Back Pain and Long Term Disability Claims: How to Get and Keep Your Benefits

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If your back hurts, you are not alone. About 15 to 20 percent of adults will have back pain in a given year, and 50 to 80 percent of adults will experience an episode of back pain at some point in their lives. In fact, back pain is the leading cause of disability worldwide.

But while so many people feel your pain, insurance companies ignore it when deciding whether your entitlement to long term disability benefits. Pain is, after all, subjective, and insurance companies often deny or terminate disability claims if your disabling back pain lacks objective evidence. Fortunately, effective ways exist for back pain sufferers to establish objective evidence of their subjective complaints.

Back pain has many potential causes

Back pain is common due to its multiple causes. Back pain may result from, for example, muscle spasms or muscle or ligament strain from strenuous and/or repetitive activity, such as sitting in a fixed position for long periods of time, or constant bending and lifting. Sometimes, the culprit is trauma, such as a car accident, sports injury or a fall. Other common causes include bulging or ruptured discs, spinal stenosis, pinched nerves, arthritis and osteoporosis.

Also, as we age, changes in our spine make us susceptible to back pain and disabling injury from simple activities, like sleeping awkwardly or bending down to pick something up. Often, the cause of the pain is difficult or impossible to pinpoint.

Why back pain can be so debilitating

In many cases, back pain is severe enough to interfere with work duties and activities of daily living. Back pain can make it difficult or impossible for the sufferer to sit at a desk for long periods of time, as office workers are routinely required to do. The condition can limit range of motion, making it impossible for an individual to stoop, bend or perform many forms of manual labor.

What’s more, back pain can radiate to other parts of the body. For instance, sciatica, which refers to pain that radiates along the sciatic nerve, can cause pain to radiate to the hips and legs, buttocks and feet, limiting the sufferer’s ability to walk, stand, sit or lie down.

How insurance companies try to discredit subjective claims

Insurance companies use many tricks and dirty tactics to discredit your suffering. They may accuse you of malingering, which refers to falsification or profound exaggeration of your symptoms for external/secondary gain, such as obtaining long-term disability benefits. Insurance companies may look to show that you did not stop working because of back pain, but because of poor work performance. They may cherry-pick medical records, honing in on words like “improved” and “feels better” in doctors’ reports, and overlooking words like “chronic” and “degenerative.”

Further, insurance companies’ trained medical interrogators will pull comments supporting the denial of your claim from busy, distracted doctors in phone conversations. Often, insurance companies will say the evidence on your imaging studies does not correspond to the level of pain you are claiming. Insurance companies will also point to a lack of medication use as an indication that the pain is mild.

How to show your pain is real

To support your case, start by keeping a pain diary, detailing how the pain impacts your ability to perform your job tasks as well as daily life activities and hobbies or interests. It’s important to see an appropriate specialist, such as, for example, an orthopedic surgeon, neurologist, rheumatologist, or pain management specialist, to obtain a proper diagnosis and prognosis of your disabling condition(s).

You should see your doctor(s) regularly and consistently, as medically appropriate, and make sure they take accurate notes detailing your pain, your symptoms and how they impact your daily life and ability to work. If the doctor prescribes medication, take it, as insurance companies can and will check if you have filled your prescriptions. Obtain studies like MRIs and X-rays, which may provide supporting evidence of a condition that is likely to cause pain. You can also insist that insurance companies present all questions to your physicians in writing, so that the physicians can provide accurate responses without insurance company manipulation.

If you have a long, successful work history, you should collect evidence, such as details of your attendance record, promotions, raises and reviews/ awards. Finally, identify co-workers as well as friends and family members who can provide statements about your work ethic and how the disabling condition has impacted your work and other life activities.

If your long term disability claim has been denied or terminated based on a lack of objective evidence to support your claim, give us a call. We understand your pain, and we understand how to overcome the tactics disability insurance companies employ to wrongfully challenge your right to receive your benefits. Contact our experienced team today for a free consultation.

Evan-Schwartz

Evan S. Schwartz
Founder of Schwartz, Conroy & Hack
800-745-1755
ESS@schlawpc.com

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