Posted on Thursday, September 1st, 2022 at 8:12 pm
Injuries or diseases of the back can cause intense, debilitating, and long-lasting pain. If you cannot work due to severe back pain, you might consider pursuing financial support through long term disability (LTD) benefits.
Back Pain Conditions that Could Qualify
Back pain by itself does not qualify someone for long term disability benefits. There must be an underlying condition that impacts your back’s structure or function, causes pain, and leaves you unable to work according to your policy’s type and terms.
You should start working with your doctor as soon as possible to identify the cause of your back pain. Some possible reasons for back pain include:
- Back injury – Pulled muscles, repetitive strain injury, or torn ligaments can cause back pain to build suddenly through trauma or gradually through aging and exertion.
- Herniated/ruptured/slipped disc – This injury occurs when a disc’s outer layer tears and the inner layer seeps through to the spinal cavity, causing shooting pain, tingles, and numbness.
- Bulging disc – If a disc is swollen, it may press against a nerve, causing back pain and “referred pain” in other body regions.
- Sciatica – Sciatica involves back pain that “shoots down” toward one or both legs. In nine out of ten sciatica patients, the cause is a slipped disc pressing against the sciatic nerve, which extends from the leg to the foot.
- Spinal stenosis – In spinal stenosis, a region of the patient’s spinal canal is too narrow, which puts pressure on the spinal cord. Back pain from spinal stenosis worsens upon standing. Patients may also experience mobility issues or problems controlling bodily functions.
- Ankylosing spondylitis (AS) – AS is a form of arthritis that affects the spine, causing lower back pain. As with rheumatoid arthritis, AS symptoms result from an overactive immune system. However, researchers do not know what first triggers the disease.
- Disc degeneration – Degenerative disc disease (DDD) is common in older people. Patients may have shorter, firmer discs with less fluid to lubricate their movement. Pain, arthritis, spinal stenosis, or other back conditions can develop from DDD.
Know Your Policy
Before preparing your application, you should understand the terms of your LTD policy. There are two common types of LTD policies:
- Own-occupation policies – Under an own-occupation policy, you might be eligible for LTD benefits if you cannot work in your specific role due to your disability.
- Any-occupation policies – Under an any-occupation policy, you might be eligible for LTD benefits if you cannot work in any role due to your disability.
The type of policy you have can determine your eligibility to obtain benefits. Some policies could have terms that change over time. For example, a policy may begin as an own-occupation policy, then change to an any-occupation policy after a certain listed date.
No matter your policy’s type, it will generally have a clause on “pre-existing conditions.” If your back pain began before you had LTD coverage, the insurer might deny your application for benefits. The policy may also exclude coverage for specific disabilities, including conditions that developed under certain circumstances. Your lawyer can help you understand these important clauses.
Documenting Back Pain for Your LTD Application
Your application for LTD benefits must contain medical documentation about your back pain. The documentation should provide answers to the following questions:
- Symptoms – What part of your back hurts? How severe is the pain, and how would you describe it? You should keep a personal pain diary to accompany your doctor’s reports.
- Ability to work – Your doctor should point to specific medical evidence supporting your inability to work, both in your field and in general.
- Diagnosis – What is the cause of your back pain? Ensure that you include lab test results and images, including X-rays and MRI scans.
- Treatment – What is your treatment plan, and how are you following it? What treatments have you tried that didn’t work?
- Specialty referrals – Did your GP send you to an orthopedic or rheumatology clinic? You should submit findings and recommendations from each specialist who treated your back pain.
- Mental health – Severe or chronic pain can cause depression and anxiety. How does your mental health factor into your inability to work?
What if My Application Gets Denied?
Back pain is a common complaint that disability insurers receive. They may dismiss your legitimate pain and symptoms to deny your application, using arguments such as:
- Others can work in the same position with the same impairment.
- The applicant’s impairment does not preclude them from working in a different job or career path.
- The applicant’s medical documentation shows signs of improvement or uses language pointing toward improvement.
- The pain the applicant reports is inconsistent with their test results or images.
- The applicant’s prescribed treatment plan does not match the pain they report.
If you need to apply for LTD benefits or you’re struggling with a denied LTD application involving back pain, don’t wait to contact the long term disability attorneys of Abell and Capitan Law. We focus on long term disability law and have a nationwide reach, giving us deep knowledge and experience with insurers’ latest tactics. Our firm can help you file your initial application, appeal denials, and defend your rights if an insurer unfairly changes or terminates your benefits. Call our office today at (267) 419-7888 for a consultation.