Patients with back pain may be unable to work because of their conditions and its related complications. Patients who find themselves unable to work because of their back pain may qualify for long term disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the conditions of that plan.
Causes of Back Pain
Disability claims based on “back pain” are perhaps the most common type of disability claims. Back pain disorders may be caused by a variety of physical problems, including the following:
- Osteoarthritis (OA);
- Degenerative disc disease (DDD);
- Herniated nucleus pulposus (HNP) or herniated disc;
- Lumbar strain;
- Spinal stenosis (cervical and lumbar);
- Kyphosis; and
The issue is how your back pain impairs your daily functioning, including walking, bending, stooping, twisting, lifting, and the like. If your chronic back pain impairs your ability to perform work-like activities, then you may be eligible for long term disability benefits.
Back pain can be caused by many different medical conditions in the spine, many of which occur as we get older. Chronic conditions that cause back pain include:
- Degenerative discs (created by wear and tear as part of the aging process, or osteoarthritis);
- Inflammatory conditions like rheumatoid arthritis, arachnoiditis, and spondylitis; and
- Problems involving the nerves in the back, such as spinal stenosis, nerve root compression, herniated discs, scoliosis, or spondylolisthesis.
You can visit the above links for a more detailed explanation as to how disability insurance companies evaluate claims for those conditions, but this article will focus on how a long term disability insurance company views the symptoms of pain and why your credibility is so important with back disability claims.
Can You Obtain Disability Benefits for Back Pain?
If you experience back pain on a regular basis, you know that back pain can be agonizing, frustrating, and even incapacitating. Long term disability insurance companies do not hand out LTD benefits readily for back pain conditions.
To qualify disability benefits, you should provide adequate proof of a medically determinable impairment. This means that you should submit as much objective medical proof in support of your claim as possible, including x-rays, MRIs, CT-Scans and treatment notes after a physical examination that show that your back pain is caused by some physical abnormality of the spine or spinal canal. If you have back pain without evidence of a physical impairment that is normally expected to produce pain symptoms (like evidence of a herniated disc that is “pinching” a nerve), then you are unlikely to win disability benefits.
Note: back pain caused by temporary injuries such as muscle strains and bone fractures usually heal within a few weeks or months, so these conditions will not typically qualify for disability insurance benefits.
How the Long Term Disability Insurance Company Evaluates the Severity of Your Back Pain
Disability insurance adjusters (claims handlers) review many, many disability claims for back pain, but only approve a few of the most severe cases. Most LTD insurance companies expect most patients to be able to work through their back pain. In short, an LTD claims handler must determine which claims for back pain are the most serious. They do this by looking at:
- Your objective symptoms, to see whether the diagnostic imaging reports evidence a severe impairment;
- Your functional limitations (for example, your range of motion may be limited such that you cannot stoop or bend, you have trouble walking, or you need to switch positions frequently), to see what type of work you may be capable of performing; and
- Your credibility, since a lot of your disability claim is based on your subjective reports of back pain.
How The Insurance Company Evaluates Your Credibility
Your credibility — whether the claims examiner believes your pain is as bad as you say it is – is key in chronic pain cases. To evaluate your credibility, a disability insurance claims handler will consider some or all of the following factors (in addition to evaluating whether your objective test results support your subjective pain complaints):
- How often you have been to the doctor;
- What treatments you have tried (for example, medication, therapy, cortisone shots);
- Your doctors’ opinions as to your pain level and resulting limitations;
- How the pain affects your ability to perform activities of daily living;
- Whether you appear to be exaggerating your level of pain, and
- How much pain is normally reported by others with your physical findings.
In other words, if you say you have extreme back pain but your objective test results do not indicate a medical condition that would reasonably explain what is causing your pain, then your claim may be denied.
Work With an Experienced Long Term Disability Attorney
If your back pain is so severe that you are no longer able to work for a living, you may very well be entitled to receive long-term disability benefits. Because of the complexities involved with proving that you are disabled by a back pain disorder, it would be in your best interest to consult with an experienced long term disability attorney. If your claim is not handled correctly, your appeal may never be approved while your bills continue to pile up.
An experienced Long Term Disability lawyer knows how to obtain all of the proper documents and medical opinions to satisfy your burden of proof. Mr. Ortiz is an experienced LTD Attorney. He and his firm will work with you and with your medical team to maximize your benefits from the insurance company. Call (866) 853-7756 for a free case evaluation if your claim has been delayed, denied, or terminated.