6 Potential Pitfalls of Your Chronic Back Pain Disability Claim

Almost everyone will experience some sort of back pain during the course of their lives.  This can extend from the cervical to thoracic to lumbar, not to mention shooting into arms and legs, and range in severity from a minor, short-term twinge to protracted, excruciating pains that last for months.  For people who deal with chronic back pain on a daily basis, performing what used to be simple tasks and normal work functions can become difficult and sometimes unbearable.  Even with surgical intervention, the pain may prove too overwhelming for many people.  In addition, this pain can lead to a host of other conditions such as depression and anxiety.  When this occurs, sufferers of chronic back pain may need to consider applying for their disability benefits.

The claim process is full of unexpected pitfalls and hurdles that may weaken the claim and cause benefits to either be delayed or denied, preventing you from having the money you were counting on to pay the many bills that crop up when you become disabled.  These following six tips represent some of the most common problems our clients have experienced when filing their claim for benefits based upon conditions that cause chronic back pain and the ways to avoid these problems, helping you receive your benefits as soon as possible when you need them most.  

1. Make sure you receive a proper diagnosis.  Chronic back pain is a bit unique in that many people can suffer from it to some degree for most of their lives.  Many of our clients had been experiencing back pain for years before it became too unbearable and caused them to file for disability benefits.  While this on its own is not a bad thing, the lack of a specific, disabling diagnosis can be used as a defense by some insurance companies.  Although you may have been seeing your regular physician to receive pain medications and other treatments for your chronic pain, claims examiners can try and poke holes in your claim by alleging that you hadn’t been receiving proper care and treatment from a specialist or by having their in-house physicians say that you’re not prevented from performing your duties.  Commonly accepted medical guidelines recommend that physicians should not diagnose the causes of chronic back pain at the beginning but that they should try and treat the pain first to see if it’s chronic or acute before pursuing a diagnosis.  Waiting until you can no longer handle the pain before visiting the doctor may set your claim back months, which can mean months of missed benefits.
2. Follow all of the doctors’ recommendations – but first, make sure you both agree on your treatment plan.  Similar to the previous point, some individuals have been dealing with their back pain for so long that believe that they know what’s best to reduce their pain and help them feel better.  While this may be true, if claimants plan on receiving disability benefits, it’s important to see your doctors and follow their treatment recommendations, even if it means considering (but not necessarily having) surgery.  Depending on the causes of the back pain, there are many different invasive and non-surgical treatment options available today, so claimants and their physicians need to have candid and open discussions of what is the best or most appropriate treatment plan as of that appointment.  Regardless of your opinion, an insurance company can deny your claim for not following your physician’s orders.  This includes relying exclusively on non-traditional treatments such as acupuncture and supplements.  Those may be effective but it only as complements to traditional Western medicine in the opinion of many disability insurance companies.
3. Do not allow the insurance company to classify your claim as a mental health issue.  Chronic back pain can lead to a host of complications, such as depression, anxiety, and fatigue.  When obtaining a diagnosis from your primary physician or specialist, make sure that any mental health issues that may be present are specifically attributed to the cause, the chronic pain and/or the treatments of that pain.  Many disability policies now have clauses that allow the insurance companies to dramatically reduce the maximum length of the benefit period for claims due to mental, nervous or even self-reported conditions, so they will often try and label any claims that have such aspects into these categories to reduce their total liability for benefits.  Much more information on this sensitive topic can be found here.
4. Provide an accurate and thorough job description.  If you pay attention to many of our previous blogs, you will see this point over and over again.  We continue to bring it up because it’s so important!  Disability insurance benefits are only approved if your condition causes you to be unable to perform the duties of your occupation (or, of “any occ,” depending on the policy terms and conditions.  Claims examiners will base their view of the duties of your job on your job description.  If you leave this up to your employer or the insurance company, they can use a job description that marginalizes your actual material duties and uses very liberal definitions of the duties that are listed.  This approach gives the insurance company the latitude to deny your claim based on a job description that may not accurately describe what you did.  For example, we have a client who was considered a senior account executive when in fact he was a vice president of sales for a large, multi-national corporation.  As you can probably imagine, the job descriptions were radically different.  Providing a detailed and complete job description allows you to describe the material duties of your occupation.
5. Be aware for surveillance.  Surveillance is a common tactic used by insurance companies to intimidate some claimants and find new reasons to deny others.  Chronic back pain is a condition that has its good days and bad days, so surveillance can easily be misused against many claims.  There is absolutely nothing wrong with doing what you can.  But if you happen to be surveilled during a time when your pain has subsided enough to be a little more active in the community, an investigator may capture these moments and a claims examiner may consider them not necessarily in context as a reason to deny your claim.  There are several ways to avoid these complications.  First and foremost, be truthful when filling out your claim forms.  Exaggerating your symptoms or your inabilities can come back to haunt you.  It’s also vital that you work with your physician to make sure that your restrictions and limitations are well documented in your medical records and are able to accurately portray these facts to the claims examiner.
6. Stay calm and focus on your health.  Applying for disability benefits can be a long and stressful process.  If you begin to worry too much about the process, your already fragile mental and physical states can be damaged even further.  Another insurance company tactic is to drag the process along, while they’re supposedly documenting and investigating your claim, and stress claimants out until they either give up or feel they have to accept an inappropriate denial.  Taking care of your body and  managing your stress levels enables you to think through the process clearly and keep your focus on getting better and back to work, when and if possible.  Aggressive claims examiners often leverage these stress levels to prompt claimants to make mistakes or comments that can be used against them in a claim denial.

Chronic back pain is a condition that may not seem that evident to others at first, but the excruciating levels of pain often makes sufferers unable to concentrate on basic daily tasks.  The longer this condition continues, the worse and more complicated it can become.  We have many clients who would love to return to work, but their conditions don’t even let them get out of bed on some days.  Because of this, many claimants get angry and don’t know what to do when a claims examiner starts to question whether or not they could really work and if they’re actually suffering the extent of pain that they claim.  When this happens, it may be time to bring in outside help to assist you with your claim.  Claims examiners are experts at manipulating feeling and emotions to get what they want, and insurance companies have vast resources to prove their one side of the story, often regardless of the information submitted.  Hiring a experienced disability claims consultant or ERISA attorney to help guide you through this process can reduce its stress on your life and help you receive the benefits you deserve more quickly.

If you have any questions, or would like more information on your specific claim, please sign up for a free consultation on the right-hand side of this page or call our offices toll-free at (855) 828-4100.