The pain has no single source. It is a deep, widespread muscle ache, sharp tenderness in your joints, and crushing fatigue that settles into your bones.
It began after the fall from the scaffolding, the rear-end collision in the company van, or the strain of a repetitive motion injury, but it has now become something else entirely.
Friends and family struggle to grasp what you are going through. Doctors may have first dismissed your symptoms. Compounding this physical and emotional toll is the formal denial letter from your employer’s insurance carrier, telling you that your condition is not real or is not work-related.
For those seeking Pittsburgh workers' compensation benefits for Fibromyalgia, the fight is not just for medical coverage and wage loss payments; it is a fight to be believed.
Fibromyalgia and Disability Guide
- Fibromyalgia and Disability Guide
- Key things to know about your fibromyalgia claim
- The Direct Link Between Workplace Trauma and Fibromyalgia
- Proving Your Fibromyalgia Is a Compensable Work Injury in Pennsylvania
- The Legal Process: From Petition to Hearing
- Common Insurance Company Tactics Against Fibromyalgia Claims
- Securing the Full Range of Workers' Compensation Benefits
- Why Choose Us for Your Pittsburgh Fibromyalgia Claim?
- Frequently Asked Questions About Fibromyalgia Work Comp Claims
- Your Pain Is Real. Your Claim Is Valid.
Key things to know about your fibromyalgia claim
- Fibromyalgia triggered by a physical trauma is a recognized medical condition that can be covered by workers' compensation in Pennsylvania.
- Insurance companies aggressively fight these claims because there is no single test, like an X-ray, to prove the condition exists.
- Winning your case requires specific, detailed medical evidence from a qualified physician who can directly link your Fibromyalgia to your work injury.
The Direct Link Between Workplace Trauma and Fibromyalgia
Fibromyalgia is a disorder characterized by the way the central nervous system processes pain signals. Medical science shows that a significant physical trauma, like the kind sustained in a serious work accident, can trigger or activate this condition in certain individuals.
The initial injury acts as a shock to the system, causing a phenomenon known as central sensitization. This means your nerves become over-sensitized and amplify pain signals throughout your body.
A touch that might feel normal to someone else can feel intensely painful to you. The brain essentially gets "stuck" in a high-alert state, misinterpreting and magnifying sensations.
This is not a psychological problem; it is a physiological malfunction of your nervous system. Common work-related accidents that can trigger this response include:
- Falls from heights, such as from ladders, roofs, or scaffolding.
- Motor vehicle accidents that occur while driving company cars or trucks.
- Crush injuries or incidents where a worker is struck by heavy objects.
- Severe neck and back injuries resulting from lifting, pulling, or twisting motions.
- Repetitive stress injuries that cause significant, prolonged pain and inflammation over time.
Proving Your Fibromyalgia Is a Compensable Work Injury in Pennsylvania
An insurance company's denial is a legal challenge, not a medical finality. The Pennsylvania Workers’ Compensation Act gives you the right to file a Claim Petition and present your case to a judge.
To win, you and your legal team must present a body of evidence that convinces the judge that your Fibromyalgia is a direct result of your work duties. Your success depends on a strategy built on solid medical science and consistent documentation of your symptoms.
Building your case with medical documentation
Medical evidence is the foundation of your entire claim. Without strong, consistent, and persuasive medical support, a judge has no basis to rule in your favor.
Your Workers’ Compensation Lawyer will work with you to collect and organize this information into a compelling case.
Your medical file must contain:
- A formal diagnosis: A credible medical source, preferably a rheumatologist, must provide the diagnosis. This physician should perform a full evaluation, including a tender point exam or other diagnostic criteria, to confirm the condition.
- A causation opinion: Your doctor must be willing to state, to a reasonable degree of medical certainty, that your workplace accident was the substantial contributing cause of your Fibromyalgia. This specific medical opinion is the cornerstone of your legal argument.
- Consistent symptom reporting: Your medical records need to show that you have consistently reported symptoms like widespread pain, fatigue, and cognitive issues to your doctors since the initial injury occurred.
- Ruling out other conditions: The records should also document that your physicians have tested for and ruled out other conditions that present similar symptoms, such as lupus, rheumatoid arthritis, or Lyme disease. This shows the Fibromyalgia diagnosis was reached through a process of elimination.
The Legal Process: From Petition to Hearing
Filing a Claim Petition starts a formal legal process. An attorney manages this process for you.
- Filing the petition: Your lawyer files the necessary documents with the Bureau of Workers’ Compensation. This action officially challenges the insurer's denial and asks a judge to order the payment of your benefits.
- Discovery: Both sides exchange information. The insurance company's lawyer will request your medical records and may ask you to answer written questions. Your lawyer will gather evidence to support your case, including witness statements and expert reports.
- Depositions: You will likely have to give a deposition. This is a formal, recorded session where the insurance company’s attorney asks you questions under oath. Your lawyer will be with you the entire time, having prepared you beforehand.
The purpose is for them to learn about the accident, your injuries, and your limitations. Your lawyer will also take the deposition of your doctor to get their causation opinion on the record.
- Hearings: Your case will be heard by a Workers' Compensation Judge. This is like a trial, but less formal. The judge will hear testimony from you, medical professionals, and any other witnesses.
Your attorney will present your evidence and cross-examine the insurance company's witnesses. The judge then issues a final written decision.
Common Insurance Company Tactics Against Fibromyalgia Claims
Insurance carriers use a standard playbook for denying and fighting Fibromyalgia claims. They rely on the subjective nature of the condition to create doubt. Knowing their strategies prepares you for the battle ahead.
Arguing it is a pre-existing condition
The insurer's lawyers will subpoena all your medical records from years before the accident. They will search for any mention of chronic pain, fatigue, depression, or anxiety to argue that you already had this condition.
- They will attempt to twist minor, unrelated complaints of pain from your past into evidence of a pre-existing disorder.
- They will claim that your Fibromyalgia is simply a natural progression of aging or another health problem unrelated to your work.
Questioning the diagnosis itself
The insurance company will hire its own doctor to perform what they call an Independent Medical Examination (IME). You are required to attend this appointment.
This doctor is paid by the insurer and often produces a report that benefits the insurer's case.
- The IME physician may state that you do not meet the clinical criteria for a Fibromyalgia diagnosis.
- The doctor might suggest your symptoms are exaggerated or have a psychological, not physical, origin.
- This examiner will frequently conclude that even if you do have Fibromyalgia, it is completely unrelated to your work injury.
Using surveillance and social media
Because your symptoms are not outwardly visible, the insurer may hire a private investigator to follow you.
- They will record video of you doing daily activities like carrying groceries, driving, or walking your dog. They will then present this footage in court to argue that you are not as disabled as you claim.
- They will also monitor your social media accounts. They will look for pictures or posts of you on vacation, at family gatherings, or engaging in any activity that they can use to suggest you are not in pain. Any post can be taken out of context to harm your case.
Securing the Full Range of Workers' Compensation Benefits
A successful Fibromyalgia claim provides access to various benefits designed to protect your health and financial stability. An attorney's job is to pursue every category of benefits you are entitled to under Pennsylvania law.
- Medical benefits: The employer’s insurer must pay for all reasonable and necessary medical treatment for your work-related Fibromyalgia. This includes appointments with your rheumatologist, pain management treatments, physical therapy, and prescription medications.
- Total disability benefits: If your condition prevents you from returning to any form of work, you are entitled to Temporary Total Disability (TTD) benefits. These payments are calculated as a percentage of your average weekly wage before the injury.
- Partial disability benefits: If you can return to work in a limited capacity or at a lower-paying job, you may receive Partial Disability benefits. These payments help make up for a portion of the difference between your old and new wages.
- Lump sum settlements: Many cases are resolved through a Compromise and Release agreement. This is a lump sum settlement where you receive a single payment in exchange for closing out your claim. Your lawyer negotiates this amount to account for your future wage loss and medical needs.
Why Choose Us for Your Pittsburgh Fibromyalgia Claim?
You have a condition that is difficult to prove, and you are facing an opponent with vast resources. You need a legal team that has successfully handled these specific, challenging cases before.
We build powerful legal arguments grounded in medical science to get our clients the benefits they are owed.
- We work directly with your treating rheumatologist to develop the clear, unequivocal medical opinion needed to prove causation to a judge.
- We depose the insurance company's paid medical examiner, challenging their biased opinions and highlighting the flaws in their evaluation.
- Our attorneys present testimony from your family, friends, and coworkers to create a full, humanizing account of your life before and after the injury.
- We gather and present the medical literature that supports the link between physical trauma and the onset of Fibromyalgia.
- We file all necessary petitions, attend every hearing, and handle all communications with the insurance company, freeing you to focus on managing your health.
- We thoroughly prepare you for your deposition and hearing testimony, ensuring you are ready for the questions the insurance company's lawyer will ask.
Frequently Asked Questions About Fibromyalgia Work Comp Claims
My symptoms did not start right after the accident. Can I still have a claim?
Yes. It is common for Fibromyalgia symptoms to develop weeks or even months after the initial physical trauma. As long as your doctor can medically link the onset of the condition back to the original work injury, you can pursue a claim. The delay does not automatically defeat your case.
Can I receive benefits for the fatigue and "fibro fog"?
Absolutely. Workers' compensation covers all aspects of your disability. If cognitive difficulties and severe fatigue prevent you from reliably performing job tasks, those symptoms are part of your disability. A judge must consider them when determining your eligibility for wage loss benefits.
What kind of settlement can I expect for a Fibromyalgia claim?
The value of any settlement depends on many factors. These include the severity of your symptoms, your weekly compensation rate, and the estimated cost of your future medical care. A successful claim can result in ongoing weekly payments or a lump sum settlement designed to cover your future wage loss and medical needs.
The insurance doctor said my pain is just in my head. What can I do?
This is a common and dismissive tactic. The opinion of the insurer’s paid doctor is not the final word. Your attorney will counter this opinion with the stronger, more credible evidence from your own treating physicians who have managed your care over time. A judge will weigh the evidence from both sides.
Your Pain Is Real. Your Claim Is Valid.
Living with Fibromyalgia is a daily struggle. Proving it to an insurance company should not be your burden to bear without qualified guidance. At Pribanic & Pribanic, we see the person behind the diagnosis.
We present your case with the strength and conviction it deserves, using decades of trial experience to show a judge the undeniable reality of your work-induced condition.
You do not have to accept the insurance company’s denial. Let us provide a voice for your injury. Contact our Pittsburgh office for a free and confidential consultation to learn how we will fight for the benefits you need to protect your health and your family. Call Pribanic & Pribanic for a Free Consultation: (412) 281-8844