Is Fibromyalgia a Critical Illness?

What is Fibromyalgia?

Fibromyalgia is a complex and challenging chronic medical condition that can have a huge impact on someone’s life and wellbeing. It is characterised by widespread pain and tenderness in the muscles, ligaments, and tendons, alongside a range of other symptoms. We understand the frustration and the demands fibromyalgia can have on someone’s life, it can be a long and arduous journey.

The main symptoms of Fibromyalgia are:

  • Widespread Pain: Fibromyalgia's most defining feature is the presence of persistent, widespread pain that can manifest as a deep, enduring ache throughout the body. This pain can be physically and emotionally draining.
  • Tenderness: People with fibromyalgia often endure heightened sensitivity to pressure at specific tender points on their bodies, which can make even gentle touch painful.
  • Fatigue: The fatigue associated with fibromyalgia is not just physical but mental as well. Individuals with fibromyalgia frequently experience extreme tiredness, even after a full night's sleep, which can affect their daily lives.
  • Sleep Disturbances: Sleep problems are common among those with fibromyalgia, contributing to a range of other health issues, including increased pain and fatigue.
  • Cognitive Symptoms: Many individuals experience "fibro fog," which includes memory difficulties, trouble concentrating, and challenges with mental tasks.
  • Other Symptoms: Fibromyalgia can also bring about additional symptoms, including headaches, irritable bowel syndrome, depression, anxiety, and heightened sensitivity to light, noise, and temperature changes.

The exact cause of fibromyalgia remains a mystery, and it's believed to result from a complex interplay of genetic, environmental, and neurological factors. Diagnosing fibromyalgia requires a healthcare provider's clinical evaluation, which typically involves a physical examination and a review of your medical history. This can often take some time and can be increasingly frustrating for people, which in turn makes symptoms worse.

 
 

Can I claim on my Critical Illness Insurance Policy with Fibromyalgia?

Normally, Critical Illness isn’t listed as a critical illness directly. Often people claim under “total permanent disability”. Total Permanent Disability (TPD) cover, when included within a critical illness insurance policy, offers financial protection to people in the event that they become totally and permanently disabled due to illness or injury. The specific definitions and criteria for TPD can vary between insurance policies and providers, but it typically involves the following key elements:

  • Total Disability: The policy will define what constitutes "total disability." It generally means that the policyholder is unable to perform their own occupation or any occupation or work for which they are reasonably suited by education, training, or experience due to the disability.
  • Permanent Disability: TPD coverage typically requires the disability to be permanent, meaning that it is not expected to improve or that it is irreversible.
  • Some policies will measure this against “Daily Living tasks” or “Work related tasks”

For individuals with fibromyalgia, claiming on their TPD cover can be complex and may depend on the severity of their condition and the specific terms and definitions within their insurance policy. Fibromyalgia is generally considered a chronic condition, and while it can be severely disabling for some individuals, it may not always meet the criteria for TPD coverage, as it may not necessarily result in a complete inability to perform any (suited) work.

It's essential for individuals with fibromyalgia who have critical illness insurance with TPD coverage to carefully review their policy and think about making a claim. Resolute Claims are experts in this field, we have trained professionals that can review your policy and let you know what we think. We will often discuss this with our internal medical professionals and may review medical documentation and assessment by healthcare professionals to determine the extent of the disability and its permanence.

In some cases, individuals with fibromyalgia may be eligible for TPD coverage if their condition is severe enough to render them completely and permanently unable to work or perform any occupation. However, each case is unique, and eligibility can vary depending on the specific policy and its terms.

If you are considering making a TPD claim due to fibromyalgia, you can speak to us free and completely confidentially on 0333 050 8792 or email us at claims@resclaim.co.uk