Long-Term Disability for Spondylolisthesis

Spondylolisthesis occurs when a vertebra slips out of its proper position and onto the vertebra below it. It can happen in any part of the spine, but it most commonly affects the lower back (lumbar spine). This condition can compress nerves in the spine, resulting in back pain, numbness, and weakness in one or both legs. Some individuals may not experience any symptoms until years later.

Not everyone with spondylolisthesis is entitled to long-term disability benefits. Even if it does prevent you from working, disability insurance carriers do not make it easy for claimants to get the benefits they deserve. If you have been denied long-term disability for spondylolisthesis, Ortiz Law Firm can help you appeal the denial and recover the benefits you deserve.

Types of Spondylolisthesis

There are several types of spondylolisthesis with different causes:

• Congenital spondylolisthesis is a rare type of spondylolisthesis that occurs at birth and is caused by a defect in the formation of the spine.
• Isthmic spondylolisthesis is caused by a defect in the small bony arch connecting a vertebra’s upper and lower facets.
• The most common type is degenerative spondylolisthesis, caused by the normal wear and tear of the spine that occurs with aging.
• A traumatic injury to the spine causes traumatic spondylolisthesis.
• Pathological spondylolisthesis happens when a disease like osteoporosis or a tumor leads to the condition.
• When spondylolisthesis occurs after spinal surgery, it’s known as post-surgical spondylolisthesis.

When evaluating the severity of spondylolisthesis, your healthcare provider will assign it a grade.

• For low-grade spondylolisthesis, which includes Grade I and Grade II, surgery usually isn’t necessary. These low-grade cases often occur in teenagers with isthmic spondylolisthesis and are almost always seen in people with degenerative spondylolisthesis.
• On the other hand, high-grade spondylolisthesis, covering Grade III, Grade IV, and Grade V, might need surgery, especially if you’re experiencing a lot of pain.

Symptoms of Spondylolisthesis

Not everyone with spondylolisthesis will notice symptoms, but when they do, lower back pain is often the main one. This pain ranges from mild to severe and might spread to the buttocks or legs. People with this condition also might find their leg muscles getting weaker. This can make daily tasks like walking, standing, or climbing stairs difficult. Sometimes, spondylolisthesis can press on the nerves, causing numbness or tingling in the legs or feet. It might also stiffen the lower back, limiting how much you can move or bend.

Severe cases of spondylolisthesis can sometimes cause a critical condition known as cauda equina syndrome. This occurs when nerves at the base of your spine get squeezed in an area called the cauda equina. This compression can lead to a loss of sensation in your legs and impact your bladder function. Without prompt treatment, it could result in permanent bladder issues and paralysis.

Treatment for Spondylolisthesis

The treatment for spondylolisthesis can vary depending on the severity of the condition and the present symptoms. Some common treatments include:

• Taking a break from sports and all other high-energy activities might be necessary.
• Your doctor could suggest common pain relievers like ibuprofen or naproxen to ease your discomfort.
• Steroid injections directly in the painful area can also provide relief.
• Daily physical therapy exercises focusing on stretching and strengthening the muscles around your abdomen and lower back can help reduce your pain.
• For kids dealing with vertebral fractures (spondylolysis), wearing a back brace can limit their movement, allowing the fractures to heal properly.
• In severe cases, surgery may be necessary to realign and stabilize the spine.

How Do Disability Insurance Companies Evaluate Spondylolisthesis Claims?

Disability insurance companies handle spondylolisthesis claims like any other disability claim by reviewing the evidence and determining whether the individual meets the requirements for disability benefits. However, spondylolisthesis claims can be more complicated than other claims because the symptoms and limitations can vary widely depending on the severity of the condition.

When evaluating spondylolisthesis claims, disability insurance companies focus on medical evidence and the condition’s effect on your ability to work. They’ll look at your doctor’s notes, MRI or X-ray results, and any treatment plans to understand the severity of your condition. The insurance company may also require an independent medical examination to confirm the diagnosis and evaluate the severity of the condition. They’re checking to see if your spondylolisthesis limits your work activities or if it’s manageable with treatment. Failure to follow the recommended treatment plan could hurt your chances of being approved for long-term disability benefits.

The insurance company will also assess how your job duties align with your physical capabilities by hiring a vocational expert to review the claimant’s work history, education, and transferable skills to determine whether the individual can perform any other work. For instance, if your job requires heavy lifting and you have severe spondylolisthesis, they’ll consider how that affects your employability. It’s key to provide detailed medical records and clear explanations of how your condition affects your daily work life.

Documenting How Your Symptoms Affect Your Ability To Work

If you’re dealing with symptoms from spondylolisthesis or another health issue, it’s crucial to get medical help right away. If your health problem is serious enough to keep you from working, you might qualify for long-term disability benefits. You need to show medical proof of your condition to get these benefits. This includes details about what you’re diagnosed with, how severe it is, and how it affects your work.

You’ll need medical records, diagnostic imaging results, and statements from your doctors. Documenting your symptoms and how they affect your ability to work is crucial in establishing a claim for disability benefits related to spondylolisthesis or any other medical condition. Here are some things that should be documented in your medical records or with a residual functional capacity (RFC) form:

• Description of the symptoms experienced by the patient, including pain, stiffness, numbness, tingling, or weakness in the legs, feet, or back.
• The severity of the symptoms, including how often they occur and how long they last.
• Any aggravating or alleviating factors, such as movement or rest.
• How the symptoms impact the patient’s daily activities, including their ability to work.
• The patient’s job duties and physical demands of their work.
• Limitations or restrictions on the patient’s ability to perform their job duties, such as lifting, standing, walking, or sitting for extended periods.
• Any accommodations that could be made to allow the patient to continue working, such as reduced hours or modified job duties.
• The patient’s history of absenteeism or work-related injuries.

Why Do Insurance Companies Deny Long-Term Disability Claims?

Insurance companies deny long-term disability claims related to spondylolisthesis for various reasons, some of which may be legitimate and others that may be unfair or even unlawful. Here are some common reasons why spondylolisthesis long-term disability claims are denied:

• Lack of Medical Evidence: Disability claims require strong medical evidence to support the diagnosis and severity of the condition. If the claimant’s medical records are incomplete or do not support the diagnosis of spondylolisthesis, or if there is insufficient evidence of the severity of the condition, the claim may be denied.
• Failure to Follow Treatment Plan: Insurance companies expect claimants to follow the recommended treatment plan and comply with their doctors’ orders. If the claimant refuses or fails to follow through with treatment for spondylolisthesis, the claim may be denied.
• Dispute Over the Severity of the Disability: Insurance companies may dispute the severity of the claimant’s spondylolisthesis, arguing that the individual can perform some work or that the conditions’ limitations and restrictions do not prevent the individual from working.
• Pre-Existing Conditions: Insurance companies may deny a claim if the claimant received treatment for spondylolisthesis within a certain period, citing the exclusion of pre-existing conditions included in most policies.
• Policy Limitations: Disability insurance policies may limit coverage for certain conditions, including spondylolisthesis. If the policy does not cover spondylolisthesis or if coverage is limited, the claim may be denied.

Remember, disability insurance companies have a financial incentive to deny claims. They use sneaky tricks and tactics to delay or deny claims related to spondylolisthesis. If your claim has been denied, you should consider working with an experienced disability attorney who can help navigate the appeal process, ensure the appeal is well-supported by medical evidence, and present that evidence in the best possible light to increase your chances of a successful appeal.

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

Nick Ortiz is a national long-term disability attorney who has handled long-term disability insurance claims since 2005. He offers a free case review if your claim has been wrongfully denied or terminated. If you would like to discuss your long-term disability denial and how we can help you recover your rightful benefits, contact us online or call us at (888) 321-8131.