Disability Insurance Expert Witnesses Part 2

Disability insurance expert witnesses may write reports and opine on managed care, HMOs, and insurance claims. Medical expert Richard N. Podell, M.D., M.P.H. explains that for someone with fibromyalgia, it’s a difficult step to apply for disability and upsetting if an insurance company representative appears not to believe that they are actually very ill. He says the patient can improve their fibromyalgia disability claim by imagining themselves in the medical insurance examiner’s place.

Medical Expert Witness Issue #3:

With fibromyalgia, when you physically push through your limits the expected flare-up of symptoms might not occur right away. Often the flare-up is delayed for hours or even a day. This pattern of fibromyalgia disability is very different from that of most other illnesses. Insurance industry representatives and indeed many physicians– don’t yet understand this very basic fact.

Consider the Functional Capacity Evaluation (FCE), the insurance industry’s standard “test”. A physical or occupational therapist observes a claimant’s ability to bend, crawl, push, and pull things during a single session of two hours or so. That’s fine if the key problems are muscle weakness or stiff joints, where the symptom flare-up occurs quickly. But it misses the point for fibromyalgia, since the expected flare-up often does not occur. Current FCE protocols make no provision for follow-up; so these delayed reactions are missed.

Read more: drpodell.org.