Living with facet arthropathy often causes persistent back pain and significant mobility limitations. If you are having difficulty continuing to work due to your facet arthropathy symptoms, you may wonder what your options are for short and/or long term disability benefits.
In this article we’ll discuss how to navigate the process of securing short and/or long term disability for facet arthropathy, including key considerations, evidence to support your claim, and how The Maddox Firm can help you secure your benefits.
Can I Get Short or Long Term Disability Benefits for Facet Arthropathy?
Many people do receive short or long term disability for facet arthropathy. Whether or not your facet arthropathy qualifies you for benefits will depend on the eligibility criteria set out in your disability insurance policy and the severity of your symptoms.
Disability insurance policies can vary widely, and the specific terms and conditions will dictate whether your facet arthropathy qualifies you for benefits. First and foremost, review your policy carefully. Look for information on what conditions are covered, waiting periods, benefit amounts, and any exclusionary provisions, such as pre-existing condition clauses.
Your policy will typically require that your condition be severe enough to prevent you from performing your material job duties. The severity of facet arthropathy can vary from person to person. In order for your insurance company to approve your claim, you will need to provide ample evidence demonstrating how your symptoms interfere with your ability to work.
Ultimately, the availability of short and/or long term disability benefits for facet arthropathy depends on the specific details of your situation and your insurance policy. It’s crucial to understand your policy and gather comprehensive documentation to support your claim. An attorney experienced in disability insurance matters can provide you with invaluable guidance when pursuing a claim.
How Does Facet Arthropathy Cause Disability?
Disability insurance policies generally define disability as a medical condition that prevents you from performing the material duties of your occupation. Facet arthropathy can cause disability by affecting the function and stability of your spine, leading to chronic pain, limited mobility, and functional impairment. All of these symptoms can impair you from carrying out your job duties if presenting with enough severity and frequency.
Here are several specific ways in which facet arthropathy can result in disability:
Chronic Pain: Facet arthropathy often leads to persistent and severe back pain. This pain can radiate into the buttocks or down the legs, making it difficult to perform everyday activities, including important job functions. Your pain may be exacerbated by movements, sitting, standing, and/or walking for prolonged periods.
Reduced Mobility: As facet arthropathy progresses, it can lead to stiffness and reduced range of motion in the spine. This limitation in mobility can make it challenging to perform physical tasks, including bending, lifting, and twisting, which are often required in various jobs.
Nerve Compression: Facet joints are located near the spinal nerves, and as they degenerate, they can encroach upon these nerves. When facet arthropathy compresses spinal nerves, it can result in symptoms such as numbness, tingling, and muscle weakness in the lower back and legs. This nerve compression can seriously impact your ability to walk, stand, or engage in physical functions often required for work.
Fatigue and Reduced Endurance: Dealing with chronic pain and limited mobility can lead to fatigue and reduced physical endurance. This can affect your ability to work for extended periods or perform physically demanding tasks.
Mental and Emotional Impact: The chronic pain and disability resulting from facet arthropathy can also have psychological and emotional consequences. Depression and anxiety as a secondary condition due to a reduced overall quality of life are common among those dealing with chronic pain and disability. These secondary mental illness symptoms may contribute to your disabling condition.
Disability resulting from facet arthropathy often depends on factors such as the extent of joint degeneration, the effectiveness of treatment, and individual circumstances. Depending on the nature of your occupation, even milder symptoms may impact your ability to perform your role. If you believe that facet arthropathy is causing disability in your case, it’s essential to consult with a long term disability attorney who can evaluate your grounds for a disability insurance claim.
How Do Insurance Companies Evaluate Facet Arthropathy Disability Claims?
Insurance companies evaluate facet arthropathy disability claims by following a structured process that assesses the severity of your condition and its impact on your ability to work.
Here’s an overview of how insurance companies typically evaluate facet arthropathy claims:
Policy Terms: Your insurance company will examine the terms and conditions of your disability insurance policy, including waiting periods, benefit periods, definitions of disability, and any provisions such as pre-existing condition clauses. The specific terms of your policy will dictate your eligibility for benefits. For example, your policy’s definition of disability is crucial. Some policies use an “own occupation” definition, which considers whether you can perform your specific job duties, while others use an “any occupation” definition, which assesses whether you can work in any reasonable occupation. Your policy’s definition can significantly impact the outcome of your claim.
Review of Medical Records: Your insurance company will request medical records and documentation related to the diagnosis and treatment of your facet arthropathy. This includes diagnostic tests (e.g., X-rays, MRIs, CT scans), treatment plans, medications, surgical procedures, and evaluations from healthcare professionals.
Medical Assessment: Insurance companies often employ medical professionals, such as nurse case managers or “independent” medical examiners, to review your medical records and assess the severity of your facet arthropathy. This can be done either by consultants reviewing a paper file or via an in-person independent medical examination. These medical consultants and examiners will evaluate the medical evidence to determine if it supports your claim of disability. Of course, as your insurance company is the one paying them, their conclusions are often biased in favor of claim denial.
Occupational Assessment: Your insurance company will evaluate your occupation and job requirements. They will consider whether you can perform your specific job duties, taking into account the physical and cognitive demands of your role and the supported functional limitations caused by your facet arthropathy.
Treatment Compliance: Insurance companies may review whether you have been compliant with recommended medical treatments and therapies. Most disability insurance policies require that you be seeking “appropriate treatment” for your facet arthropathy in order to receive benefits. Non-compliance with prescribed treatments may result in claim denial.
Filing a short and/or long term disability insurance claim for facet arthropathy can present several challenges due to the nature of the condition and the way insurance companies evaluate such claims. Here are some challenges that you may encounter:
Subjective Nature of Pain: Facet arthropathy often causes chronic pain, which can be subjective and difficult to quantify objectively. Your insurance company may be skeptical if your disability claim is primarily based on self-reported symptoms of pain, making it important to provide comprehensive medical documentation and assessments to support your claim.
Lack of Objective Imaging: While diagnostic imaging such as X-rays, MRIs, or CT scans can show joint degeneration, they may not always correlate with the severity of your pain or functional limitations. Your insurance company may question the extent of your disability based solely on imaging results.
Inconsistent Symptoms: Symptoms of facet arthropathy can vary from person to person. Some individuals may have mild discomfort, while others experience severe pain and functional limitations. Likewise, you may have “good” days where your pain is more manageable, and “bad” days where it is very debilitating. Your insurance company may struggle to standardize their evaluation process for such diverse cases.
Mental and Emotional Health: Facet arthropathy can take a toll on your mental and emotional well-being. If you experience conditions such as depression or anxiety due to your facet arthropathy, your insurance company may try to wrongly allege that your disability is due to a mental illness instead of your facet arthropathy. This is because most disability insurance policies limit the amount of time benefits are paid out for mental illness disability claims.
Given these challenges, if you are pursuing a facet arthropathy disability claim, you should consider seeking legal advice from an attorney experienced in disability insurance claims. A long term disability attorney can help you navigate the complexities of the claims process, gather appropriate documentation, and advocate for your rights to maximize the chances of a successful claim.
What Evidence Can I Use to Support My Facet Arthropathy Disability Claim?
Supporting your facet arthropathy disability claim with strong and comprehensive evidence is crucial to increase your chances of approval. Insurance companies typically require thorough documentation to assess the severity of your condition and its impact on your ability to work.
Here are some examples of evidence you can use to support your facet arthropathy claim:
Medical Records: Provide all relevant medical records related to your facet arthropathy diagnosis and treatment. This includes records from specialists, primary care physicians, physical therapists, and any other healthcare professionals involved in your care.
Diagnostic Imaging: Include X-rays, MRIs, CT scans, or other imaging studies that show the degeneration or damage to your facet joints. These can provide objective evidence of your condition.
Treatment Documentation: Include records of all treatments you’ve received, such as medications, injections, physical therapy, chiropractic care, or surgeries. This demonstrates your efforts to manage your condition and your compliance with your doctors’ recommendations.
Attending Physician Statements: Obtain detailed statements from your treating physicians that describe the nature and severity of your facet arthropathy. These statements should connect the dots from your objective evidence to your self-reported symptoms, explaining how your facet arthropathy limits your ability to perform the necessary functions of your occupation.
Functional Capacity Evaluation (“FCE”): An FCE is a valuable tool for bolstering a facet arthropathy disability claim. By objectively assessing your physical abilities and limitations, it quantifies the extent to which facet arthropathy hinders your capacity to perform job-related tasks and daily activities. The evaluation report serves as objective evidence of your functional impairment.
Pain Journals: Maintain a pain journal where you document your daily pain levels, any activities that exacerbate or alleviate pain, and how your condition affects your ability to function. The more detailed information you provide, the better. A pain journal can substantiate your self-reported symptoms.
Prescription History: Include a list of all medications you’ve been prescribed for pain management, including dosage, frequency, and any side effects you experience that may contribute to your disability. The side effects of medications can themselves be disabling.
Vocational Evidence: Provide documentation related to your work history, including your resume, official job descriptions, evaluations that demonstrate a decline in work due to your facet arthropathy, and any accommodations or modifications made to your job due to your condition.
Vocational Assessment: A vocational assessment is an expert analysis that assesses your occupational demands (both physical and cognitive), your essential duties and responsibilities, and the impact of your facet arthropathy on your ability to perform your role. The resulting assessment can be used as evidence demonstrating your inability to perform your current job or any other reasonable occupation.
Statements from Witnesses: If family members, friends, or coworkers can attest to the impact of your facet arthropathy on your daily life and ability to work, their statements can be valuable.
How Can The Maddox Firm Prove My Facet Arthropathy Disability Claim?
The experienced team at The Maddox Firm has helped hundreds of our clients successfully secure their disability insurance benefits, including many for arthritic conditions such as facet arthropathy. We understand the difficulties in navigating these claims and what your insurance company will require to approve you for benefits.
Here are just a few ways we can help prove your facet arthropathy claim:
We Examine Your Insurance Policy: Disability insurance policies can include complex and hard-to-parse language. The Maddox Firm will thoroughly review your policy and explain to you the eligibility terms you must meet to receive benefits. This can set the stage for your claim strategy, allowing us to formulate a plan on how to best get your claim approved.
We Obtain, Organize, and Review Your Evidence: The Maddox Firm will request medical records from your doctors on your behalf, as well as any doctor statements and/or supplemental letters. We review each piece of evidence to ensure that your facet arthropathy symptoms are substantiated sufficiently. If we identify any gaps or potential red flags, we preemptively address these, coordinating with your healthcare providers to address them in opinion letters and referring you to any necessary additional testing, such as an FCE or a vocational assessment.
We Handle All Communication with Your Insurance Company: Dealing with your insurance company’s badgering and constant requests for information can be exhausting. The Maddox Firm will take over all communication with your insurance company, so all correspondence goes through our office. We provide your insurance company with all paperwork and requested documentation in a timely manner, while also ensuring that your rights are protected in the process.
We Can Appeal and/or Litigate Your Claim: If your insurance company has denied your facet arthropathy disability claim, The Maddox Firm can prepare and file an appeal of the wrongful decision on your behalf. In the event that litigation becomes necessary, The Maddox Firm can sue your insurance company for you to obtain the disability benefits you deserve.
Whether you are looking for assistance in navigating the claims process, appealing a claim denial, or litigating a final adverse decision, The Maddox Firm can help with your facet arthropathy disability claim. The experienced team at The Maddox Firm will examine your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your arthritis short and/or long term disability claim.