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Evaluation of disability claims based on back pain

As we have noted in a number of our posts, dishonest long term disability insurers can exploit the medical complexity inherent in many neurological conditions as a basis to formulate a plausible-sounding denial. This is why disability claims stemming from back injuries can be particularly difficult. It is no secret that disability claims adjusters deny many requests based on back ailments. However, it is possible to be successful if you know how insurers evaluate claims.

This post will provide some insight into the evaluation process and highlight what insurers look for. 

Objective symptoms – Insurers will likely review all of your medical reports, especially diagnostic imaging reports, to determine if they can find what objective evidence substantiates your ability to work.  Granted, insurance companies generally must consider objective complaints, including pain, fatigue and the side effects of medication in assessing whether you cannot perform your job.  But a lack of objective medical findings is a common rationale for denying legitimate claims.

Functional limitations – All clinical records detailing a limited range of motion, impaired reflexes, neurological symptoms like skin sensitivity (or lack thereof), swelling, pain on palpation and temperature changes should be reviewed to determine whether you can work in your condition.

Physician support – The most important part of an insurance claim is to have a supportive and disability-savvy physician who corroborates the existence of the disabling medical condition.  This is particularly true in back injury cases, where a diagnosis is often based upon detailed clinical findings from examination and the patient’s self-report.    Working with doctors to appropriately document the patient’s record is a critical part of the disability process that we can provide.

Ultimately, if you have extreme back pain but objective tests do not provide conclusive proof of a cause, the insurer will look for ways to deny your claim. This is where an experienced disability law attorney can be helpful. If you have questions about how insurers evaluate claims based on back pain, we invite you to contact us. 

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