• Is A Claimant's Complaints Of Pain Enough To Qualify For Short Or Long Term Disability Benefits?

Is a Claimant’s Complaints of Pain Enough to Qualify for Short or Long Term Disability Insurance Benefits?

The answer to this question applies to the vast majority of long term disability insurance claims that we handle on a daily basis. Pain is subjective. This means that there is no medical device or verifiable method for confirming pain. A claimant’s ability to collect disability benefits based upon pain will depend upon the level of documentation and treatment received from treating physicians. In a recent case in Pennsylvania against the Cigna Insurance company (Horn v. LINA 7/22/15) the court stated as follows:

It is well established that “pain in itself may be disabling.” Brown v. Cont’l Cas. Co., 348 F. Supp. 2d 358, 367 (E.D. Pa. 2004) (citing Chrupcala v. Heckler, 829 F.2d 1269, 1276 n.10 (3d Cir. 1987) (“Pain itself may constitute a disabling impairment.”); Smith v. Califano, 637 F.2d 968, 971 (3d Cir. 1981)). “Nonetheless, where claims as to the existence or degree of subjective pain are unsubstantiated, the plan administrator has the discretion to disregard them.” Eppley v. Provident Life & Acc. Ins. Co., 789 F. Supp. 2d 546, 572 (E.D. Pa. 2011). In Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003), the Supreme Court held that ERISA does not require plan administrators to “accord special deference to the opinions of treating physicians. Nor does the Act impose a heightened burden of explanation on administrators when they reject a treating physician’s opinion.” Id. at 831. However, Nord “does [not] insulate plan decision makers whenever they reject a treating physician’s opinion in favor of a consultant’s opinion.” Matson v. AXA Equitable Life Ins. Co., No. 10-cv-5361, 2011 WL 4345848, at *7 (E.D. Pa. Sept. 15, 2011) (alteration in original) (quoting Kaufman v. Metro. Life Ins. Co., 658 F. Supp. 2d 643, 649 (E.D. Pa. 2009)) (internal quotation marks omitted). The court “may still evaluate the weight of each doctor’s opinion based on the extent of his or her treatment history with the patient…” Brown v. Cont’l Cas. Co., 348 F. Supp. 2d 358, 368 (E.D. Pa. 2004). Moreover, where a disease is “subjective and variable,” direct contact with a patient over an extended period of time seems “especially important” since it can allow “more thorough examination of the patient’s credibility and true range of abilities.” See id.

It is never enough for a claimant to just state that they cannot work due to pain. The pain must be well documented by the claimant’s treating physician(s). Please read the attached opinion from the Eastern District Court of Pennsylvania to learn more about the type of evidence that a court looks for in order to support a disability claim based upon pain complaints. Contact any of our long term disability insurance lawyers to discuss how we could assist you with you claim for benefits.

Leave a comment or ask us a question

Questions About Hiring Us

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Nancy R.

I have worked for AT&T for 41 years and have never had a disability claim. I woke up one morning in severe pain and to make a long story short I was diagnosed with spinal stenosis in my neck. AT&T and Sedgwick Claims Management Services denied my claim until Gregory Dell took over my claim and eventually I was paid for six months after he won my appeal. I was immediately denied again by Sedgwick following an IME exam. Without the help of Gregory Dell and his associates I don’t know what I would have done. AT&T’s claims management company Sedgwick tries to scare you into coming back to work and jeopardize your health. Dell & Schaefer lawyers know what to do and let you concentrate on working on your health problems. I feel lucky to have Gregory fighting for my disability benefits.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us