What Kind of Spinal Conditions Is Disabling?
A host of conditions can result in disability due to a “bad back.” To name some, common conditions that are often the basis of a disability benefits claim include:
All of those conditions can affect one or all three of the main parts of the spine – the cervical spine (neck), the thoracic spine (mid-back), and the lumbar or lumbosacral spine (lower back).
In addition to causing pain, spinal impairments can result in a loss of feeling in the hands and feet, strength deficits, headaches, balance difficulties, and an inability to perform basic activities such as sitting, standing, walking, and lifting.
When Does a Spinal Impairment Become a Disability Claim?
Someone whose ability to work is impacted by a spinal impairment may be entitled to disability insurance benefits. A surgeon or other medical professional who can no longer perform medical procedures due to a spinal impairment may qualify for disability. Likewise, a worker who needs to stand throughout the day may be able to pursue disability benefits. But even someone who sits all day at their job may have a claim if they are unable to tolerate sitting or their spinal impairment keeps them from using a computer at work.
What Is Needed to Prove a Disability Claim Due to a Spinal Impairment?
X-rays, MRI can diagnose spinal conditions and clinical examination findings since certain examination techniques elicit results specific to spinal impairments. Another test that can be very useful is electromyography (EMG), which can detect nerve damage. Even with those tests, though, the findings themselves usually are not sufficient to establish disability. However, symptom complaints themselves, without corroboration from radiologic and electrodiagnostic testing, are generally insufficient to establish disability; and the test results will make symptom complaints more credible.
Of course, the treating physician’s input is critical in establishing disability. The more detailed the doctor’s notes, the likelier it is that the claim will be approved. The notes should also cover a sufficient time to show that the condition is chronic, and repeated findings at each visit help verify the truthfulness of symptom complaints. Also, physical therapy records are invaluable because the therapist documents problems, goals and includes measurements that help corroborate a benefit claim.
What Can I Expect When I Submit a Back and Neck Pain Claim?
So long as the claim is well-supported with test results and examination findings, there is a greater likelihood that the claim will be approved. But not all claims are approved, and the insurance company is likely to investigate the claim thoroughly before approving benefits.
Although all disability insurance companies retain the right to have a claimant examined by a physician of their choosing, such exams are growing rarer. Instead, the insurance companies rely on in-house doctors to review the medical records or hire a consulting physician through an outside vendor. Insurers may also utilize other investigative tools such as surveillance. Although surveillance is not as common as some believe, it is used regularly. And, if a claimant is videotaped performing activities that are inconsistent with what has been claimed, it will be difficult to sustain a claim. Insurers also use social media and even Google to investigate claimants’ activities. Again, if there are activities revealed by such investigations which contradict representations made to the insurance company, that can be problematic.
What Should I Do If My Claim is Denied?
If your claim is denied, you will likely be offered an opportunity to appeal. If your benefits were provided through your employer, the appeal might be mandatory. Although the appeal is intended to be informal, hiring an attorney is virtually compulsory to assure success. Because the appeal may also be the last opportunity to submit evidence that a court would consider if the appeal is unsuccessful, an attorney’s assistance is critical to help navigate the appeal process.
Because back and neck disability claims are often dependent on subjective symptom reports, ways in which the appeal can be enhanced with an attorney’s advice and guidance include assistance in obtaining a functional capacity evaluation to quantify functional limitations. An attorney’s help could also potentially lead to producing a “day-in-the-life” video to depict a typical day in the claimant’s life and collecting other supporting documentation. It may also be necessary to arrange a vocational evaluation to assess the impact of the documented impairments on a claimant’s ability to perform their job.
Hiring an experienced attorney who has handled numerous back and neck disability claims when someone cannot work and their benefits are at stake is essential to success.
It is not necessary to wait for a claim denial to hire an attorney. Hiring an attorney even before claiming disability to solicit advice and guidance can be beneficial in heading off problems down the road.
Know Your Rights
You may qualify for disability benefits if you are experiencing a mental health condition that impacts your ability to work.
Our team has the experience and proven track record to guide you and protect your benefits.
Does This Apply to You?
Contact DeBofsky Sherman Casciari Reynolds P.C. for an attorney consultation. We will work with you to figure out your problem, and how we can help.
Disability and ERISA Lawyers Experienced in Back and Neck Disabilities
DeBofsky Sherman Casciari Reynolds P.C. attorneys understand how difficult it can be to deal with back and neck pain, keep up with your treatment, and navigate the disability benefits process.
- Advice and Consultation Regarding Benefit applications
- Claim appeals if your benefits are denied or terminated
- Challenging the denial or termination of your benefits in court
- Challenging the limitation of your benefits if you have a co-morbid, disabling physical condition
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Sally G| Client
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