Hello everyone, I’m Nick Ortiz. I’m a board certified disability insurance attorney, and owner of the Ortiz law firm.
Today I’m here to talk to you about back pain and lumbar spine problems as they relate to long term disability claims. So you’re probably here today because you have a back pain problem. And that may be caused due to degenerative disc disease, a disc herniation, a bulging disc, an annular tear, a burst fracture, something along those lines in your lumbar spine. And your lumbar spine is obviously the lower back, for low back pain.
And you’re wondering “what type of evidence do I need to win my long term disability claim with an insurance company?”
So that’s what we’re here today to talk about. The most important thing in a lumbar spine case is the medical evidence to support your case. The gold standard in a back pain problem is an MRI, to show the full extent of your medical problem. So if you’ve had an MRI performed, then you want to make sure that that is part of your record. And not just the image, not the picture of the MRI, but want you really want to have is the radiology report. That is the written report identifying the problems that you have. You may also have x-ray evidence. Evidence of your treatment notes with your primary care doctor, a pain management doctor, a chiropractor, that goes to show their physical examination findings as well. Because that will also go to show the full extent of the problems that you’re having in terms of range of motion issues, straight leg testing, they’ll get into a lot of detail about the restrictions that you have as a result of your condition.
Perhaps as a way to further illustrate this point, I have an idea, so I’m going to go grab something that will help us understand this a little bit better. So here we have a representation of what a couple of the vertebrae from the lumbar spine look like. And so we have the two vertebrae here. We have the disc in between the vertebrae here, and right in between the two literally here and then in the middle denoted by this red part here this is the nucleus pulposus. And this is the central part of your disc. And its all soft tissue in nature. That’s why and MRI is so important to be used and its the gold standard is because an x-ray will pick up the boney structure which is the vertebrae. But it doesn’t pick up the soft tissue in between the vertebrae which is the disc, and the nucleus of the disc, and this is the spinal cord which has all the nerve root endings. So none of that soft tissue from the core to the disc will show up in an x-ray. An MRI goes to show the soft tissue damage that occurs. So this is a sample of when the nucleus herniates extends out. And you’ll see this is one of the nerve root endings that extends out from the spinal cord and it is impacting it and indenting it and its causing what we refer to as a pinched nerve. So if you’ve heard the term I have a pinched nerve in my back, that’s what this is referring to. This is an HNP, a herniated disc punching into the nerve root. And that’s what’s causing the significant pain cause these are nerve root endings.
So if you have an MRI that shows an HNP, herniated disc that’s causing a pinched nerve, that is great evidence to show the extent of a condition that is reasonably expected to produce significant pain.
Then we want to take things one step further. Not only do you want to have the medical evidence, you want to have opinion evidence from your treating doctor about what your functional restrictions are as a result of your condition. What that means is its one thing to be diagnosed with a condition like degenerative disc disease, or herniated disc, but the real question is how does that impact you? For example, you might have someone who has a high pain threshold, and they could take a couple pain pills and even if they have a herniated disc, they’re basically okay enough to function get up and go to work and they’re okay. But then you have someone else who maybe doesn’t have as high of the pain threshold. Even if they’re taking multiple pain pills their still in excruciating pain and can barely get out of bed. And they are unable to function in their daily life. The question is, where are you on that scale? From very mildly limited to extremely limited and your doctor can help flush that out as it applies to your individual case. So what we use is medical source statements or they are sometimes referred to as residual functional capacity evaluation forms. They are meant to try to flush out the full extent of your level of impairment in your individual case.
The insurance company will sometimes give you an attending physician’s statement that you’re to take to your doctor, but they are super generic and you really want one that’s customized to your individual case. I can tell you that here at the Ortiz law firm, we have a custom lumbar spine questionnaire that’s specifically tailored to lumbar spine problems. Some other things that you might add to your claim in addition to the medical evidence, the opinion evidence, is a statement from you, maybe a sworn statement, or an affidavit under penalty or perjury about the specific restrictions that you have as the results of your pain.
You might also go over the limitations you have as a result of your medications. Any negative side effects that you have. You really want to spell those out in a statement, because the more evidence you have that shows your functional impairment, the more likely the insurance company is to approve your case. So we help our clients package together all the evidence that we think is critical to getting an approval of an LTD case. If you’d like to talk to us further about what we could do to help you then we encourage you to contact us today at 850-898-9904 for a consultation. We do offer free consultations to those that have been denied benefits by the insurance company. If you’d like some other additional information in writing, then I do have an offer to make to you and that is I’ve written a book called The Top 10 Mistakes That Will Destroy Your Long Term Disability Claim. You can download a free digital copy of the book at www.FreeLTDBook.com today and I’ll electronically send you a free copy of that book. So we look forward to hearing from you and good luck with your claim.