costs and insurance

Fibromyalgia and the Courts: Here Comes the Judge

Dr. Mark Borigini Health Guide July 28, 2008
  • There is a lot of debate as to whether there is such a thing as "secondary" fibromyalgia due to some sort of trauma. Often, the trauma is the result of a fall, or a car accident. Such "post-traumatic" fibromyalgia patients are more severely affected, with more pain, and are therefore more difficult to treat.

     

    Fibromyalgia may take many weeks to fully develop after a trauma. One theory holds that pain spreads from one region (for example, the shoulder after a fall) to the rest of the body. In fact, this post-traumatic fibromyalgia phenomenon can be seen as starting as a myofascial pain problem which over weeks to months spreads throughout the body, resulting in the total body pain seen in fibromyalgia.

     

    Many patients are previously healthy and functional individuals, who due to their chronic pain find it necessary to seek a modified work environment, or perhaps eventually find it necessary to leave the workforce. Obviously, such a major life change can lead to additional emotional and psychological pain, not to mention financial hardship.

     

    The financial hardship serves as the main engine for the use of the courtroom in fibromyalgia cases. A medical problem now becomes a legal problem.

     

    However, the legal problem is not just for the patient, but can be for the patient's doctor, as it is not unusual for a patient to call upon his or her doctor to render an opinion as to whether or not a fall or an assault or some other type of accident resulted in the chronic pain of fibromyalga, which in turn has rendered the patient unable to engage in a productive manner in the workforce.

     

    The judge will ask questions such as the following:

    • What is the diagnosis?
    • Is the fibromyalgia the result of a particular injury or accident?
    • Would the patient have developed fibromyalgia anyway, regardless of any history of trauma?
    • Is the severity of the fibromyalgia a life-long problem that may limit the patient's ability to function in the workplace?
    • What will the cost of care be, now and in the future?

    These are weighty questions for a doctor because the answers may play a huge role in determining whether the patient is eligible for disability payments, or a settlement if the patient may have brought a lawsuit against the party felt to be responsible for an accident or other trauma that has resulted in chronic pain.

     

    As we all know, the severe pain of fibromyalgia can sometimes never become significantly better, or may only become somewhat tolerable with continued drug treatment or physical therapy--all of which can be very expensive over time. So, patients may have to fight insurance companies to assure themselves of the treatment they feel they deserve.

     

    This fight can become an epic battle, because many insurance companies have difficulty believing, for example, that a seemingly uncomplicated fall can result in chronic and debilitating pain.

     

    For the patient, the courtroom battle can be just as painful to watch, as there is a deep division in many cases between those doctors who simply do not believe that chronic pain/fibromyalgia can result from a sometimes rather minor injury, and those doctors who believe with all their heart that there is such a disabling thing as post-traumatic fibromyalgia.

  •  

    Who is right? As with many things in life, it may be left for the courts to decide.

     

Helpful Tools and Devices How to Make Life with RA Easier

Most Popular

Costs and Insurance
10 Affordable Pain Solutions