Getting Long-Term Disability Benefits for Back Problems

Some of the most common long-term disability (LTD) claims are those based on back pain. Not surprisingly, insurance companies tend to deny these claims at alarming rates, often citing a lack of objective evidence to support the level of pain alleged. Because LTD claims based on back problems are hard to prove, it's essential to understand how to give yourself the best chance at getting the benefits you deserve.

First, let's look at some of the most common back conditions that could qualify you for LTD benefits, followed by some advice on how to pursue your LTD case.

Common Types of Back Problems

The bones, ligaments, discs, muscles, and tendons that comprise the back can each give rise to painful medical conditions, any of which can qualify you for LTD benefits if they're severe enough. Here are some of the most common:

• Degenerative disc disease (DDD) is a condition marked by the deterioration of the cartilage discs that cushion your vertebrae. While healthy discs are flexible and shock-absorbing, those with DDD have discs that are thin and rigid, generally causing chronic lower back pain that can radiate into the buttocks, hips, or legs. Most individuals over 60 have some degree of disc degeneration. Severe cases of DDD may be treated with spinal fusion surgery or the insertion of an artificial disc.
• A herniated disc, sometimes called a ruptured disc or slipped disc, occurs when the soft interior portion of the disc's cartilage breaks through the discs's tougher exterior, and extends into the spinal canal. This can cause nerve irritation and result in pain, tingling, and numbness which radiates into the arms and legs. Herniated discs may cause sciatica, in which pain radiates down the long sciatic nerve running from the lower back into the lower legs. A bulging disc, in which the cartilage simply swells outside its normal position, is less serious than a herniated disc and rarely disabling on its own.
• Spinal stenosis is a narrowing of the spinal canal, which occurs most often in the cervical (neck) or lumbar (lower) regions of the back. Stenosis causes compression of the nerve roots (in lumbar stenosis) or spinal cord (in cervical stenosis), with the latter being particularly dangerous. Common symptoms of stenosis include discomfort in the back, shoulders, arms, and hands, and numbness and pain radiating into the buttocks and legs. Treatment can include anti-inflammatory medication, an exercise regimen, physical therapy, or nerve decompression surgery.
• Inflammatory conditions such as ankylosing spondylitis, sacroiliitis, and arachnoiditis may be caused by arthritis, infection, or osteoporosis. Thought to be genetically inherited, ankylosing spondylitis is an arthritis of the spine, often accompanied by symptoms such as stiffness, fatigue, chills, and fever. It's usually treated with muscle relaxers or anti-inflammatories but may require surgical intervention. Sacroiliitis is inflammation of the sacroiliac joints, those connecting the pelvis and lower spine, while arachnoiditis is a painful condition marked by inflammation in the membrane protecting the nerves of the spinal cord.
• Osteoporosis is characterized by a loss of bone density that makes bones more brittle and more susceptible to fracture. Vertebral fractures caused by osteoporosis can result in intense pain and require surgery.

Having said that virtually any disorder of the back can qualify you for LTD benefits, your chances of success will greatly depend on the functional limitations you experience. For example, two different individuals with the same spinal stenosis diagnosis and even similar MRI findings can nonetheless possess marked variations in their abilities to sit, stand, walk, lift, or carry.

How to Document the Functional Limitations of Your Condition

It's uncommon for LTD claims based on back pain to be supported by overwhelming objective evidence of disability. In these rare cases, an MRI revealing severe DDD, for example, along with a functional capacity evaluation showing highly restricted range of motion, may be sufficient proof of disability for your LTD insurer.

In the majority of cases, however, the objective evidence reveals abnormalities that could cause disabling limitations in some, but might allow others to work. In most of these borderline cases, LTD insurers won't hesitate to deny your claim for benefits and force you to submit persuasive evidence of disability on appeal. How should you demonstrate to your insurer that you can't work?

Get a diagnosis and treatment. First, receive regular treatment from your physicians and specialists, undergo diagnostic testing and medical imaging (X-rays, MRIs, and CT scans), and follow your prescribed treatment. Claims examiners are more likely to credit your allegations if they see that you've failed conservative treatments such as medication, rest, and physical therapy. If your back pain is accompanied by mental health symptoms such as depression or anxiety, seek out a psychiatrist or other mental health provider. The contents of your medical records are often the deciding factor in a disability case.

Have your doctor document your limitations. Second, ask your treating specialist to assess your functional limitations on a Residual Functional Capacity form or in a narrative report. Your doctor should describe any restrictions you experience with lifting, carrying, sitting, standing, walking, stooping, and bending. Secondary symptoms such as fatigue and poor concentration should also be noted, especially if your doctor believes you would frequently be absent from work or require unscheduled breaks. The more detail and explanation your physician can provide for the assessed limitations, the better for your case.

Gather other statements and opinions. Finally, disability attorneys often recommend submitting statements from friends, family members, and colleagues describing their observations of your physical limitations. Favorable disability decisions from the Social Security Administration, Workers' Compensation board, or other sources should also be submitted. Whatever evidence you submit, make sure that your LTD carrier receives it before the administrative appeals process closes. If your case is appealed to federal court, most judges limit their review to the "administrative record" that was before your insurer -- that is, the evidence that your insurer had access to during its internal appeal process.

Hire a Disability Attorney

While some degree of back discomfort is typical as you age, severe pain that interferes with your daily life and ability to work may give rise to a disability claim. The single best choice you can make to increase your chances of success is to hire a qualified disability attorney to represent you. LTD carriers have experienced attorneys working for them; you should too.