Fibromyalgia

Fibromyalgia is a syndrome that has been questioned many times, both in the medical community and in the legal community, particularly in claims within the SAAQ or the CNESST.

Once diagnosed, the burden of demonstrating a plausible, logical and sufficiently close link between fibromyalgia and any accident still rests with the victim. The latter will therefore have to put in evidence medical documents denoting continuous pain for the duration of his medical follow-up.

Diagnosis

According to the Canadian Rheumatology Society (CRA), which established the Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome, fibromyalgia syndrome is characterized by diffuse body pain.

In addition to chronic and widespread pain, fibromyalgia is often accompanied by:

• Fatigue;
• Sleep disorders;
• Mood disorders;
• Neurocognitive changes (memory problems, verbal difficulties, etc.);
• And other somatic manifestations.

In addition, fibromyalgia mainly affects women between the ages of 30 and 50, but the SCR states that it can affect people of any age regardless of gender.

In order to validate the diagnosis of fibromyalgia, the Tribunal and the SCR agree to give probative weight to the 3 diagnostic criteria of the American College of Rheumatology (ACR):

• The Widespread Pain Index;
• The presence of painful symptoms for at least three (3) months;
• The elimination of any other cause of chronic osteo-articular pain.

It will therefore be up to a competent expert to demonstrate the conformity between his diagnosis and the CRA’s criteria.

The time to obtain the diagnosis

Medically, there has long been some skepticism about this syndrome and it can take a long time to get a diagnosis of fibromyalgia.

First, it is a syndrome whose site and intensity can vary daily. This explains why diffuse body-wide pain must have been present for at least three (3) months before making a diagnosis of fibromyalgia.

Second, as recognized by the SCR:

The delay in diagnosing fibromyalgia can be attributed to a gap in the identification of fibromyalgia on the part of the patient and health professionals.

Indeed, the syndrome is often confused with diagnoses of a musculoskeletal, neurological, psychiatric or psychological nature. Subsequent medical judgments will then be influenced for a long time by these first diagnoses before detecting the presence of fibromyalgia in a patient.

Finally, the diagnosis of fibromyalgia is considered an exclusion diagnosis, that is, it is made only when the symptoms cannot be explained by another disease.

The relationship with the accident

Once the diagnosis is obtained, it is necessary to demonstrate the causal relationship between the syndrome and the accident at the origin of your claim. In other words, it will be up to an expert to determine if independent events to your accident could have triggered your condition instead.

The complexity of this approach stems from the fact that the triggers of fibromyalgia are numerous. Indeed, the SCR states that fibromyalgia can appear as a result of any traumatic event of a physical or psychological nature. The Quebec Fibromyalgia Society (SQF) recognizes that events as common as surgery, a viral infection or childbirth can trigger the syndrome.

In order to assess the causal relationship between the accident and fibromyalgia, the court will consider certain criteria including, but not limited to:

• The personal condition of the victim;
• The intensity of the trauma;
• The nature of the damage;
• Severity;
• The time to onset of symptoms;
• Evolutionary continuity.

In addition, in a recent case, the Court added that in the particular context of fibromyalgia, pain cannot simply be explained by the injuries or permanent sequelae that were directly impacted during the accident. Indeed, the pain must be generalized and extend beyond the sites affected by the accident.

The time to onset of symptoms

In the context of fibromyalgia, the question of the time to onset of symptoms can be particularly problematic. It should be remembered that for the reasons mentioned above, obtaining a diagnosis of fibromyalgia can take a long time. However, case law recognizes that the longer the time it takes for symptoms to appear, the less the relationship with the accident.

In a 2014 decision, the Tribunal reviewed some 20 decisions to determine whether it gave probative weight to a seven (7) year delay between the diagnosis of fibromyalgia and the accident. He came to the conclusion that beyond one (1) year of time of onset between the accident and the suggestive symptoms of fibromyalgia (and not the diagnosis, which may be even later), the causal relationship will be mostly refused. Following this decision, the trend of the courts is leaning towards the rejection of claims with late diagnoses.

However, this is not an absolute rule. Sometimes medical consultations, carried out within a reasonable time, document symptoms specific to fibromyalgia, without pronouncing the diagnosis. In a decision, the Superior Court of Quebec confirmed that the period of one (1) year could not be presumed and that each case had to be analyzed, regardless of the time between diagnosis and accident. The court also established, based on the evidence presented to it in this case, that a period of two (2) and a half years was reasonable.

Consequently, it is important to distinguish between, on the one hand, the period incurred between the occurrence of an accident and the pronunciation of the resulting diagnosis, and, on the other hand, the period of onset of the symptoms specific to that diagnosis. Thus, although it is likely that the pronunciation of your diagnosis will occur several months after your accident, what really matters is that you can demonstrate a short time to onset of symptoms, and this, by presenting objective traces of your pain taken in a contemporary way to your accident.

Compensation

If it is recognized that your fibromyalgia is related to your accident, you may be able to get an income replacement benefit if you are unable to perform your job.

However, as mentioned above, fibromyalgia is a syndrome that is highly variable. Therefore, it is not automatically disabling. Indeed, it will be necessary to take into consideration the symptoms specific to your condition as well as your functional limitations resulting from it in order to assess whether they are incompatible with the tasks you perform in the context of your employment.

In addition to the income replacement indemnity, the SAAQ provides compensation for the bodily injury suffered during your accident. Although fibromyalgia does not appear in the list of functional units, it is generally directly associated with the saAQ’s category of endocrine, hematological, immune and metabolic functions . This category is divided into six (6) severity classes and these will determine the amount that will be granted to you.

Each case being a case in point, do not hesitate to contact our office for an evaluation of your file.