According to the World Health Organization, low back pain is the leading cause of disability worldwide. With the prevalence of this condition, many people are living and working through their pain. However, you may reach the point where you are simply no longer able to continue working because of your condition, despite your best efforts. If you have a short- or long-term disability insurance policy through your employer, you might be wondering if your condition qualifies for benefits. Back conditions are one of the most common reasons people apply for long-term disability insurance benefits. They are also among the most frequently denied.
Yes, Back Pain Can Qualify for Long-Term Disability
Long-term disability insurance does not require a catastrophic spinal injury. Many valid claims involve conditions like:
- Herniated or bulging discs
- Degenerative disc disease
- Spinal stenosis
- Spondylolisthesis
- Chronic sciatica
- Radiculopathy
- Failed back surgery syndrome
The real issue is not simply whether you have one of these diagnoses. The issue is whether you meet the definition of disability under your policy. While you should consult your policy for specifics, you are generally required to be disabled from performing your own occupation for the first two years (24 months) of benefits and after that you are required to show that you are disabled from performing any occupation.
Why Long-Term Disability Claims for Back Pain Can Be Difficult
Back pain cases can be challenging because pain itself does not appear on imaging. An MRI may be described as showing only “mild degenerative changes,” even though those findings can cause significant functional limitations. Imaging does not measure pain, and it does not reflect how your condition affects your ability to work. Additionally, if you are not visibly wincing from pain or limping, your physical exam may be described as “largely normal” in the medical records. Insurance companies can seize on this language to deny claims. They often argue that imaging findings are “age-appropriate,” the imaging does not match the severity of your complaints, and that there is a lack of “objective evidence” supporting disability.
How to Prove Disability for Chronic Back Pain
When dealing with back pain, it is important to focus not only on diagnosis, but on function. The insurer may concede that you have a herniated disc, spinal stenosis, or similar condition, but they need to also agree that your diagnosis limits your function enough to render you unable to work and they can demand objective medical evidence of this fact. While courts recognize that some symptoms are not objectively measurable, such as pain, courts have held that insurers are permitted to require objective evidence of functional limitations, even for symptoms that are not objectively measurable. (See “More Than a Diagnosis: The Objective Evidence Gap That Sinks LTD Claims.”)
This is why detailed medical records and physician statements are important. Your providers should document their physical examination findings and clinical observations of symptoms and limitations. A supportive provider should also explain specific restrictions, such as limits on sitting, standing, lifting, bending, and the need to change positions frequently, and specify medical reasoning behind these restrictions. Vague statements like “patient is disabled” are easy for insurers to dismiss.
In many cases, a Functional Capacity Evaluation is key evidence to objectively measure your ability to tolerate activity over time. These evaluations can demonstrate why full-time work is not sustainable, even if you can perform short tasks intermittently.
Issues with Sedentary Jobs
If you had a sedentary job (one that primarily involves sitting) before your disability, or you are at the “any occupation” stage and the insurer is trying to prove that you can do an alternative job, the insurance company may argue that you have some limitations, but should still be able to perform sedentary work. However, sedentary work is not the same as easy work.
Sedentary jobs typically require sustained sitting, consistent focus, reliable attendance, and limited unscheduled breaks. Many people with chronic spinal conditions cannot sit longer than 20 to 30 minutes without needing to stand, stretch, or lie down. Some need to recline during the day. Others miss work unpredictably due to flare-ups. Others take pain medications that cause significant side effects like fatigue and brain fog. Ensuring that these issues are documented in your medical records and that your doctors clearly explain the link between your symptoms and your inability to perform even a sedentary job is crucial for Long-Term Disability claims based on back pain.
Need Help with a Long-Term Disability Claim for Back Pain?
If your spinal condition is preventing you from working, the disability process can feel overwhelming. You are dealing with pain, uncertainty about income, and an insurance company questioning your credibility.
If you are considering filing a long-term disability claim for back pain, or if your claim has already been denied, understanding how these cases are evaluated can make all the difference. An attorney can help you understand the process and gather evidence such as detailed physician opinions, updated diagnostic testing, a Functional Capacity Evaluation, and a clear explanation of how your back condition affects your ability to function day after day. Please contact our office today to learn how we can help.