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Qualifying Conditions

Getting Long-Term Disability Benefits for Herniated Disc

Man holding back due to back pain

The process for getting your long-term disability (LTD) benefits for a herniated disc and other back conditions is not always as easy as filing a claim and receiving your checks from your insurance company. Wrongful denials are unfortunately very common for those who suffer from herniated discs, back pain, and resulting symptoms.

Insurance companies are powerful entities with a lot of resources and are too often motivated by their own financial interests. At Chisholm Chisholm & Kilpatrick LTD, our team of professionals can help you access your ERISA and non-ERISA LTD benefits, while taking the burden and stress off of you and allowing you to focus on your health. Contact us now at 401-331-6300 for a FREE consultation to see if we are able to fight for you.

Understanding Herniated Disc

A herniated disc occurs when there is a rupture of the central, softer portion of the discs between your vertebrae. This rupture can irritate nearby nerves, resulting in pain and weakness in your back and sometimes radiating outward towards your extremities. Disc herniations commonly occur in the lumbar spine (lower back), however it is possible to have a herniated disc at every level of your vertebrae.

Symptoms of a herniated disc typically include pain, numbness, tingling, and weakness in your back and outer extremities. Typically, if your herniated disc is in your lumbar spine, you will likely experience these symptoms in your lower back, buttocks, thighs, legs, and radiating down towards your feet. If your herniated disc is in your cervical spine (neck), these symptoms will often be present in your upper back, neck, shoulders, arms, and radiating down towards your hands.

Although a traumatic event or injury can cause a herniated disc, it can also be the result of prolonged wear and tear of the spine. Aging, repetitive movements, using improper lifting techniques, and poor posture can all contribute to a disc herniation. People with physically demanding jobs that require a lot of bending or lifting have a greater risk of herniating a disc.
Doctors use a combination of movement assessments, a patient’s report of their symptoms, imaging tests, and nerve tests to diagnose a herniated disc. An MRI can confirm the location of a disc herniation and detect any impact on nearby nerves.

Depending on the severity of the herniated disc, conservative treatment like pain management and physical therapy will often be used before more aggressive treatments are attempted. If symptoms worsen or do not subside after several months of conservative treatment, surgery is often considered to remove a portion of the herniated disc. In severe cases, a spinal fusion or artificial disc replacement may also be necessary.

How can CCK help you with your Herniated Disc LTD claim and appeal?

The attorneys and professionals at CCK take a comprehensive approach to completing LTD claims and appeals. CCK helps levels the playing field for you against the insurance company. We use our knowledge and experience assisting people, including those with herniated discs and other back conditions, access their LTD benefits.

Finding insurance company errors

If your LTD claim has been denied, we analyze the insurance company’s denial letter, the claim file, the policy, and any other plan-governing documents and use our knowledge and expertise with ERISA, the U.S. Department of Labor Regulations, and different insurance policies in order to identify errors that the insurance company made while handling your claim. This will often govern the information we will need to gather from you, your doctors, and other experts in drafting your appeal.

Communication with doctors during the appeal process

Individuals with back pain often have a difficult time getting the benefits to which they are rightfully entitled. This is typically because pain is a subjective symptom that can be difficult to objectively measure, and thus is often not sufficiently documented by treating doctors. It is important to have treating doctors that support your claim and who are willing to thoughtfully complete forms and provide reports. It is also helpful for your doctors to document as much as possible in your medical records to establish a good base for your disability claim. For example, things like diagnostic imaging results, range of motion tests, and other physical exams are key when proving disability. It is also important for you to communicate your day to day struggles with your doctors and let them know about any limitations you have either at work or in your regular daily activities. For example, it is important to ask your doctor to document examination findings, medication changes and side effects, your symptoms, and how they impact your ability to function.

Gathering evidence and writing the appeal

Once we have a good plan of attack for your appeal, we often need to gather evidence from you, your doctors, or other experts in order to prove your disability. This often includes:

  • Medical records
  • Test results
  • Reports from your treating doctors
  • Expert opinions
  • Witness statements from you, your family, friends, or co-workers

Preparing a strong and complete evidence record to file with an LTD appeal is particularly important with ERISA-governed LTD appeals because often, the administrative appeal is the last chance that claimants have to submit substantive evidence into the record. One of the major hardships that ERISA LTD claimants face is the fact that new evidence is seldom allowed to be added to the administrative record in court. We take care of this for our clients.

After gathering the evidence, we write the appeal. We thoughtfully explain why our clients meet the policy’s definition of disability and other conditions for coverage. Our arguments are based on and supported by the evidence.

Call Chisholm Chisholm & Kilpatrick Today

Let us help you. Contact us now at 401-331-6300 for a FREE consultation to see if we can fight for you.