Understanding Your Long Term Disability Benefits For Chronic Pain


Is Your Chronic Pain Covered By Your Policy? Long-Term Disability Claims For Chronic Pain In DC

If you have a long-term disability claim involving some type of chronic pain or pain syndrome, like fibromyalgia or another medical illness or disorder that is hard to diagnose or prove you need to be careful with your long-term disability benefits appeal and presenting your case to the insurance company. Fibromyalgia claims based on pain sometimes get extra scrutiny from disability insurers.

Here is Why, and What You Can Do About It

Pain syndromes are relatively new medical diagnoses. Not much is known about many of them and some people, even doctors, don’t even believe they exist (or think the person or treating physician is making them up, or can’t figure out the real cause of the problem.

They are subjective, not objectively verifiable (you can see a broken arm on an x-ray)​​

There is no objective medical test that can definitively diagnose them (no x-ray, MRI, or CT scan will show pain or fibromyalgia)

They often cannot be cured and can become permanently disabling

Insurance companies don’t want to set a precedent for paying such claims, and

Insurance companies may believe you can work even with pain, and that pain doesn’t prevent you from working

So the typical situation is that disability insurance companies fight to pay these claims. If your disability claim is based on fibromyalgia, chronic regional pain syndrome, trigeminal neuralgia, occipital neuralgia, or generalized pain, then you may be in for a fight. But this doesn’t mean you are not entitled to disability benefits. It just means you have to prepare for the fight to get your disability benefits. And you’ll need thorough documentation (and a good attorney helps too – we formulate a plan for your appeal).

Here are Steps to Take or Focus On In an ERISA Case Based Primarily on Pain:

Focus on a prescription history – narcotic pain management, nerve damage medications, etc. are evidence of pain.

Focus on the side effects of prescription medications – how do the side effects affect your ability to work full time?

Focus on personal statements – get testimonial letters from friends, family, and co-workers to describe the extent and severity of the pain from someone who sees you often or over time.

List the types of pain management therapies you’ve attempted, and anything you’ve tried that your doctor has recommended – any type of therapy, massage, acupuncture, anything that shows you’re trying to deal with the pain.

Focus on how the pain affects your ability to work – get testimonial letters from supervisors and coworkers that show how you’re limited in what you can do at work.

Focus on getting independent medical opinions and testing to validate the pain and the consequences of it

Focus on the limits in the ADLs (activities of daily living) – can you drive, take care of your lawn, and clean the house? Do you need help getting in and out of a car, to the bathroom, or getting dressed?

Document-related diagnoses – chronic pain is almost always accompanied by fatigue and depression. These can be, themselves, disabling. But you have to be careful because many disability policies have limitations for disability caused by mental illness.

If Need to Appeal Your Denied Long Term Disability Claim, Contact our Experienced DC Long Term Disability Lawyers Today

If your claim is denied, you need a long-term disability lawyer who has experience in preparing an administrative record and is very familiar with medical litigation. You can’t hire just any lawyer who doesn’t deal with insurance companies and physicians all the time – your financial future is riding on this choice. There are many other things an attorney can do to help you get your disability benefits. Give us a call at 202-393-3320 to find out more about our track record with civil litigation and how we can make your life better with just one phone call.

Denying ERISA Long Term Disability Claims in Washington, D.C.

Before you were seriously injured or developed a medical illness and could no longer do your job, if you’re like most people, you didn’t worry too much about what would happen if you suddenly couldn’t work because of injury or illness. The reality is, that none of us think it will happen to us (but 1 in 4 Americans will become disabled over their work-life).

That’s normal. Nobody thinks it will happen to them. Plus, with the long-term disability insurance your company provides, most people believe they will be protected in case the worst-case scenario happens.

And if you’re like most people, if the disability insurance company denied your legitimate claim for benefits and you can’t work, you were probably shocked when you got the news (and upset and irritated), but really caught off guard by getting denied, because let’s face it, you live your life a certain way, honestly, with integrity. And you’ve worked hard to get to where you are now. So when something like this comes along, it’s a total shock.

First, you’re dealing with the injuries, hospitals, doctors, surgeries, rehab, therapy, and everything else. Now you’re dealing with stress and anxiety over finances (that you thought were at least covered by disability insurance).

The #1 Thing You Need to Know About Insurance Companies

Insurance companies exist for one reason only – to make a profit for their shareholders. So even if you are right and your doctor agrees with you, most of the time, you can’t just write them a letter showing that in order to get your disability benefits going.

They also love their forms and they will send these to you or your doctor periodically. But remember, those disability insurance company forms are often intended to be used in denying disability claims. These forms ask for all kinds of information from you, which is later used against you when the insurance company denies your claim.

And insurance company employees are trained to find ways to deny disability claims.

Also, the insurance company may offer an appeal process (they have to do this under ERISA) and they sometimes make it sound simple and fair, but it’s not fair and unbiased. When you think about it, the insurance company is the one who has to pay your disability benefits if they lose the appeal, and they are in charge of the appeal process, and are the ones who decide who wins!

Another built-in incentive to deny your disability claim.

Federal judges and law professors have written a lot about the unfairness of ERISA, and how it seems like the insurance company holds all the cards. That’s generally true, but don’t give up! With a good system, and the right medical and legal guidance in place, your appeal can formidable.

So call us today at (202) 393 – 3320 to discuss your ERISA long-term disability claim.

Your treating physician, or any doctor who has treated you for the injury or illness that caused your disability, is critical to a successful ERISA long-term disability claim. The reports, office notes, and evidence from your doctor will often make or break your claim.

It can be tough – we totally get that. We represent a lot of people with serious injuries and disabilities and some of the doctors they deal with can be difficult.

And many times, doctors don’t really get it – they have an attitude that it’s just up to the insurance company to determine your disability benefits and they think the insurance company will take care of that and be fair. And they’re really busy.

So you have to prepare to educate your doctor – he or she needs to know how your disability policy defines disability and how your limitations from your injury or medical condition fit that definition, plus be able to specifically outline your limitations and restrictions.

A lot of people are intimidated by physicians – or don’t know what to ask or how to approach them. But medical evidence is critical to your disability claim – especially your appeal if you’ve been denied. Read more about our tips for talking to your doctor about your disability claim.

And if you’ve received a denial letter either denying or terminating your disability benefits, call us today. We’ll review it for you and give you our thoughts – it’s free and confidential. But you only have 180 days to file an appeal, and that appeal is a big deal. So don’t wait – call us at (202) 393 – 3320 to see how we can help you and your family.

by Frank R. Kearney, Attorney-at-Law

Experienced DC Workers’ Comp, Long Term Disability & Accident Lawyer,

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