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Courts Interpret Disability Insurance Limitations

Is the two-year limitation in most disability plans that applies to self-reported symptoms no longer applicable to fibromyalgia? Recently, the Seventh Circuit, in an opinion styled Weitzenkamp v. Unum, found that the disease of fibromyalgia may, in fact, be based on objective medical evidence. In this case, Weitzenkamp was diagnosed following an 18-point “trigger test” for the condition. The Seventh Circuit had previously recognized that the trigger test can “more or less objectively” establish the disease where the findings of the test are consistent with fibromyalgia. See Hawkins v. First Union Corp. Long-Tem Disability Plan, 326 F.3d 914, 919 (7th Cir. 2003). Accordingly, the court held that because “the disabling illness, in this case, fibromyalgia, is not primarily based on self-reported symptoms, but rather can be based on the verifiable evidence of its manifestations, the self-reported symptoms limitation does not apply in this case.”

If you have fibromyalgia and have been denied benefits based upon a two-year limitation on self-reported symptoms contained in disability policy, please contact us as we may be able to help.