Disability Benefits for Back and Neck Pain

According to WebMD, one of the leading causes of disability is back pain. Back and neck pain and other spinal impairments are caused by accidents, working conditions, and the aging process. Certain professions are especially prone to back and neck disability claims such as surgeons and dental professionals. Depending on the nature of the condition and its severity, spinal impairments can result in disability. However, it is important to understand that except for severe trauma to the spine that results in paralysis or hemiparesis, disability is not due to the impairment itself, but is usually due to the symptoms of the condition. For that reason, disability claims involving spinal impairments can be difficult to assess because there is no objective means of measuring pain and discomfort. Moreover, a back or neck disability that might be career-ending for people who work in certain professions or occupations may not be disabling for those who work in other occupations.

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 disabling 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.