Chronic Pain, Your Doctor, and Your Disability Insurance Company
According to the National Institutes of Health, more than 11 percent of Americans experience chronic pain. To put it another way, 25.3 million adults have suffered pain every day for the past three months. These numbers provide a startling reminder of how many people suffer from chronic pain every day. In some cases, the pain may create a minor inconvenience. In other cases, chronic pain can leave people disabled, essentially dominating every day and aspect of their lives.
Chronic Pain Can Disable You
If you suffer from severe chronic pain, you may find it harder and harder to keep a 40-hour work week. Your absences pile up, and you may soon exhaust your sick leave. After consultation, your treating doctor diagnoses you with chronic pain. In addition, your treating doctor states that you should not return to work.
Because you can’t work and you exhausted your sick leave, you contact your individual or group long-term disability insurance carrier, hoping to receive timely benefits. Your carrier reviews your claim application, and despite your treating doctor’s recommendation, the insurance company denies your valid disability claim.
The situation has pitted your treating doctor against your disability insurance company. Do you focus on your health and risk financial ruin? Or do you try to struggle through, knowing that you’ll probably get fired because you can’t perform the important duties of your occupation? You’re stuck in the middle with a lot to lose.
You need someone on your side who can help you get what you need, and fight for what you deserve. Call DarrasLaw now at (800) 458-4577.
The Challenge of Chronic Pain
Disability insurance cases that involve chronic pain face unique challenges. Individual and group long-term disability insurance companies want objective, hard medical proof of a disability before they agree to pay out monthly benefits.
Unfortunately, chronic pain doesn’t always produce physical manifestations. Unlike something that an X-ray or MRI can reveal, chronic pain is something the patient feels. Either treating doctors cannot identify the cause of the pain, or believe it may result from multiple causes. It can prove difficult to treat, and treatments that successfully helped manage the pain can suddenly stop working or produce other problems, like addiction. It may take your treating doctor quite a while to identify the appropriate course of treatment, prescriptions, and care.
Meanwhile, your debilitating pain makes it nearly impossible for you to perform the important duties of your occupation. Your performance suffers, leading to negative reviews and maybe even disciplinary action. You decide that you need to seek disability because it isn’t fair to your employer or your co-workers that you can’t pull your weight.
To make matters worse, now you are faced with skepticism from your disability insurance company, despite all those premiums that were timely paid.
Documentation Is Critical
Insurance companies rely heavily on medical documentation when deciding whether to approve a valid disability claim. It goes without saying that they won’t just take your word for it that you’re disabled—they want proper and persuasive medical proof that demonstrates that you are unable to perform the important duties of your occupation. Most people are caught off guard when they learn that the insurance company won’t take their treating doctor’s word for it, either.
Keep in mind that treating doctors are not experts on how to prepare a disability claim—their focus is on the diagnosis, course and progress of treatment.
It’s not enough for your treating doctor to write a report that merely states that you can’t return to work. Instead, the documentation needs to indicate why you can’t return to work and provide as much specific detail as possible. For example, the documentation should contain the following information:
- A summary of your occupation, including your daily responsibilities and activities that are necessary for its performance, both physical and mental
- A specific itemization of all the ways your chronic pain limits your ability to reliably perform the important duties of your occupation
- A specific statement that your condition will not improve if you return to work, and that returning to work would make your condition worse
It may also help if your treating doctor indicates expertise or significant experience in treating patients who suffer from chronic pain. In short, you want the documentation to offer as much compelling medical evidence and objective proof as possible that your condition is genuine and that you are entitled to payment under your individual or group disability policy.
Consult DarrasLaw. Our seasoned long-term disability attorneys and stellar ERISA disability lawyers understand chronic pain and can help you and your treating doctors present the proper medical and occupational evidence to your disability carrier.
How to Move Forward
We always recommend that people consult with DarrasLaw’s premier long-term disability attorneys and nationally respected ERISA disability lawyers before beginning the claim application process. However, we understand that most people assume that their insurance company will do the right thing and timely pay their valid claims for individual or group disability benefits.
If your insurer has denied your valid claim, you realize now that this is not the case—your disability carrier probably told you which forms to fill out and not much else. If you received a denial of your valid claim, we strongly urge you to consult with a top rated disability insurance attorney or nationally preeminent ERISA disability lawyer at DarrasLaw as soon as possible.
If you have a group ERISA long-term disability policy, the next step is for you to timely file a comprehensive administrative appeal. The administrative appeal is time-sensitive, and failing to file by the strict and unforgiving deadline could result in a permanent loss of your legal rights. As part of the administrative appeal, you will need to go back to your doctor and request a letter or memorandum that includes the disability information, along with updated testing, films, MRIs, CTs, and medications tried.
If you are unsuccessful in the group administrative appeal, your last remaining option is to file a federal ERISA lawsuit.
Under a federal law known as the Employee Retirement Income Security Act of 1974 (ERISA), a federal judge in an ERISA group claim may only rule on the medical records, statements, and documentation you and your carrier used in the underlying claim and your administrative appeal. The judge will review the record and will generally only overturn the insurer’s decision if it was arbitrary and capricious.
If you believe that you have a valid group long-term disability claim, consult a nationally prominent ERISA disability attorney from DarrasLaw right away.
ERISA is difficult for most attorneys to navigate successfully, let alone non-lawyers. You will need to litigate against a corporate legal entity that will certainly retain experienced ERISA legal representation. If you choose to proceed without a top-rated national group ERISA attorney at DarrasLaw, your chances of success will be in jeopardy.
ERISA generally does not govern individual disability plans that you purchase out of your own pocket from an agent or broker. You have many more legal rights and consumer protections when contesting a wrongful delay, denial, or termination of individual disability benefits.
If you buy individual disability insurance, then you face a more traditional litigation process that may not require an administrative appeal. You may generally take your bad-faith disability denial straight to the courts in most cases. There, you may submit evidence, use discovery to get insurance company documents, call witnesses on your behalf, cross-examine the insurance company’s personnel, and try your case before a jury. You may also seek emotional distress, punishment damages and attorney fees, depending on the state you live in. Individual disability benefits also flow tax-free if you paid the premiums.
Contact a Top Rated Long-Term Disability Attorney or Seasoned National ERISA Lawyer at DarrasLaw for Help
If you suffer from chronic pain and are unable to work, you need someone to help you understand your options. DarrasLaw is an award-winning and nationally recognized disability litigation firm whose top-ranked disability lawyers and knowledgeable national group ERISA attorneys have helped thousands get the individual and group disability benefits they deserved.