible alternative is to consider invoking the Family and Medical Leave Act (FMLA). This legislation allows you to take off time from work for a specified length of time due to illness without losing your right to work for the employer. Its purpose is to help those who need treatment or need to help an ailing family member. It allows an employee to take up to 12 weeks a year of unpaid time off without worrying about losing their job. You must, however, meet the criteria as defined in the law.

The law only applies to employers who have 50 or more employees. Eligibility also requires that you meet certain requirements. For example, you must have worked for at least one year with your employer. There are other requirements as described by the U.S. Department of Labor.

If you qualify by meeting all of the requirements and have a serious illness like fibromyalgia, it’s possible to take time off work until your condition stabilizes. The time off can range from several days to 12 weeks. The longer time period is especially helpful if you and your doctor believe you can take control of your fibromyalgia and resolve or learn to manage the symptoms during the allotted time.[5]  If the FMLA allotted leave is depleted or you are not eligible for this leave and are unable to continue working, another option is to apply for disability.

Disability

There are 2 types of disability that may provide income while you are dealing with fibromyalgia. These are short term and long term disability. Though both can provide you with income, long term disability is usually more difficult to get than short-term disability.

Some employers offer disability insurance as private insurance. It’s always important to apply for private insurance disability first and then apply for government benefits. If you don’t have disability insurance through work or a policy you have purchased, then the next step is to apply through the Social Security Administration.

Social Security has two benefit plans for those with disabilities. Social Security Disability Insurance (SSDI) covers those who are part of the Social Security system and have paid Social Security taxes. Supplemental Security Income (SSI) pays disability benefits based on your financial need. Social Security (SS) has defined disability as being unable to do work you did before and unable to do a different type of work. In addition, your disability should last for one year or more. Since the diagnosis of fibromyalgia can take a long time to deliver in many situations, people with this medical condition often suffer for years before discovering they can apply for disability. Social Security only approves disability payment for those who will not recover from illness or injury for at least a year and does not make provision for short-term disability.

  • Short-Term Disability – As the name indicates, this type of disability offers income for a short period of time. It’s offered through employer policies or a private policy you purchase. It is not for those who have a life-long health problem that prevents them from ever working again. It is a temporary measure intended to provide income while recovering or healing from sickness or injury. Since it’s temporary insurance, it’s easier to get onto than its long term counterpart.

You need to have an illness that meets the specific definition of “disability” in accordance with the insurance policy. You must have ample proof that you are unable to work your current job or even a scaled down version if your employer is accommodating. Your doctor will need to provide documentation on your condition, medications and potential recovery.

  • Long Term Disability – Long term disability is another option offered by private and commercial insurance companies as well as the federal Social Security Administration. As in the case of short-term disability, there may be a question concerning whether fibromyalgia is covered according to the definition of disabilities and especially when applying for Social Security insurance. Whether it is through your insurance company at work, a state program, SSDI or SSI, you will have to go through a long, tedious and often complicated process to prove you cannot work.

Proving disability requires careful and complete documentation. You will need letters from your physicians verifying your condition. You will need copies of account and financial statements proving monthly expenses, and proof of past income when applicable. In many instances, you are not eligible for long-term disability under insurance terms unless you are incapable of doing your former work or any type of related work. Sometimes this means you cannot be employed in any capacity.[6]

The reality is that you need to be prepared to be declined for long-term disability insurance. The Social Security Administration (SSA) in particular denies applicants with regularity. In fact, they are well-known for refusing individuals not once but twice before granting disability benefits. This is certainly true for those who have fibromyalgia.[7] If you have been refused, do not necessarily give up. Hiring an experienced disability attorney to appeal your case may lead to approval.

Conclusion

When you are unable to work, loss of income can quickly cause financial problems. Long before this occurs, you should evaluate your financial circumstances and determine what you will do in the event you are unable to work. Reducing your workload to part time may provide you with a temporary breather. Taking advantage of Family Medical Leave is a good plan if you can afford the unpaid leave. If not, and you are unable to work, it’s possible to apply for short term disability with Social Security for temporary help while you work with doctors to overcome fibromyalgia.

If your health does not improve and, instead, continues to deteriorate, you may need to apply for long term disability.

References

[1] Hall, MB (2009). The Fibromyalgia Controversy. Amherst, NY: Prometheus Books.

[2] Silverman, S; Dukes, EM; Johnston, SS; Brandenburg, NA; Sadosky, A; and Huse, DH (2009). “The Economic Burden of Fibromyalgia: Comparative Analysis with Rheumatoid Arthritis.” Current Medical Research and Opinion, 25(4): 829–840.

[3]  Palacio, A; Uribe, CL; Li, H; Hanna, J; Deminski, M; Alvir, J; Chandran, A; and Sanchez, R (2010). “Financial and Clinical Characteristics of Fibromyalgia: A Case-Control Comparison.” American Journal of Managed Care, 16 (5): S118.

[4] Bossema, ER; Kool, MB; Cornet, D; Vermaas, P; de Jong, M; van Middendorp, H; and Geenen, R (2011). “Characteristics of Suitable Work from the Perspective of Patients with Fibromyalgia.” Rheumatology doi:10.1093/rheumatology/ker312.

[5] Marek, CC (2004). The First Year: Fibromyalgia. New York: Marlowe and Co.

[6] Ibid.

[7] Mitchell, D (2011). The Complete Guide To Healing Fibromyalgia. New York: St. Martin Press.

This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015