Disability insurance companies don’t always make it easy for policyholders who have low back problems to get the disability benefits they deserve. Low back pain is one of the most common reasons for filing a disability claim, and carriers are notorious for denying and terminating low back claims.
The Common Reasons Disability Carriers Deny Low Back Pain or Lumbar Spine Disorder Disability Claims
Many claims are denied because the disability insurance company says:
(1) There is no objective basis of the diagnosis,
(2) There is no objective basis for the restrictions and limitations assigned by your physician because of your low back problems,
(3) There is no causal relationship between your low back diagnosis and/or restrictions and limitations, and your inability to do your own or any occupation.
(4) The MRI, CT-Scan, EMG/NCT are normal or consistent with your age,
(5) Your pain is subjective, and
(6) The surveillance shows that you can do more than you or your doctor say you can do.
Nancy Cavey, with 35 years experience handling disability claims, has successfully represented many policyholders with low back problems. Ms. Cavey overcomes a claims denial by working closely with you and your physician. She has had low back surgery herself, so she understands what you are going through!
She offers a free initial consultation and welcomes the opportunity to speak with you about your disability claim.
What Are The Causes of Chronic Back Pain and Symptoms?
Your spine is a beautiful piece of architecture. The principal building block is bone, which can have structural problems, including degenerative disc disease, stenosis, facet arthrosis, osteophytes, bone spurs, foraminal narrowing, or osteoporosis. Any one of these structural problems can cause pain or dysfunction.
Between the bones of the spine are discs that allow you to move your spine. The disc is a pad of cartilage that has a tough outer layer called the annulus, and a soft inner layer called the nucleus. It is like a jelly-filled lifesaver.
In a herniated disc, a portion of the nucleus pushes out through a tear in the annulus. This can irritate the nerves of the spine, which carry electrical signals from the brain to the legs and feet.
Common symptoms of a herniated disc can include sciatica, a radiating pain with tingling and numbness that starts in your buttock and travels down your leg. You also might have back pain and numbness with weakness of your legs.
Degenerative Disc Disease
Degenerative disc disease also can cause chronic back pain that can flare-up with severe lower back pain that can radiate into the hips down to the knee.
A narrowing of the spine, spinal stenosis, can cause pain or numbness in your back and legs. It can result in weakness and a loss of sensation in your legs. Severe cases can result in bowel or bladder problems.
How Do I Get The Disability Insurance Benefits I Deserve?
Regardless of your diagnosis, back pain and radiculopathy can interfere not only with your daily activities but with your ability to work. If you no longer can work or your doctor has told you to apply for disability before you apply for benefits, you should:
- Obtain a copy of your disability policy. See how it defines “disability,” “occupation” and “self-reported conditions.” You’ll need to understand what you have to prove and whether there are limitations in your coverage.
Some policies consider back pain without objective findings a subjective condition and limit benefits to two years. Find any applicable policy limits before you apply for benefits.
- Obtain a copy of your medical records. Review them to see if there is an objective basis for your diagnosis, what your records say about your report of symptoms and your restrictions and limitations. In denying claims, carriers commonly say there is “no objective evidence to support your subjective complaints of pain.’’
Often there just are no objective findings on x-rays, CT scans or MRIs to explain someone’s pain. The disability carrier often makes a leap of logic and concludes that the policyholder either is exaggerating or faking their pain. Nancy Cavey, who has had spine surgery herself, knows what proof is necessary to meet the policy definition of disability.
- Obtain a copy of your personnel file to see whether your back pain has affected your work performance.
- Obtain a copy of your job description. Create your own description of your physical duties with an explanation of how your symptoms impact your ability to do your occupation.
- Provide your doctor with the occupational description. Ask your doctor to prepare a report that explains the objective basis for your diagnosis, the objective basis of your restrictions and limitations, and the objective reasons you can’t perform some or all of the material and substantial duties of your occupation.
- Prepare a pain diary that explains your pain and the side effects of the medication you are taking. Be sure to give examples of how your low back pain and symptoms interfere with your ability to do things on a daily basis. Your pain also may give you problems with concentration.
- Hire Nancy Cavey to help you file your initial application. The application process is confusing and designed so you and your physician make mistakes that can result in a delay or even a denial of your benefits. Ms. Cavey knows how to prepare and file a winning shock and awe disability application that leaves the carrier little reason to question your claim.
- Hire Nancy Cavey to help you appeal a wrongful denial or termination of your disability benefits. Disability carriers are in the business of collecting premiums and not paying disability benefits for low back pain. They’ll use any reason to deny your claim. The odds of getting your benefits on appeal are greater when you are represented by an experienced ERISA/private ID policy disability attorney.
Contact Disability Attorney Nancy L. Cavey, Who Can Help You Regardless of Where You Live
Low back pain can make it difficult, if not impossible, to work. You owe it to yourself and your family to get help today! Nancy Cavey can review your policy and your medical records, and explain to you what your policy says and how to get your disability benefits. Call today for a free consultation at 727-894-3188.