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
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 activity, then you may be eligible for long term disability benefits.
Causes of Back Pain
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 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 Evaluate 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.
If your LTD claim for back pain is delayed or denied, contact the Ortiz Law Firm for a free case evaluation at 850-308-7833.