Sciatica And Long Term Disability Insurance Claims

What is Sciatica?

The sciatic nerve runs from the lower back down the buttocks and into the lower legs. Sciatica is pain from that nerve, usually caused by compression of the sciatic nerve from a bone spur or herniated disk. This compression causes inflammation, severe pain, and numbness of the legs. Sciatica can come suddenly and without warning.

One of the significant symptoms of sciatica is pain radiating down the legs, which can be in a range from mild tingling pain to sharp shooting pain or electrical shocks. Usually, this pain is on only one side of the body. Sitting for long periods can make this pain worse.

Risk factors for sciatica include age, obesity, diabetes, sedentary lifestyles, and jobs that require heavy lifting or twisting the back. Sciatica can happen to anyone but limiting these risk factors is an excellent way to reduce the risk.

Diagnosing Sciatica

For some people, their mild sciatica pain goes away after a short period. For severe cases, seeing a doctor is the first step in treatment. See a doctor as soon as possible if the pain is sudden and severe or occurs after an accident or fall. Incontinence problems are also a reason for immediate care. This is a sign that the nerves in the bowels or bladder are affected.

The first step in diagnosing sciatica is a clinical exam. The doctor will have the patient perform basic exercises like walking on the toes or heels, lifting the legs when lying flat, and standing up from a squatted position. He or she will also test the patient’s strength and reflexes. Further medical imaging may be required to determine what may be the cause.

Diagnostic tests can include:

  • MRI
  • CT scan
  • X-ray
  • Electromyography (EMG)

Treating Sciatica

Many people with sciatica find that their symptoms go away with self-care like ice packs, heating pads, gentle stretching, and over-the-counter pain relievers. If home remedies for sciatica do not work, the next step is medication. Medications used to treat sciatica include anti-inflammatory drugs, narcotic pain relievers, muscle relaxants, antidepressants, and anti-seizure medications.  The next step in treatment is physical therapy to prevent future injury. The doctor may also prescribe steroid injections to relieve inflammation further. If these methods do not work, surgery may be an option. The primary goal of surgery is to decompress the sciatic nerve and fix the cause of the compression. If a herniated disc causes sciatica, for example, surgically treating the affected disc should relieve the pain.

Disability Evaluation of Sciatica

The majority of people suffering from sciatica may have manageable pain do not have the level of impairment required to qualify for disability benefits. For others with more severe symptoms, their sciatica qualify them for benefits. Patients who find themselves unable to work because of their sciatica may qualify for Long Term Disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the specific plan.

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 complete the work duties of almost any occupation for the years following the initial 2-year period. Each LTD plan defines disability as slightly different, so look over your plan policy to see how your plan determines “disabled.” In other words, the key provisions in an LTD plan/policy may differ from policy to policy, so you would need to check the specific terms of your policy to determine how the insurance company defines the term “disability” or “totally disabled”.

Evaluating Disability for Claimants with Sciatica

Sciatica is not one of the conditions that automatically qualify a person for disability benefits. Patients seeking disability payments for sciatica will have to prove that they are impacted in a way that they cannot perform their job (or potentially any job that they could be trained to work). The primary qualifier for patients seeking disability benefits will be the Residual Functional Capacity (RFC) assessment that indicates how sciatica affects and limits their life activities. Since pain is a major factor of sciatica, the insurance adjuster handling the long term disability claim looks at pain 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
  • Any other factors that affect your pain

What the insurance Company Needs From You and Your Medical Providers

You should tell the insurance company about any doctor that has treated you for your sciatica. 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.

Your doctors should send their complete exam notes and all relevant medical testing and lab results. 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.

Many patients with severe sciatica are limited in how long they can walk or stand. Their RFC may limit them to only sedentary work. If your sciatica 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 also balancing. If your sciatica causes incontinence, you may be prevented from working any job that prevents you from using the bathroom whenever you need to go and as many times as you need. Make sure that you are as honest as possible with your doctors so that they can complete an accurate RFC for you.

Working with an Experienced Disability Attorney

Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your sciatica. The application process is complicated enough to confuse anyone who has little experience in legal matters. Missing a deadline can cause you to lose your case and need to reapply.

If you have been denied disability benefits, do not lose hope. Many people are denied benefits the first time they 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 daunting, your expert disability attorney will be able to guide you through 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.

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 sciatica 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 to help you through the appeal process.