Avoiding Pitfalls in Chronic Pain Disability Claims

Several of our clients have become disabled due to chronic pain conditions.  This is an unfortunately common problem.  In fact at some point during their lifetime, more than 10% of workers under the age of 30 will experience chronic pain requiring them to miss work.  Chronic pain is usually less intense than acute pain, which is excruciating and follows a trauma or medical procedure for a specific limited duration.    Chronic pain is also much more than the aches and pains people attribute to getting older.  Chronic pain lasts for months or even years,  fundamentally altering the way people feel on a daily basis and how they behave in work and personal situations.  There are three basic thresholds of what constitutes chronic pain: pain that cannot be remedied through standard treatments, pain that persists beyond the scope of standard treatment, and pain with no known origin.  These vague definitions, as well as the subjectivity of the diagnosis, make the insurance claims of people who have become disabled due to chronic pain conditions prone to being denied by disability insurance companies.  We have seen an increase in the numbers of questioned, delayed, and denied disability claims due to chronic pain recently.  So today, I would like to explain some of the techniques we use to help these disability claims be understood and approved.

  • Provide an accurate and complete medical diagnosis

There are few objective tests for pain, so the doctor will base the diagnosis and treatments on the symptoms reported by the patient.  Disability insurance companies fight claims that have little objective medical evidence – many companies have even imposed 12 or 24-month benefit limits for so called “self-reported” or “non-verified” conditions.  One of the best ways to satisfy the claims examiner and avoid an inevitable delay in benefit payments is to more fully document the underlying condition(s) that cause the chronic pain.  For example, some people develop a chronic pain condition after suffering a broken bone.  Even after the bone has healed, sharp lingering pains and weakness can prevent the individual from being able to work, even at a partial level.  Make sure that you and your doctor clearly document this progression in the medical records to help provide an objective information about the injury and a verifiable cause for the chronic pain condition.

While most chronic pain can be traced to a previous condition or injury, this is not true in all cases.  If a chronic pain condition has no identifiable cause, there are other ways to help strengthen the diagnosis for the disability claim.  One new approach is to use a team of experts, such as a neurologist, a psychiatrist, and an orthopedist, to help diagnose the condition and provide proof through their medical opinions from several perspectives.  While finding and scheduling such a multi-discipline medical examination may be difficult, their report may shed light on better approaches to treat the chronic pain and also provide strong information to satisfy the proof of loss required for a successful claim for disability insurance benefits.

  • Make sure to receive “appropriate” care and treatment

Most disability insurance policies require that the insured must be receiving appropriate care and treatment for their disabling condition.  Chronic pain is notoriously hard to treat and does not have a cure that squares neatly with the diagnosis.  Chronic pain is among an increasing number of conditions that many people choose to treat with alternative or Eastern-style medicine.  These treatments can provide relief for many people and are an important part of their treatment plan.  However, most insurance company doctors will expect (or even demand) that you also receive traditional medical care.  For the purposes of a disability claim, it may be prudent to include traditional along with any alternative types of treatments so the insurance company cannot delay or deny your claim by accusing you of neglecting to receive “appropriate” care and treatment.

  • Provide a thorough and complete job description

I have touched on the physical symptoms  associated with chronic pain, but the psychological and social consequences of chronic pain can be far worse than any physical symptoms.  Over 50% of people dealing with chronic pain report dipping into depression and 10% have even contemplated suicide.  Going from doctor to doctor trying to treat chronic pain with limited or no success can be frustrating and disheartening.  Simply dealing with chronic pain can make a person introverted and prevent them from normal social interactions.  Demonstrating how these related conditions stop you from working will support your disability claim and help get the benefits approved.  For example, if you were a sales professional and your chronic pain limited you from connecting with prospects or reduced your ability to close sales, you may be disabled and qualify for disability benefits.  This approach can also help prevent a total disability claim from being incorrectly labeled a residual disability, an insurance company tactic I blogged about last week.

A complete and thorough job description is one of the best methods to show how your symptoms restrict and limit your ability to work.  If you are experiencing psychological and social issues, make sure the job description includes the material and substantial duties that have been lost due to ALL of the issues involved in the chronic pain condition.  This is the place to describe how sitting all day, as an example, was a material and substantial duty and how the chronic pain prevents you from doing your job.  Your job description is probably the most direct way the insurance company is going to define your job and your important duties.  It’s important to specifically list every important duty and not leave your job description or duties up to interpretation by the insurance company.

These tips are just a sample of the approaches required for a successful claim for disability benefits.  Every claim is unique – and certain approaches work better than others at different insurance companies.  Sometimes subjective conditions like chronic pain are always a problem for insureds due to insurance companies taking advantage of the very nature of the disabling condition – a lack of objective testing or effective treatment – as a reason to deny or delay disability benefits.  Even though you may be in pain, you don’t have to accept this!  Don’t be afraid to question the claims examiner or investigator and push back.

You’re not alone in suffering from chronic pain and struggling with your disability claim.  If you would more advice, please visit our website for disability claim help or call us at 855-828-4100.  If you would like to add your experiences for our readers, feel free to leave your story in the comments section below!

2 thoughts on “Avoiding Pitfalls in Chronic Pain Disability Claims

  1. Pingback: The Doctor’s Corner: 9 Tips for Dealing With Chronic Pain Syndrome | Royal Claims Advocates

  2. Pingback: March Madness: Our Elite Eight Blog Posts | Royal Claims Advocates

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