5 Ways to Defend Your Chronic Back Pain Disability Claim

We have a number of clients who suffer from severe chronic back pain that have resulted in their inability to satisfactorily perform their duties and continue in their jobs. Unfortunately, we also see the push back and disputes from claims examiners when disability claims are filed, and we try to help our clients receive the benefits they deserve.

There are many different ways that insurance companies use to fight and deny claims, so it’s important to know the best practices to fight back against their attacks. These five tips are some of the strategies our firm find help our clients suffering from back pain get the disability benefits they deserve.

1. Make sure your job is well defined and your duties properly explained when submitting paperwork to the insurance company. Often, insurance companies will try and downplay certain aspects of a claimant’s job that are most affected by back pain. For example, a dentist may spend a large portion of their day bent over and twisting, working in their patients’ mouths for both routine examinations and procedures. If you happen to be self-employed or own your own practice, the claims examiner may assert that you spend a majority of your day on paperwork and practice management instead of treating patients. Having proof that you performed procedures and were actively practicing can prove your actual duties and prevent the disability claims examiner from making assumptions about your responsibilities and duties.
2. Continue to see a doctor and receive treatment throughout the claims process. Although we have several clients whose back pain isn’t expected to improve in any significant manner, we always tell them to continue to follow their doctor’s recommendations and schedule appointments with their treating physician as often as is suggested by the doctor. While you may not feel like physical therapy appointments are worth the pain or repetitive doctor visits are beneficial to your health, claims examiners can twist that into evidence of a lack of medical care and treatment as an easy reasons to deny a legitimate claim. Even if an alternative medical solution seems to be helping, discuss it with your treating physician(s) before you make any changes to their prescribed treatment plan.
3. Complete personal narratives thoroughly. When initially filing a disability claim, insurance companies will have claimants fill out a statement or complete a form that specifies the problems or symptoms that prevent them from working. The information on these forms can often make or break a disability claim. Many claimants are assured that they can breeze through these long forms and submit them as quickly as possible. This is rarely a good idea. It’s important to give the claims examiner clear and complete descriptions of your issues and how they affect your ability to perform your occupational duties. If there isn’t enough room on the form, (and there almost never is), attach your own document where you can fully detail your issues and answer the questions.
4. Complete personal narratives truthfully. Some people think that they should play games and exaggerate their medical conditions, almost like they’re beginning a negotiation. This is a terrible idea. These people tend to be scared and intimidated by the claims process and while they may be truly disabled, they are worried about their claim being denied, so they think that they should exaggerate and stretch the truth to make sure their benefits are approved. This is a bad, bad idea.  Often, these exaggerations lead to more serious claim issues down the road that claimants really don’t comprehend. We’ve seen claims get in trouble after surveillance reveals inconsistencies or after tax forms reflect amounts that otherwise wouldn’t have impacted their disability claim. If you have earned income, report it on your tax returns (and claim forms, if needed). If you are able to perform a few sporadic tasks some days, make sure you don’t report that you spend your entire day, every day, in bed. Insurance companies hire experienced and well equipped investigators who can provide information to leverage such inconsistencies to delay or deny benefits. And ironically, if these types of facts had been appropriately reported in a thoughtful and strategic manner, they likely would not have even damaged the claim.
5. Always keep your cool. With issues such as chronic back pain, you may feel utterly and completely disabled even if claims examiners can’t or won’t immediately grasp the issues. Having people doubt you, especially your claims examiner and the doctors hired by the insurance company, can be discouraging and even infuriating. It’s important to keep your calm and continue to fight for your benefits in manners that can have positive effects on your claim. To many claims examiners, yours is just one more case on their pile, and your getting angry or making threats won’t help your benefits get approved any quicker. In fact, the opposite will usually happen. Considering your medical conditions, your time and energy is not unlimited. Use what you have to build a team to support you and then work together to build a stronger case for your claim to eliminate any reasons the claims examiner may have to deny the benefits you deserve.

Chronic back pain is a very difficult and overwhelming struggle but getting the insurance benefits you deserve shouldn’t make the struggle worse. Even if you follow the tips provided above, there’s no promise that the insurance company will do the right thing and approve your claim to provide the income you need to support yourself. If you or someone you love is having issues with a disability claim resulting from chronic back pain, our firm can help. Call us toll-free at (855) 828-4100 or fill out the contact form on the right-hand side of this page to fine out how we can help you get the benefits you deserve.