Patients with chronic back pain may be unable to work due to their musculoskeletal condition, related complications, and functional limitations. Patients who cannot 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 are eligible for disability for back pain under the conditions of that plan.
Causes of Back Pain
Claims for disability due to back pain are perhaps the most common long term disability claim. Chronic pain can be caused by many different back problems, many of which occur as individuals age. Problems that cause chronic back pain include wear and tear as part of the aging process, inflammatory conditions, and problems involving the nerves in the back.
Specific conditions that can cause chronic back pain include:
- Ankylosing Spondylitis;
- Degenerative discs (created by wear and tear as part of the aging process, or osteoarthritis);
- Herniated nucleus pulposus (HNP) or herniated disc;
- Lumbar strain;
- Nerve root compression;
- Rheumatoid arthritis (RA);
- Spinal cord injury
- Spinal stenosis (cervical spinal stenosis and lumbar spinal stenosis);
- Tumor; and
- Vertebrogenic pain syndrome
What Back Conditions Qualify for Disability?
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 a disability claim for back pain and why maintaining your credibility is so important when you are trying to get approved for disability benefits for back pain.
Can You Obtain Disability Insurance Benefits for Back Pain?
If you experience back pain regularly, you know that back pain can be agonizing and frustrating, affecting your ability to work. The issue is how your back pain impairs your daily functioning, including standing, walking, bending, stooping, twisting, lifting, etc. These are your functional limitations. If your chronic back pain impairs your ability to perform work-like activities, you may be eligible for long term disability benefits. Your functional limitations should be included in your medical records, and a residual functional capacity (RFC) form can also help you document your limitations. If your doctor cannot complete the RFC form, they may refer you to physical therapy for assistance with the form.
Long term disability insurance companies do not hand out LTD benefits readily for back pain conditions. To qualify for disability, you should provide adequate proof of a medically determinable impairment. This means you should submit as much objective medical proof supporting your claim as possible, including x-rays, MRIs, CT scans, and treatment notes from a physical examination that demonstrate your back pain is caused by a physical abnormality in the spine or spinal canal.
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 long term disability insurance benefits, even if they are documented with an x-ray or some other objective evidence. If you have back pain without evidence of back problems or another medically determinable physical impairment normally expected to produce pain symptoms (like evidence of a herniated disc that is “pinching” a nerve in your spinal cord), you are unlikely to qualify for benefits.
What About Social Security Disability?
Are you seeking information on receiving Social Security Disability benefits from the Social Security Administration (SSA) for your chronic back pain? Click here to read our explanation of the various musculoskeletal disorders recognized by the Social Security Administration and how your condition could qualify you to receive Social Security Disability benefits.
How the Long Term Disability Insurance Company Evaluates the Severity of Your Back Pain
Disability insurance adjusters (claims handlers) review many disability claims for back pain but only approve a few of the most severe cases to get disability benefits. 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 of 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 large part 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 claim — 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, physical 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
- The pain levels others with your physical findings typically report.
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 cannot work for a living, you may very well be entitled to disability benefits. Because of the complexities of proving that a back pain disorder disables you, it would be in your best interest to consult with an experienced long term disability attorney. If your claim is improperly handled, your appeal may never be approved while your bills pile up.
An experienced long term disability lawyer knows how to obtain the proper documents and medical opinions to satisfy your burden of proof. Mr. Ortiz is an experienced LTD attorney who can offer legal advice and guidance to help you navigate your claim. He and his firm will work with you and your medical team to get the compensation you deserve.
Request a Free Consultation
If your claim has been wrongfully denied or terminated, call (888) 321-8131 to request a free case evaluation. You will only need to answer a few questions to help us determine if we can assist you with your claim. Afterward, we can schedule a time to discuss your claim with an attorney.