The person you were before the accident feels like a stranger now. Before the injury at your job, you had energy. You could get through a workday, handle chores at home, and still have something left for your family.
Now, a deep, radiating pain has taken root in your muscles and joints, accompanied by a heavy, persistent fatigue that no amount of sleep can fix. Doctors may have struggled to name your condition at first, but now you have a diagnosis: Fibromyalgia.
When you present this to your employer’s insurance company, you are met with skepticism and a denial letter. Pursuing a White Oak workers compensation claim for Fibromyalgia is a demanding process.
It requires you to prove the existence of an "invisible" injury to a system that prefers to see broken bones on an X-ray.
Fibromyalgia and Disability Guide
- Fibromyalgia and Disability Guide
- How a Work Injury Can Rewire Your Body’s Pain Response
- Building an Undeniable Claim for Your Work-Induced Fibromyalgia
- The Human Pillar of Your Case: Telling Your Story
- Anticipating the Insurance Company's Defense Strategy
- The Full Scope of Benefits a Successful Claim Provides
- Why Choose Us for Your White Oak Fibromyalgia Claim?
- Frequently Asked Questions about Fibromyalgia and Workers Comp
- A Voice for Your Injury
Here are three key things to know before you read further:
- A traumatic work event can physically trigger Fibromyalgia, making it a legitimate injury covered under Pennsylvania law.
- Insurance companies view these claims with automatic suspicion and will use their own doctors to challenge your diagnosis and its connection to your job.
- The success of your claim will be determined by the quality of your medical evidence and the strength of the legal case built around it.
How a Work Injury Can Rewire Your Body’s Pain Response
Fibromyalgia is not a psychological condition; it is a neurological one. Medical science recognizes that a significant physical trauma can cause the central nervous system to malfunction.
This process is often called central sensitization. Think of it like a car alarm that gets stuck after a minor bump; it continues to blare long after the initial event is over.
Your nervous system does something similar. The trauma of a work injury can "rewire" your brain and spinal cord, causing them to amplify normal sensations into high-level pain signals.
Workplace events known to trigger this neurological response include:
- Sudden, violent trauma from a motor vehicle accident in a company vehicle.
- A serious fall from a ladder, roof, or other elevated surface.
- Repetitive strain injuries that cause chronic inflammation and pain over a long period.
- Crush injuries or being struck by falling materials on a construction or industrial site.
- Severe back or neck injuries that result in prolonged, intense pain signals.
Building an Undeniable Claim for Your Work-Induced Fibromyalgia
Because an insurer has already denied your claim, you must now prove your case to a Workers' Compensation Judge. This is not something you do with a single document.
Instead, you build a case piece by piece, combining medical facts with the human story of how this condition has impacted your life.
The medical pillar of your case
The judge in your case is not a doctor. Your lawyer must present medical evidence in a clear, logical, and persuasive way that leaves no room for doubt. This is the bedrock of a successful claim.
Your case requires these medical elements:
- A credible diagnosis: The diagnosis must come from a physician with a background in treating this condition, typically a rheumatologist. Their medical report serves as the official starting point of your claim.
- A clear opinion on causation: Your doctor must provide a formal medical opinion stating that your work injury was a substantial contributing factor in the development of your Fibromyalgia. This statement directly connects your condition to your job.
- A history of consistent complaints: Your medical records from the time of the accident onward must show your consistent reports of widespread pain, fatigue, cognitive issues, and other symptoms. This history defeats the insurer's argument that this is a new or invented complaint.
- Proof of a differential diagnosis: The best medical reports show that your doctor ruled out other conditions with similar symptoms, like arthritis or lupus. This demonstrates that the Fibromyalgia diagnosis was reached through a careful and professional medical process.
The Human Pillar of Your Case: Telling Your Story
The medical records provide the science, but the judge also needs to see how Fibromyalgia has affected you as a person. Your attorney will present evidence that shows the true scope of your daily struggles.
This personal evidence includes:
- Your detailed journal: A daily log of your pain levels, fatigue, sleep patterns, and the activities you can no longer do is a powerful piece of evidence. It transforms your subjective pain into a tangible record of suffering.
- Testimony from people in your life: Statements from your spouse, family members, or close friends who can describe the changes they have seen in you since the accident are incredibly persuasive. They knew you before, and they can attest to the person you have become.
- Evidence from your workplace: Testimony from former coworkers can confirm the details of your accident and describe how they saw you struggling with pain and fatigue on the job before you had to stop working.
Anticipating the Insurance Company's Defense Strategy
Insurers do not evaluate Fibromyalgia claims with an open mind. They begin from a position of denial and work backward, using a set of predictable tactics to defeat your claim. Your legal team must be ready to counter each one.
The Independent Medical Examination (IME)
The insurer will require you to see a doctor they have hired and paid. This examination is rarely impartial. The doctor's job is to review your file and examine you for a short period to produce a report for the insurance company.
Often, these reports claim you do not have Fibromyalgia, that it is a pre-existing condition, or that you are exaggerating your symptoms. Your attorney will challenge this doctor's opinion during a deposition, exposing their bias and the limited scope of their examination.
The Pre-Existing Condition Argument
The insurance company’s lawyer will request every medical record they can find from your entire life. They will hunt for any note from any doctor about past pain, fatigue, or even anxiety, and use it to argue that your condition existed long before your work accident.
They will ignore the fact that you were able to work without issue before the injury that triggered your disabling symptoms.
Surveillance and social media monitoring
Because your injury is not visible, the insurer may hire a private investigator to follow you with a video camera. They hope to catch you on a "good day" performing an activity like carrying a bag of groceries or bending over to pull a weed.
They will then present this short video clip to the judge as "proof" that you are not disabled. They will also comb through your social media, looking for photos or posts they can take out of context to harm your credibility.
The quick, low settlement offer
Sometimes, an insurer will offer a small, quick settlement early. They do this hoping you are desperate for money and will accept the offer before you hire a lawyer or learn the true lifetime value of your claim.
Accepting this offer will permanently close your case, leaving you without coverage for future medical care or wage loss.
The Full Scope of Benefits a Successful Claim Provides
Winning your Fibromyalgia case secures a range of benefits under Pennsylvania law. These benefits are a crucial lifeline that provides medical care and financial support when you are unable to work.
- Complete medical coverage: The insurer is required to pay for all reasonable and necessary medical care for your Fibromyalgia. This includes appointments with specialists, pain management, physical therapy, and prescription medications for the rest of your life.
- Wage loss benefits: If your condition leaves you unable to work, you receive weekly payments known as total disability benefits. If you can perform some work but at a lower wage, you may receive partial disability benefits to make up a portion of the difference.
- Lump sum settlements: Your case can be resolved with a lump sum settlement, which is a single payment to close out your claim. Your attorney negotiates this amount based on your past and future wage loss, the projected cost of your medical care, and the strength of your case.
Why Choose Us for Your White Oak Fibromyalgia Claim?
A Fibromyalgia case requires a law firm that is prepared for a complex fight against a skeptical opponent. Our background as trial attorneys informs how we handle every workers' compensation case.
We build your claim from day one with the expectation that we will have to prove it to a judge in a courtroom.
- We manage the entire legal process, from filing the initial claim petition to representing you at every hearing and deposition.
- Our lawyers coordinate directly with your doctors to build the comprehensive medical evidence needed to prove the connection between your work injury and your Fibromyalgia.
- We aggressively challenge the insurance company’s medical examiners in depositions, breaking down their biased and often unfounded opinions.
- You get direct communication with your attorney. We provide clear answers to your questions and ensure you are informed at every stage of your case.
Frequently Asked Questions about Fibromyalgia and Workers Comp
Will I definitely have to go to court for my case?
You will have to give testimony, but most of this happens in a formal conference room during a deposition, not in a public courtroom. While your case is assigned to a judge who will hold hearings, many cases settle before a final trial-like hearing becomes necessary. Your attorney will handle all formal court appearances.
What if I can work some days but am too fatigued to work on others?
This is a common reality for people with Fibromyalgia. Your condition may prevent you from maintaining regular, reliable attendance, which makes you unemployable in the real world. Your attorney can present evidence, including your own testimony and that of a vocational professional, to show a judge that your inability to work consistently makes you totally disabled under the law.
My employer is pressuring me to come back to work. What should I do?
You should never return to work until your own doctor gives you a written release to do so. Do not rely on the opinion of the insurance company's doctor or pressure from your supervisor. Returning to work before you are medically ready can harm your health and your legal case.
A Voice for Your Injury
You know your pain is real. You know your life has been changed by a work injury. Now, you need to make the legal system recognize it, too. At Pribanic & Pribanic, we stand with injured workers in White Oak who are facing difficult, complex claims. We use our extensive litigation experience to build the powerful, evidence-based case you need.
Let us handle the fight with the insurance company so you can focus your limited energy on your health. Call us for a free, confidential consultation. We will review your denial letter, listen to your story, and explain exactly how we can help. Call Pribanic & Pribanic for a Free Consultation: (412) 672-5444