Long-Term Disability Insurance Claims: Overcoming Denials Related to Spinal Injuries [Part I]

J.P. Gonzalez-Sirgo
Founder of J.P. Gonzalez-Sirgo, P.A.

Back pain has a fundamental impact on the lives of many people throughout the U.S., as well as other countries.  If you have ever experienced the debilitating impact of crippling back pain, it may come as little surprise that back pain is the most prevalent disability worldwide.  Further, nearly half of all Americans report suffering back pain at some time during a typical year.  Back-related pain also is one of the leading causes of missed work and the second leading reason for visits to the doctor behind only upper respiratory infections.  Despite the prevalence and severity of back injuries and conditions, private long-term disability insurance carriers frequently deny disability claims involving back injuries. 

In this two-part blog post, we provide an overview of information related to long-term disability insurance claims based on back injuries.  Part I of this blog focuses on common types of spinal injuries that might constitute a basis for long-term disability insurance benefits whereas Part II focuses on suggestions for protecting a back pain related claim for benefits.

The basic challenge in bringing disability insurance claims based on back injuries or conditions involves difficulty in proving that a back injury meets the definition of “disability”.  Many debilitating back injuries that cause devastating pain are difficult to establish with indisputable medical evidence, such as diagnostic imaging.  Since pain is subjective in nature, an understanding of the types of serious back injuries that cause disability and the appropriate steps to preserve a long-term disability insurance claim are essential to maximize the probability of a desirable outcome.

There are many types of back conditions that can result in the inability to continue in your occupation or even work in any occupation.  Common disabling back issues include:

Herniated Disc: This medical condition also is referred to as a “slipped disc” or a “ruptured disc”.  When the soft internal cartilage of a disc penetrates through the hard exterior of the disc, penetrating material can protrude into the spinal canal and cause nerve irritation.  This contact with nerves can cause numbness, pain, and tingling that radiates into the extremities.  Sciatica often is caused by this type of disc deterioration, which is characterized as pain that radiates down the sciatic nerve from the lower back into the legs.  Less intense pain can be caused by a condition that is not as severe referred to as a “bulging disc,” which simply causes swelling of the disc.  

Osteoporosis: Severe vertebrae fractures that can be caused by diminished bone density can inflict severe pain and necessitate surgery.  The decreased bone density causes the bones of the spine to be brittle and susceptible to fractures.

Degenerative Disc Disease (DDD): This spine disorder is characterized by deterioration of the discs made of cartilage that act as cushions between the vertebrae.  If the discs are healthy, they have the ability to absorb considerable shock, but diseased discs become rigid and thin.  This condition typically causes chronic pain of the lower back that radiates into the hips, legs and buttocks.  Surgery might be needed to insert an artificial disc or to relieve pain with disc fusion.

Spinal Stenosis: This medical condition occurs when the spinal canal narrows in the lumbar or cervical spine.  When this narrowing occurs the result can be compression of the root portion of the nerve.  If the narrowing of the spinal canal occurs in the spinal cord, the condition can be life-threatening.

These are just a few serious examples of back injuries that can justify long-term disability insurance benefits.  While any of these spinal conditions and others can result in functional impairment that merits long-term disability insurance benefits, this determination will depend on the degree of functional limitation of an individual.  These limitations can vary widely between disability claimants despite similar diagnostic imaging and/or diagnoses.

You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

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