Fibromyalgia can be a life-altering condition, and navigating the disability claim process in Ontario can feel overwhelming, especially after a denial. But you don’t have to go through it alone.
If your claim has been denied, speak with a fibromyalgia claim Lawyer who has experience dealing with complex disability cases. With the right legal guidance and medical support, you can build a strong case for the benefits you deserve.
Need help now? Contact Affinity Law today to claim your disability benefits and take the next step toward securing the support you’re entitled to.
1. Lack of Objective Medical Evidence
One of the biggest challenges with fibromyalgia is that it doesn’t show up on standard diagnostic tests like X-rays, MRIs, or blood work. Unlike conditions with visible injuries or lab results, fibromyalgia relies heavily on self-reported symptoms chronic pain, fatigue, brain fog, and sleep disturbances.
Unfortunately, many insurance companies still expect “objective medical evidence” to back up a claim. If your medical file lacks sufficient detail or support from a recognized specialist (such as a rheumatologist), the insurer may argue there’s not enough proof of disability.
How to fix it: Work closely with your healthcare providers to document your symptoms consistently. Ask your doctor to provide detailed notes and reports outlining how your fibromyalgia limits your ability to work and function day-to-day.
2. Insurer Bias and Misunderstanding of Fibromyalgia
Despite growing awareness, fibromyalgia is still surrounded by stigma and skepticism. Many insurers continue to view it as a “subjective” or “psychosomatic” condition. This bias can lead to unfair treatment during the claims process.
Claims adjusters may assume you’re exaggerating or that your symptoms are “not severe enough” to prevent you from working especially if you don’t appear outwardly ill. This attitude can result in claims being dismissed prematurely.
What you can do: Consider including medical opinions from multiple professionals (family doctor, specialists, pain clinic) to strengthen your case. A well-supported file from a multidisciplinary team carries more weight and reduces the risk of being dismissed as a “soft” claim.
3. Inconsistent Medical Records or Gaps in Treatment
Consistency is critical when it comes to disability claims. If your medical records show gaps in treatment, missed appointments, or long periods without follow-up care, the insurer may use this to argue that your condition isn’t serious or that it has improved.
Inconsistent documentation can also be a red flag. If you report intense pain and fatigue in your claim, but your doctor’s notes don’t reflect the same level of severity, this disconnect could lead to denial.
Solution: Be proactive with your healthcare. Attend all medical appointments, follow treatment recommendations, and keep a personal symptom journal to track flare-ups and limitations. Share this regularly with your doctor to ensure your medical records align with your actual experience.
4. Surveillance and Social Media Activity
Insurance companies often use surveillance tactics, including reviewing your social media accounts to check whether your lifestyle matches your claimed limitations. If you post photos from a vacation, a family gathering, or a day when you felt well enough to be active, it can be taken out of context and used against you.
Even when you’re genuinely disabled, insurers may seize on these moments to argue that you’re capable of working or that your symptoms are exaggerated.
What to do: Be mindful of what you post online. Avoid sharing photos or updates that could be misinterpreted. Remember: insurers aren’t looking for the full picture just evidence that seems to contradict your claim.
5. Poorly Written Claim Forms
Filing a claim for fibromyalgia requires more than just filling in a few boxes. Your initial application including forms from your doctor and employer must clearly explain how your condition prevents you from doing your job or any job for which you’re reasonably suited.
Many denials stem from vague or incomplete forms. If your physician simply writes “chronic pain” or “fibromyalgia” without elaborating on how it affects your ability to concentrate, stand, sit, lift, or handle stress, your application might be quickly dismissed.
Tip: Work with a disability advocate who understands fibromyalgia claims. They can help ensure your application is detailed, thorough, and framed in a way that aligns with legal and medical standards.
6. Failing the Definition of “Total Disability”
Most long-term disability policies in Ontario require you to meet a specific definition of “total disability.” For the first two years, this usually means you can’t perform your own occupation. After that, it shifts to any occupation meaning any job you’re reasonably suited for based on your education, training, and experience.
Insurers often deny claims after the two-year mark by arguing that you’re capable of doing some form of work, even if it’s part-time or low-paying.
What to expect: Be prepared for a tougher fight after the change in definition. You’ll need strong medical evidence to show that your condition hasn’t improved and that you’re not capable of holding any job on a regular, predictable basis.
Final Thoughts
Fibromyalgia can be a life-altering condition, and navigating the disability claim process in Ontario can feel overwhelming especially after a denial. But you don’t have to go through it alone.
If your claim has been denied, speak with a fibromyalgia claim lawyer in Toronto who has experience dealing with complex disability cases. With the right legal guidance and medical support, you can build a strong case for the benefits you deserve.
