Getting Long-Term Disability (LTD) Benefits for Back Problems

Back pain is among the most common reasons people file long-term disability (LTD) insurance claims. But getting long-term disability benefits for back pain can be extremely difficult. Insurance companies tend to deny these claims at alarming rates—often citing a lack of objective evidence to support the amount of pain claimed.

LTD claims based on back problems are hard to prove. But there are some things you can do to improve your chance of getting the benefits you deserve. This article will discuss some of the most common back problems that could qualify for LTD benefits and how to build your strongest case so you can get long-term disability for your back pain.

What Type of Back Problems Qualify for Disability?

Any medical condition that causes back pain could qualify you for long-term disability benefits—if it's severe enough. Serious and painful impairments can involve any part of your back, including the:

• bones
• ligaments
• discs
• muscles, and
• tendons.

Some of the most common back problems can also be some of the most difficult medical conditions to document using objective evidence. The following are some common types of back pain that could be severe enough to qualify for long-term disability benefits.

Degenerative Disc Disease (DDD)

Degenerative disc disease causes back pain when the cartilage discs that cushion your vertebrae deteriorate. While healthy discs are flexible and shock-absorbing, DDD causes discs to become thin and rigid. Degenerative disc disease generally causes chronic lower back pain that can radiate into your:

• buttocks
• hips, or
• legs.

Most people over 60 have some degree of disc degeneration, but not everyone feels pain from this deterioration. Severe cases of DDD can be extremely painful and are sometimes treated with spinal fusion surgery or the insertion of an artificial disc.

Herniated, Ruptured, or Slipped Disc

A herniated disc, sometimes called a ruptured or slipped disc, occurs when the soft interior portion of the disk breaks through the disc's tougher exterior and extends into the spinal canal. This rupture can cause nerve irritation and result in some or all of the following symptoms:

• pain in the back at the site of the affected disc
• pain, tingling, and numbness that radiates into the arms and legs
• sciatica (pain radiates down the long sciatic nerve running from the lower back into the lower legs).

A bulging disc (when a disc simply swells outside its normal position but doesn't rupture) is less serious than a herniated disc and rarely disabling on its own.

Spinal Stenosis

Spinal stenosis is a narrowing of the spinal canal and most often affects the cervical (neck) or lumbar (lower) regions of the back. When the spinal canal narrows, it causes compression of the nerve roots (in lumbar stenosis) or the spinal cord (in cervical stenosis). Cervical stenosis can be particularly dangerous.

Common symptoms of spinal stenosis can include any or all of the following:

• pain in your neck
• pain in your lower back
• shoulder pain
• arm or hand pain, and
• numbness and pain radiating into the buttocks and legs.

Spinal stenosis is treated in several different ways, depending on the severity and location of the stenosis. Treatment can include anti-inflammatory medication, physical therapy, or nerve decompression surgery.

Inflammatory Conditions

Inflammatory conditions involving the spine can be caused by arthritis, infection, or osteoporosis (see below). Spinal inflammation can cause severe back pain and other symptoms. Some common inflammatory conditions affecting the spine include the following:

• Ankylosing spondylitis is thought to be genetically inherited. It's an arthritis of the spine that's usually treated with muscle relaxers or anti-inflammatories but can require surgical intervention. It's often accompanied by symptoms such as stiffness, fatigue, and chills or fever.
• Sacroiliitis is inflammation of the sacroiliac joints (which connect the pelvis and lower spine).
• Arachnoiditis is a painful condition marked by inflammation in the membrane protecting the nerves of the spinal cord.

Osteoporosis

Osteoporosis is characterized by a loss of bone density—bones become more brittle and easier to break (fracture). Vertebral fractures caused by osteoporosis can result in intense pain and can require surgery.

How to Qualify for Long-Term Disability for Back Pain

Virtually any medical condition involving your back can qualify you for LTD benefits. But you'll need to prove to the insurance company that you have a back abnormality that's causing you to be limited. You'll have to gather evidence that relies on objective medical tests like:

• x-rays
• discography or a myelogram
• CT scans
• MRIs, or
• an EMG (nerve conduction test).

Objective medical tests are the best evidence to submit to your insurance company, but still, they can't measure how much pain you're in. Alone, they're often not enough to win an LTD claim for back pain because not everyone experiences back trouble the same way.

For example, two different people with the same spinal stenosis diagnosis and even similar MRI findings can possess marked variations in their abilities to function, including sitting, standing, walking, or lifting objects.

Your chances of success will greatly depend on the functional limitations you experience because of your condition and the way you demonstrate those limitations to the LTD insurance company.

How to Document the Functional Limitations Your Back Pain Causes

It's uncommon for long-term disability claims for back pain to be supported by overwhelming objective evidence of a disability. But an MRI revealing severe DDD, for example, along with a functional capacity evaluation showing your range of motion is highly restricted, might be sufficient proof of disability for your LTD insurer.

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

Get a Diagnosis and Treatment for Your Back Pain

There are three things you can do to strengthen your case for long-term disability for back pain:

• get regular treatment from your doctors 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 believe your back pain keeps you from working if they see that you've tried conservative treatments and they haven't worked, including:

• 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

Ask your treating specialist to assess your functional limitations in a narrative report or on a Residual Functional Capacity form (using a physical RFC form or a mental RFC form). Your doctor should describe any restrictions your back pain causes with:

• lifting
• carrying
• sitting
• standing
• walking
• stooping, or
• bending.

Secondary symptoms such as fatigue and poor concentration should also be noted—especially if your doctor believes you'd have to miss a lot of work or need unscheduled breaks. The more detail and explanation your doctor can provide about your limitations, the better for your case.

Gather Other Statements and Opinions That Support Your LTD Claim

Disability attorneys often recommend submitting statements from others who know you well, describing their observations of your physical limitations. You could submit letters from:

• friends
• family members,
• coworkers, or
• supervisors.

For more information, see our article on how to write a disability letter for a relative or employee.

If you've received a favorable disability decision (an approval) from the Social Security Administration, Workers' Compensation board, or another source, submit that with your claim or appeal.

Whatever evidence you submit, make sure to get it to your LTD insurer before the administrative appeals process closes. If your case is appealed to federal court, most judges limit their review to the "administrative record" that your insurer had access to during the internal appeal process. You won't be allowed to add new evidence at this stage.

What LTD Benefits Could You Get for Back Pain?

Long-term disability insurance pays cash benefits when you can't work because of a medical condition, like severe back pain. Generally, your benefit amount is a percentage of your working wages (typically 50-80%).

For example, let's say you earn $1,000 per week, and your LTD policy pays benefits equal to 75% of your wages. If your insurer grants your long-term disability claim for back pain, you'll get $750 per week.

Your long-term disability benefit amount could go up a little if you're disabled for more than a year. Some LTD policies include annual cost of living adjustments (COLAs) that raises the benefit amount by a few percentage points each year.

Other factors could lower your LTD benefits, including any money you earn from work and any Social Security benefits or workers' compensation awards that you get.

Learn more about how much long-term disability pays and what can affect how much LTD you get.

Hiring an LTD Attorney for Your Back Pain Disability Claim

While some degree of back discomfort is typical as you age, severe pain that interferes with your daily life and ability to work might prompt you to file a long-term disability claim. The single best choice you can make to increase your chances of winning benefits is to hire a qualified disability attorney to represent you. Long-term disability carriers have experienced attorneys working for them. You should too.

(Also, see what it takes to qualify for Social Security disability for back pain.)