According to the American Chiropractic Association, “back pain is the single leading cause of disability worldwide.” Each year, half of all working Americans complain of or miss work as the result of back pain. In fact, about 80 percent of Americans will experience back or neck pain at sometime in their life.
As you can imagine, the economy would collapse if half of all working Americans claimed individual or group long-term disability benefits for back pain. In fact, the condition is so common that some individual and group ERISA long-term disability insurers may only cover back pain for 12, 18, or 24 months. This doesn’t change the prominence of neck, back, and spinal injuries in the United States or how they prevent you from performing the material and substantial duties of your occupation.
Spinal injuries such as slipped discs, strains, and sprains caused by accidents are also very common. Serious injuries or illnesses may also cause disabling neck, back, and spinal conditions, including:
- Inflammatory arthritis
- Paralysis
- Fractures
- Infections
- Cancer
If your spinal condition prevents you from performing the important duties of your occupation with reasonable continuity and in the usual and customary way, you may need to fight your individual or group long-term disability insurance company to win your valid disability claim. At DarrasLaw, our top-rated long-term individual disability lawyers and nationally prominent group ERISA attorneys have industry-leading experience as spinal injury practitioners.
Frank N. Darras and his firms have recovered nearly $1 billion in wrongfully delayed, denied, and terminated insurance benefits. Call DarrasLaw to see if our stellar disability attorneys and seasoned group ERISA lawyers can help you. To schedule your free disability policy analysis and free claim consultation, call us today at 800-898-7299 or contact us online.
Individual and Group Long-Term Disability Benefits and Musculoskeletal Injuries
If you suffer from a disabling injury or illness that prevents you from performing the important duties of your occupation, you may qualify for long-term disability insurance benefits. Whether your disability plan is individually purchased from an agent or broker, or sponsored by your employer, union, or government, you’ll need to prove you’re entitled to benefits. Typically, claimants accomplish this by providing their insurer with clear and convincing objective medical evidence, such as MRIs, X-rays, nerve studies, blood tests, pharmacy records, and their treating doctors’ statement of total or partial disability.
Once your treating doctor diagnoses you with a clinical condition, such as a spinal infection, you’ll need to show how your condition prevents you from performing the important duties of your occupation. Even if the injury or illness is inherently disabling in context, such as a construction worker with a broken back, don’t expect the benefit of the doubt. Remember that your long-term disability insurer is looking for ways to cut losses and make money, so you must bulletproof your individual or group long-term disability claim application, even for serious neck and back conditions.
You may also need to prove your employer did not, or cannot, make reasonable accommodations for your illness or injury. Back and neck pain is so common that employers often attempt to offer ergonomic solutions such as standing desks. If your spinal pain, numbness, tingling, or related symptoms keep you from working your occupation even with such accommodations, your treating doctors may need to identify the root of your illness or injury for you to successfully claim individual or group long-term disability benefits.
Overview of the Spine
Your spine actually runs from your brain stem to your pelvis and does more than simply hold you up. Instead, your spine contains the majority of your central nervous system, which is essential to life itself. Your central nervous system controls almost all of your bodily functions, and your spine acts as the central communication hub between your body and brain. An interruption in this signal can result in a variety of symptoms including, but not limited to:
- Paralysis
- Inability to speak
- Inability to breathe
- Inability to control eye movements
Unlike other areas of your body, your central nervous system cannot heal itself. That means surgical intervention is the most appropriate care for most central nervous system injuries. While surgery can help support your spine and technology can help you breathe, injuries to the nerves in your spine or brain are often permanent and disabling.
The spine contains three areas, each of which is essential to your overall health and wellbeing:
- Cervical spine/neck – Seven individual vertebrae constitute your cervical spine, which is responsible for supporting the skull, moving your spine and head, and protecting the nerves that connect your spine to your brain. Injuries to the cervical spine are often the most serious because they threaten your central nervous system, which the brain uses to communicate with the rest of your body. Interruption of this communication can paralyze you from the neck down.
- Thoracic spine – Your thoracic spine’s primary function is to hold together the rib cage and protect your heart and lungs. Thoracic spinal injuries can result in a hunched back and make walking or breathing extremely difficult.
- Lumbar spine – Most back pain is centered in the lumbar spine because its primary function is to bear the weight of your body. Accordingly, you have larger vertebrae in your lumbar spine that help you walk, bend, and lift objects.
Types of Spinal Injuries
The two main types of spinal injuries include: (1) injuries to your central nervous system and essential neurons, and (2) injuries to your vertebrae and the gel-like discs that connect and cushion them.
A traumatic car accident or fall, however, can result in both types of injuries. Furthermore, some physical injuries to your spinal cord can compress and damage your central nervous system. Typical disabling injuries to your vertebra and discs include the following:
- Vertebrae spurs – These small, bone-like growths form on your vertebrae and push against your nerves and discs, causing pain, discomfort, swelling, tingling, and difficulty moving.
- Bone cancer – Certain cancers, such as osteosarcoma, begin in the bones. An abnormally large growth on your spine could constitute an osteosarcoma. If the tumor is too intertwined with the spinal nerves and a surgeon can’t operate on it, the Social Security Administration (SSA) considers you disabled.
- Degenerative disc disease and arthritis – As you age, the discs between your vertebrae thin, and your bones may rub together. This causes the majority of back, neck, and spinal pain.
- Herniated discs – Bulging or herniated discs often occur after a car accident or fall. They can cause serious pain and require surgery to correct. Severe herniation can result in something called “nerve root compression,” which causes serious discomfort and spinal stenosis.
Disabling injuries and illnesses to your central nervous system typically include:
- Paralysis – The most serious injuries to your spinal cord result in paralysis. Paralysis is defined as the loss of ability to move and/or feel certain parts of your body, and if a traumatic injury causes it, it’s typically irreversible. If you break your neck and it permanently injures your nerves, you’re likely paralyzed from the neck down. Typically, your paralysis begins directly below your injured nerves. A serious injury in your lower back, therefore, may result in paralysis of your legs.
- Spinal stenosis – This condition causes your spinal cord to narrow, which in turn compresses your nerves. This will greatly inhibit your brain’s ability to send signals to the rest of your body. Patients with spinal stenosis may experience weakness in their limbs, arm pain, reflex abnormalities, and sensory deficits.
- Muscular dystrophy – These genetic, degenerative diseases cause loss of muscle tissue. Muscles and ligaments help support your spine, and muscle degeneration can cause back and neck pain.
- Vertebral osteomyelitis – This serious infection of the bones in your vertebrae can cause paralysis or death if not aggressively treated. It often manifests as lower back pain, but the infection can travel into the spinal canal, causing bacterial abscesses that compress or damage your central nervous system.
- Cauda equina syndrome – The compression of the nerves at the base of your spine—your tailbone—cause this devastating disease. These nerves control signals to your legs, bladder, and bowels. If not properly treated, it can cause paralysis in your legs.
Individual or group long-term disability insurers typically deny benefits for normal age-related spinal degeneration, even when they result from legitimate spinal injuries and illnesses. In fact, your individual or group long-term disability insurance company and its so-called independent medical examiners my classify any back pain you experience as “age-related” and then wrongfully deny your valid long-term disability claim.
Don’t let your insurance company get away with this denial strategy. The nationally renowned individual disability insurance lawyers and top-rated group ERISA lawyers at DarrasLaw know the tricks your long-term disability insurer will play, and we’re ready to help you fight and win your benefits.
Applying for Long-Term Individual or Group Long-Term Disability Benefits for Your Spinal Injuries
At DarrasLaw, the first major hurdle we see when spinal injury claimants apply for individual or group long-term disability benefits is policy exclusion. Back pain is so prevalent in the United States that some private individual and group long-term disability insurers severely limit the coverage.
While this seems counterintuitive, insurance is a business. A for-profit corporation that performs a risk-benefit analysis before offering benefits provides your individual or group long-term disability insurance policy. If one factor, such as spinal claims, offsets the risk-benefit analysis and hurts profit margins, your individual or group long-term disability insurance company will limit the benefit period. This ensures that your individual or group long-term disability insurance insurer is making more money than it pays out.
The second major hurdle we see are bad-faith denials for preexisting conditions or age-related degeneration.
After you file a valid claim for individual or group long-term disability benefits for back pain, you may be required to attend “independent” medical examinations to validate your medical condition. Your appointment may take 15 minutes, and most claimants are surprised by the insurance company’s doctor’s report. This so-called “independent” doctor, paid by the insurance company, may report that you don’t have a serious spinal condition because you “walked into the office unaided.”
Furthermore, the insurance company-paid doctor, who may lack the proper training or specialization to examine and evaluate you, may look at your medical records and claim your condition is “normal” for your age, or that a car accident caused your pain before your individual or group long-term disability insurance coverage kicked in.
Insurance companies often-base wrongful denials on these so-called independent examiners reports. Most individual or group long-term disability insurers hope that you won’t challenge their bad-faith denials despite inaccurate and often unfounded medical conclusions by their on-site company physicians or “go to” less than independent examiners.
Don’t give up because wrongful denials are not the end of the claim line. The top-rated long-term disability attorneys and nationally preeminent group ERISA lawyers at DarrasLaw know how to fight wrongful delays, denials, and terminations by working with you and your treating doctors to present the proper medical evidence to your individual or group long-term disability insurance company.
The third major hurdle we encounter is wrongful denials based on the important duties of your occupation. For example, if you work at a call center, does your paralysis prevent you from performing the important duties of your occupation with reasonable continuity and in the usual and customary way? If your individual or group long-term disability insurance company believes that your employer made reasonable accommodations for you, it may deny your valid claim for benefits.
Your disability insurer requires the whole picture of your disability. Claiming paralysis, although serious, may not prove on its face to be enough. You’ll need to describe your incontinence, breathing difficulties, numbness, bedsores, and requirement for hourly physical therapy to prove you can’t perform the material and substantial duties of your occupation. This is where the litigation and claim experience of the award-winning group ERISA attorneys and nationally respected individual disability lawyers at DarrasLaw can prove essential.
Contact America’s Top-Rated Long-Term Disability Insurance Lawyers and Nationally Preeminent Group ERISA Attorneys at DarrasLaw
Don’t be surprised if your individual or group long-term disability insurer wrongfully delays, denies, or terminates your valid claim after a serious spinal injury or illness. With more 100 years of cumulative litigation and claim experience in the field of disability law, DarrasLaw has seen everything.
Led by America’s top-rated long-term disability lawyer, Frank N. Darras, the nationally renowned disability lawyers and top-rated group ERISA attorneys at DarrasLaw have defeated every major disability insurer in America. Many of our successful individual and group long-term disability insurance cases involve the wrongful delay, denial, or termination of back and neck pain benefits.
To schedule your completely free disability policy analysis and free claim consultation, call us today at 800-898-7299 or contact us online.
