To identify the prevalence, risk factors, and treatment outcomes of patients with chronic disabling occupational musculoskeletal disorders (CDOMD) who met criteria for fibromyalgia. This was a prospective prognostic study of a consecutive cohort of CDOMD patients (n = 449) admitted for treatment. Patients were assessed for chronic widespread pain and fibromyalgia. The measures included demographic, injury-related and occupational information, psychosocial measures, and 1-year work status follow-up. The CDOMD patients with fibromyalgia reported higher-level psychosocial distress. Women with fibromyalgia were 9.6 times less likely to return to work 1-year posttreatment and, of those who did, were 4.3 times less likely to retain work. Of this cohort, 23.2% patients met criteria for fibromyalgia. Patients with fibromyalgia were found to show greater psychosocial distress and significantly poorer rates of work return and work retention 1-year postrehabilitation.