If you have a disability claim that involves neck pain, you might be wondering exactly how much neck pain does it take to get a long-term disability insurance claim approved? Despite what a disability insurance companies may lead you to believe, there is no machine or tool that allows you prove how much neck pain you have. So what evidence do you need to prove you are disabled by neck pain? In the video above, disability insurance attorneys Gregory Dell and Cesar Gavidia sat down to provide some tips on how a person with neck pain can prove their eligibility for long term disability insurance benefits.
In our video we discuss the following questions:
- The type and severity of neck pain is always a key factor, yet how exactly is that pain measured?
- Since pain is subjective, what types of objective evidence should someone with a neck disorder obtain for a disability claim?
- What do you recommend to your clients in terms of getting the best possible documentation into the medical records, so that they can be in the best position to get their benefits approved?
- What are some other ways claimants can be their own advocates in their disability claim?
- Do you recommend that your clients with neck pain consult with an orthopedic doctor or a neurosurgeon as part of the claims process?
- How important is the quality of the attending physician statements that are completed by treating doctors?
- If a patient does decide to have surgery, does this negate their need for a disability insurance claim?
- What if the claimant’s condition is chronic, and they have been working with the medical condition for months or years prior to filing for disability?
- What advice can you offer potential clients?
You have helped thousands of disability claimants dealing with all types of neck disorders. The type and severity of neck pain is always a key factor, yet how exactly is that pain measured?
CESAR GAVIDIA: There is no way to measure the amount of pain somebody’s in. It’s completely subjective because the frequency, the intensity, is reported by the patient, by the claimant. There’s not going to be anything the doctor’s going to be able to visualise and see on you that’s going to tell them how much pain you’re in. You’re reporting to them that this is what’s causing my pain, how often it’s occurring, and how intense it is.
They sometimes even give you a scale, like, where would you measure it on a scale of 1 to 10, but it’s just a measure of what you report to them.
And since pain is subjective, what types of objective evidence should someone with a neck disorder obtain for a disability claim?
CESAR GAVIDIA: What the disability insurer’s looking for is the correlation of your diagnosis or your symptoms to the pain that you’re experiencing. With a neck disorder, just one of the fundamental diagnostic studies and tests that you want is an MRI, which your doctor will most likely order if you report that you are having this intense pain in your spine or neck. If you’re having symptoms that are radiating or traveling through your extremities, through either your legs, or through your upper arm into your wrists and your hands, then they may ask or look for some sort of neurological issue. Is there some sort of nerve damage or compression? It might be found on the MRI, but they might request an EMG nerve conduction study to see if there’s any damage or injury to those nerves
GREGORY DELL: The nerve conduction studies can be good sources. They could show that you have some kind of radiculopathy, another type of objective evidence in addition to an MRI. It’s going to be almost impossible to get approved on a neck disorder claim if you don’t have some kind of objective testing. That doesn’t mean that you need to have an MRI result that shows you have some giant herniation, severe osteoarthritic formations, or neuroforaminal narrowing in your neck. Doctors will say they don’t treat the chart, they treat the patient. However, the disability company treats the chart, meaning they only look at the records. They don’t care about what you tell them. They care about what’s in the record.
So, what do you recommend to your clients in terms of getting the best possible documentation into the medical records, so that they can be in the best position to get their benefits approved?
CESAR GAVIDIA: One fundamental thing we talk about in our field is that you are only as disabled as you appear in your medical records and those charts. The disability insurance company looks at your medical records to see what your issues are, what the diagnoses are, what the symptoms are, how you’re being treated for them, how often you’re reporting how intense this pain is, how frequent this pain is, and where it’s occurring and what types of activities, and how long you’ve had it. The only way to prepare for that is frequently reporting to your doctors. You have to be your own best advocate reviewing and having these medical records on hand, to ensure that they’re being accurate, that your complaints are accurately being documented. Doctors are not often the best record keepers. They may use a medical assistant for dictation or putting things into the notes. You need to have a fundamental understanding of what’s in your medical records, and report often. You can also keep your own charts and logs so that when you report to your doctor, you can go in and say, here’s when I experience these problems. Here’s how often it occurred, how intense it was, and what type of activity I was engaged in when it was happening.
What are some other ways claimants can be their own advocates in their disability claim?
GREGORY DELL: It’s this theme of looking messed up on paper. You need to communicate with your doctors and ask what other types of medications you can try. What other types of testing can I get beyond an MRI? Can you send me for an EMG, nerve conduction study test, or fluoroscopic exam? What other types of injections can I try? Can you send me to a pain management anaesthesiologist or a physical medicine rehabilitation doctor? We like to paint a picture where we can say our client has tried everything there is to try, short of surgery. There are always therapies and medicines to try, and insurance companies often say if you’re in so much pain, why didn’t you try a potential remedy? So, the more you do, the worse off you’re going to look on paper, and the better position you’re going to be in with the claim.
Speaking of surgery, do you recommend that your clients with neck pain consult with an orthopedic doctor or a neurosurgeon as part of the claims process?
GREGORY DELL:Yes, we often recommend that claimants treat with or at least consult with a surgeon because we want to know if there’s a surgical remedy. People think you walk into a surgeon’s office, they’re always going to recommend surgery because they get paid if you have surgery, but they’re usually not going to recommend surgery unless you have some serious spinal cord damage. In other words, if you don’t have the surgery on your neck, you could become paralyzed. You could lose complete feeling in your hands or your arms or movement and they’re doing surgery to try to stabilize your condition.
However, if you’re not already treating with an orthopedic doctor or neurosurgeon and you go to them, they may not want to fill out anything about your restrictions and limitations for the disability company.
That brings us to another important point. How important is the quality of the attending physician statements that are completed by treating doctors?
CESAR GAVIDIA: It’s extremely important to have that paperwork and documentation completed by your treating doctors. Primary care family physicians and general practitioners often don’t want to complete this paperwork. It’s even less likely that a surgeon, a neurosurgeon, or orthopedic surgeon will. You must have good communication and rapport with your doctor and surgeon so that they understand what it is that you need. That’s where the conflict arises. If they’re going to do a spinal surgery that is supposed to alleviate or resolve your problem, they’re most likely going to expect that you’re going to return to a certain quality of life or even work capability. So, you have to speak to your doctor, before and after surgery, about what the ongoing limitations will be.
If a patient does decide to have surgery, does this negate their need for a disability insurance claim?
GREGORY DELL: Surgeons are proud of their work and expect that you will improve as a result, but more often than not, the surgery is like a stabilization to stop making things get worse. The reality is, for every claim that we have, if they could have surgery and go back to work, they want to because they’re always going to make so much more money working than they are on disability. It’s a falsehood when the disability carrier expects that after surgery you should be better and getting back to work. It’s insulting because if you’re the claimant, you want to go back to work. You would love to go back and do your job if you could. Surgery doesn’t mean you’re better. It means the condition got so severe that you couldn’t take it anymore. Maybe you have less pain, but you still have symptoms and you still have functional limitations.
CESAR GAVIDIA: I mean, think in terms of a race car and the engine blows out and you replace the engine with a whole new one. Surgeons aren’t replacing your entire spine, they’re fixing a component of it and you’re not going to go back to full capacity. Many clients that have had neck surgery have successfully returned to some level of work, but every case is unique. In some cases, they’re going to remain disabled. They’re not going to be able to return because really, the surgery is to kind of stabilize and maintain a certain quality of life. If they go back to standing for four or five hours in their job and performing their job duties, and it’s a matter of time before they start to break down again.
What if the claimant’s condition is chronic, and they have been working with the medical condition for months or years prior to filing for disability?
GREGORY DELL: Neck conditions are almost always chronic. Patients are usually dealing with them for six months, a year, or two years before they stop working. Hopefully, during that time they’ve been getting medical treatment, which is what you need to do to support the claim. The classic argument is well, you had those symptoms and that diagnosis for two years and now, all of a sudden, you stopped working. We’re prepared to deal with that issue. It’s probably the most common issue that we deal with.
In about 90% of the denials we do where the claims get approved, the insurer puts them on a claim for a while with a chronic cervical condition. Then the carrier reviews the file and decides they don’t think that your complaints are supported by your objective evidence and we think you can work now.
That always blows my mind. Your neck is degenerative by nature and is only going to get worse over time. How now are you better? That’s where you exhaust all of the available remedies for treatment and care, and see all the doctors and therapists and consultants that you can, so that you can fall back on that argument that you’ve done everything you could for that amount of time. Unless some miracle drug or surgery came out, I’m not getting better. You can’t rest, you have to keep up with all of that treatment.
Some great information here, Greg and Cesar. What advice can you offer potential clients?
GREGORY DELL: If you’re a claimant with a neck condition, we encourage you to reach out to me or Cesar. We always provide initial free consultation, where we’re going to review your policy or review your denial letter. We’ll let you know immediately how we can help you. We encourage claimants to spend some time looking through our website for information specific to their medical condition, disability company, or occupation. We have lots of summaries about disability benefit lawsuits and other cases that we’ve handled, reviews from other clients about disability companies, and frequently asked questions and answers. The more educated you are, the better position you’re going to be in to get your benefits approved. It’s about having a strategy, being prepared, and thinking like the company. You have to be ready and you have to think like them, to be in the best position to get benefits approved. We look forward to the opportunity to help anyone seeking disability insurance benefits.