Does My Long Term Disability Policy Cover Fibromyalgia?
April 6, 2023
Fibromyalgia is a chronic disorder which causes people to experience pain and tenderness throughout the body, accompanied by fatigue and insomnia. Doctors are not exactly certain what causes the condition, however, one primary theory is that people who suffer from the condition have developed changes in the way the central nervous system processes the pain messages carried around the body. These changes could be due to alterations in the chemicals traveling through the nervous system.
Approximately 4 million adults in the United States, or 2% of the population, are affected by fibromyalgia. Although people of any age can have the condition, most develop fibromyalgia later in life. Women are twice as likely as men and other risk factors include traumatic events, repetitive injuries and viral infections.
A former Hewlett Packard employee was recently awarded long-term disability benefits due in part to his years-long battle with fibromyalgia. The employee worked as a IT Customer Service Representative for Hewlett Packard. In 2017, he was diagnosed with fibromyalgia along with rheumatoid arthritis. His symptoms included joint pain, fatigue, muscle pain and spasms. His doctor concluded that his limitations at work, which were many, were due to his fibromyalgia, not his arthritis.
Over time, the employee made a long-term disability claim due to his inability to perform his duties at work. His pain and stiffness were not well controlled due to swelling in his fingers and joints. The employee’s doctor restricted him to no lifting, no repetitive or heavy manual labor and no typing.
While on disability, the claim administrator handling his disability claim referred the employee to an independent medical exam. The doctor conducting the exam found the employee’s arthritis to be inactive and recommended the employee work in 20 minute intervals where he would take a break from typing every 20 minutes. The insurer interpreted the report to mean the employee could work for 40 minutes per hour for a total of 5 hours and 30 minutes per day.
The employee read the report to mean every twenty minutes he would need to take a break from typing, so this would limit his ability to work to 4 hours per day. Eventually the employee sued his insurer and the issue of disability under the policy was considered by a federal judge. As to the amount of hours the employee could work, the court agreed with the employee that he was limited to working 4 hours per day. As the court explained, “a shift from 5.33 hours to 4 hours of typing in an 8-hour workday could make a substantial difference in the plaintiff’s employability in various computer-based jobs like his own prior role.”
Based on this and other evidence, the court reversed the insurer’s denial of benefits and ordered the plan administrator to “accurately consider plaintiff’s functional limitations.” This was a win for the employee, however, the court did not expressly find that fibromyalgia is a qualifying condition under the policy. The court noted that “for whatever reason,” HP’s long-term disability plan “excludes fibromyalgia from consideration in determining an employee’s disability.” This did not disqualify the employee from coverage, however, because the insurer accepted the employee’s claim based on his rheumatoid arthritis. Therefore, even though fibromyalgia was not expressly covered, the employee could prevail based on his arthritis.
If you wish to read the court’s decision, it is available on the court’s docket. See Johnson v. Hewlett Packard Enters. Co., No. 9-cf-01878-RBJ, 2021 WL 2254965, at *9 (D. Colo. June 3, 2021).