Post-Laminectomy Syndrome and Long-Term Disability Insurance Claims

What Is Post-Laminectomy Syndrome?

Post-laminectomy syndrome should not be confused with pain from the healing process after surgery, though it is often confused with normal post-surgical pain. Pain can vary depending on the patient, including:

• Aching pain at the surgical site;
• Pain that spreads across the back or neck;
• Pain that shoots down the buttocks and legs; and
• Hyperalgesia, or increased sensitivity to pain.

While not everyone who has post-laminectomy syndrome/failed back syndrome can be considered disabled, severe cases can limit people from working or normal life activities. People who cannot work because of their post-laminectomy syndrome may apply for long-term disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the terms of the plan.

Diagnosing Post-Laminectomy Syndrome

Patients must have already undergone a spinal surgery to be considered for an evaluation for post-laminectomy syndrome/failed back syndrome. The first step for diagnosis is a physical exam where the patient’s pain is assessed, including levels and severity, and the patient’s gait and range of motion are evaluated. A complete neurovascular and muscular evaluation should be considered to rule out other causes of pain. Further diagnostic testing can determine what physical causes could be contributing to the patient’s symptoms. Diagnostic tests can include:

• MRIs;
• CAT scans;
• X-rays; and
• Bloodwork to rule out infection.

Comparing patient pain before and after surgery is an important part of the diagnosis. The pain must have either continued or worsened in order to qualify for a diagnosis of post-laminectomy syndrome.

Treating Post-Laminectomy Syndrome

Treatment for post-laminectomy syndrome can vary depending on the cause and severity of symptoms. Options for treatment include oral or injected medication, physical therapy, and spinal cord stimulation (SCS). Common medications include pain relievers, including narcotics, and steroids. As in many other conditions, the least invasive options should be evaluated before more invasive methods should be considered. In some cases, surgery to fix an underlying condition or surgical error may be necessary. For some people, alternative therapies like acupuncture, therapeutic massage, and mindfulness can bring relief to their pain.

Disability Evaluation of Post-Laminectomy Syndrome

Definition of Disability

Most LTD plans consider a person disabled if they have a medical condition that causes them to 1) be unable to perform their work duties for the first two years of the policy and 2) be unable to work in almost any job for the following years. Each LTD plan defines disability as slightly different, so look over your plan policy to see how your plan determines “disabled.”

Evaluating Disability for People with Post-Laminectomy Syndrome

You must prove that your post-laminectomy syndrome keeps you from doing your old job or any job that you could be trained to work and that the condition will last for at least a year. The insurance company will look to see if your symptoms match closely with another condition in the Blue Book, the document the Social Security Administration (SSA) uses to list conditions that are recognized as disabling. Chronic pain is the primary condition that post-laminectomy syndrome is evaluated against.

The primary qualifier for many patients seeking disability benefits for post-laminectomy syndrome will be the Residual Functional Capacity (RFC) assessment that indicates how the condition affects and limits their life activities. Since pain is the primary symptom of post-laminectomy syndrome/failed back syndrome, the insurance company looks at the claimant’s pain level when assessing claims for this condition.

Pain is evaluated on:

• How your everyday life is affected;
• The location, frequency, intensity, and duration of your pain;
• What causes, worsens, or relieves your pain;
• Medications used to treat pain and their side effects;
• Any treatments you have used to alleviate your pain and their effectiveness; and
• Any other factors that affect your pain.

What the Insurance Company Needs From You and Your Medical Providers

It is important to tell the insurance company about any doctor that has seen you for your post-laminectomy syndrome, back pain, and any conditions that contributed to your back pain. The insurance company will need to obtain all relevant medical records to get the full picture of your health. If for any reason they cannot get these records from your doctors, you should request them and provide them to the insurance company yourself. Important records to include are:

• Physician notes;
• Bloodwork;
• Physical therapy notes;
• Diagnostic test results; and
• Surgical notes.

You will need to provide proof of your diagnosis and your ongoing symptoms, as well as proof of how you are affected by your symptoms. Providing detailed documentation is key to a successful claim. Residual Functional Capacity (RFC) assessments determine how you are affected by the condition and what you can do despite your limitations. It is used to determine what jobs you may still be qualified to perform.

RFCs for many patients with severe post-laminectomy syndrome limit strenuous physical activity, bending, and lifting. Patients with severe failed back syndrome may be unable to stand for long periods of time. Their RFC may limit them to only sedentary work. If pain prevents you from sitting for an extended period, even sedentary work may be out of the picture. Leg weakness or numbness may limit the patient in climbing, walking, or balancing.

Working With a Disability Attorney

An experienced disability attorney will give you the best chance of getting the disability benefits you deserve for your post-laminectomy syndrome. Even if you have been denied disability benefits, that does not mean your case is over. It is not unusual to be denied the first time you apply. You have the right to file an appeal and try to get more information that may help your case. Getting expert help is often the difference between being denied and being approved for benefits.

While the process can be intimidating, your disability attorney is an expert on the process. Since they receive their payment from awarded funds, they do not get paid unless you win your case. You can seek help without worrying about upfront costs or unexpected bills.

Get a Free Case Evaluation with a Long-Term Disability Attorney

The Ortiz Law Firm has successfully represented people in disability cases across the United States. If you would like to talk to one of our experienced disability lawyers about your post-laminectomy syndrome and its impact on your ability to work, call us at (888) 321-8131. We would be happy to evaluate your case and to discuss how we can help you through the appeal process.