If you’re experiencing cervical and/or lumbar conditions that are preventing you from working, you may be eligible for short term or long term disability insurance benefits.
However, navigating the complex process of filing for disability benefits can be overwhelming, especially when dealing with insurance companies looking for any reason to deny your benefits. That’s where an experienced ERISA attorney can help.
In this article, we will explore the basics of short term and long term disability for cervical and lumbar conditions, and how The Maddox Firm can assist you in obtaining the benefits you deserve.
What cervical and lumbar conditions cause disability?
Common cervical and lumbar conditions that may cause disability include:
Herniated discs: A herniated disc occurs when the soft inner material of a spinal disc pushes out through a tear in the outer layer, causing pressure on nearby nerves and resulting in pain, numbness, and weakness.
Spinal stenosis: Spinal stenosis is a narrowing of the spinal canal that can cause compression of the spinal cord and nerve roots, leading to symptoms such as pain, numbness, and weakness.
Degenerative disc disease: Degenerative disc disease is a condition in which the discs between the vertebrae of the spine break down over time, causing pain and stiffness in the neck and upper back (cervical) or lower back (lumbar).
Cervical spondylosis: Cervical spondylosis is a degenerative condition that affects the discs, vertebrae, and joints in the neck, leading to symptoms such as neck pain, stiffness, and headaches.
Cervical radiculopathy: Cervical radiculopathy occurs when a nerve root in the cervical spine becomes compressed or irritated, causing pain, weakness, and numbness in the arms and hands.
Lumbar radiculopathy: Lumbar radiculopathy is similar to cervical radiculopathy, but it affects the nerve roots in the lower back, causing pain, weakness, and numbness in the legs and feet.
Sciatica: Sciatica is a condition in which the sciatic nerve, which runs from the lower back down through the legs, becomes compressed or irritated, causing pain, numbness, and weakness in the legs and feet.
Whether or not your specific condition will qualify you for short or long term disability depends on how your symptoms interfere with your ability to work. If you can provide your insurance company sufficient proof of your diagnosis, the nature of your symptoms, and how they prevent you from working, you may qualify for short or long term disability benefits. Top of FormBottom of Form
How do insurance companies evaluate cervical and lumbar condition disability claims?
Insurance companies evaluate cervical and lumbar condition disability claims to determine the veracity of your diagnosis and symptoms and whether your symptoms prevent you from working. Depending on the terms of your policy, you may have to prove you cannot work in your own occupation, or you will have to prove you cannot work in any occupation reasonable for your education, training, and experience. It’s essential to understand what definition of disability you must meet to be approved for short or long term disability benefits.
Your insurance company will review your claim to establish your level of medical disability. This means verifying your cervical and/or lumbar diagnosis and any objective medical evidence that supports your reported symptoms. Secondly, your insurance company will consider your inability to work. Your occupational tasks and responsibilities, and how your symptoms impact your ability to perform these duties, will be taken into consideration.
Filing a cervical and/or lumbar disability claim can present several unique challenges. Here are a few of the most common challenges:
Subjective nature of symptoms: Many cervical and lumbar conditions involve symptoms such as pain and numbness, which are subjective and difficult to measure objectively. This can make it challenging to provide evidence to support a disability claim.
Complexity of medical records: Medical records related to cervical and lumbar conditions can be complex and difficult for your insurance company to interpret. This can lead to misunderstandings or misinterpretations of the medical evidence, which may impact the outcome of your claim.
Pre-existing conditions: Your insurance company may argue that your cervical or lumbar condition is the result of a pre-existing condition, which can complicate the claims process and make it more difficult to obtain benefits.
Undergoing an independent medical examination (“IME”): Your insurance company may require you to undergo an IME with a doctor of their choosing to obtain an independent evaluation of your condition and assess your ability to work. These “independent” doctors are incentivized to side with your insurance company, and their assessment may be used to justify a denial of your benefits.
Navigating these challenges can be difficult, but it’s important to remember that you have rights under ERISA that protect your ability to seek disability benefits. Working with an experienced ERISA attorney can help you overcome these challenges and obtain the benefits you deserve.
What should I submit with my cervical or lumbar condition disability claim?
When filing a cervical and/or lumbar condition disability claim, you must submit evidence demonstrating your diagnosis, symptoms, and your inability to work due to your condition. Below we’ll discuss the different types of evidence you may submit in support of your short or long term disability claim.
Proving Cervical and/or Lumbar Medical Disability
Objective medical evidence is one of the most important types of documentation you can use to support your claim. It is difficult for insurance companies to argue with objective medical evidence such as test results and imaging. This evidence can also provide support for any self-reported subjective symptoms, such as pain or numbness.
Some types of objective medical evidence include:
Imaging studies: X-rays, MRIs, CT scans, or other imaging studies can provide objective evidence of structural damage to your spine or surrounding tissues.
Nerve conduction studies: Nerve conduction studies can help identify nerve damage or dysfunction that may be contributing to your symptoms.
Electromyography (EMG): An EMG can help identify muscle weakness or atrophy that may be associated with nerve damage.
Physical therapy or rehabilitation records: Records from physical therapy or rehabilitation sessions can provide objective evidence of functional limitations and show you are seeking appropriate treatment for your condition, which is generally a requirement of all disability policies.
Medical records from specialists: Records from specialists such as neurologists, orthopedic surgeons, or pain management specialists can provide objective evidence of your diagnosis, treatment, and functional limitations.
Medication records: Records of medications prescribed for pain or other symptoms can provide evidence of the severity of your symptoms, as well as any side effects that may contribute to an inability to work.
Functional Capacity Evaluation (“FCE”): An FCE is a type of medical examination that can help prove a cervical and/or lumbar condition disability claim. An FCE assesses your physical abilities and limitations, such as your ability to sit, stand, walk, lift, and carry, and can provide objective evidence of your functional capacity. The report can be used to support your claim with proof of your physical limitations and restrictions.
Proving Inability to Work Due to Cervical and/or Lumbar Disability
Your insurance company will require evidence that you cannot perform your occupational duties due to your condition. Your evidence must demonstrate that your cervical and/or lumbar condition and symptoms impact your physical and cognitive functioning in ways that make it impossible to meet the demands of your occupation.
Keep in mind that aside from your physical limitations, you may want to include how your symptoms affect your cognitive abilities. For example, if you have severe disc degeneration in your back, the resulting pain may distract you from being able to focus on high-level cognitive tasks as required by your role.
Vocational evidence you may submit in support of your claim include:
Official job descriptions: Job descriptions for your occupation can establish the physical and cognitive demands of your job, such as lifting, bending, standing, or sitting for extended periods of time, or needing to concentrate for extended periods, multi-task, and turn tasks around quickly.
Vocational assessments: A vocational assessment is an analysis done by an expert that provides a detailed overview of your occupation, material duties and responsibilities, and whether your cervical and/or lumbar condition and symptoms interfere with your ability to perform your role. This information can be used to demonstrate to your insurance company that you are unable to work.
Statements from your employer and/or co-workers: Personal statements from your employer and/or co-worker can provide detailed descriptions of your work and how your cervical and/or lumbar condition has affected your job performance.
How can The Maddox Firm help prove my cervical and/or lumbar disability claim?
The experienced team at The Maddox Firm has helped successfully prove many cervical and/or lumbar disability claims. We understand what evidence your insurance company will require in order to approve your short or long term benefits.
Here are a few ways The Maddox Firm can help prove your cervical and/or lumbar disability claim:
Examine your insurance policy: The Maddox Firm can examine the terms of your disability insurance policy to determine what standard of disability you must meet. If your policy contains any pre-existing condition clauses or other provisions, we will explain these to you and craft a strategy to maximize your chances of claim approval.
Communicate with your insurance company: Once retained, The Maddox Firm will take over all communications with your insurance company. We will make sure all requested forms and documentation are provided in a timely manner, while protecting your rights and any overstepping from your insurance company.
Gather medical evidence: The Maddox Firm can help you gather objective medical evidence from your treating physicians and specialists to support your claim. Beyond your existing medical records, we will coordinate with your treating providers to complete your insurance company’s paperwork and obtain supplemental statements outlining your restrictions and limitations. The Maddox Firm will also refer you out for additional testing, such as a Functional Capacity Evaluation, with trusted professionals. We will review the FCE report for accuracy and comprehensiveness before submitting it to your insurance company.
Gather vocational evidence: The Maddox Firm can help you gather vocational evidence, such as job descriptions from your employer and vocational assessments from trusted experts, to support your claim.
Prepare and submit your claim: The Maddox Firm can help you prepare and submit your short or long term disability claim, ensuring that all evidence demonstrating your cervical and/or lumbar disability is included and presented in a clear and convincing manner.
Appeal a denied claim: If your short or long term disability claim is denied, The Maddox Firm can appeal the decision on your behalf by gathering additional evidence and presenting a strong case to the insurance company.
Litigate your claim in court: If your appeal is denied, The Maddox Firm can represent you in court to litigate your claim and seek the disability benefits you are entitled to.
Proving a cervical and/or lumbar disability claim can be complex and challenging, but an experienced ERISA attorney can help guide you through the process and increase your chances of success. 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.
The team at The Maddox Firm will look over 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 cervical and/or lumbar disability claim.
Contact us to help you file your claim, appeal, or litigation the right way.