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Orthopedic LTD Claims — When You Can’t Work

Saturday, March 31st, 2018

At our law firm, we often represent claimants seeking long-term disability benefits under their disability insurance policies after sustaining orthopedic injuries or diseases that prevent them from performing the tasks of their jobs 

These kinds of impairments require comprehensive medical evaluation and detailed documentation so insurance claim examiners have all the medical evidence they need to accurately assess disability and to prepare a file should an appeal be needed.

Claim examiners are required to use this medical evidence to determine carefully the extent and nature of orthopedic injuries or illnesses, as well as resulting symptoms and functional limitations. 

Many of our cases center on the insurance company or their third-party administrator’s failure to review the complete medical information. In many cases, the insurance company selects a limited amount of materials for the claims adjuster to review. 

Role of vocational expert 

Because of the potential complexity of orthopedic conditions, an occupational specialist may be brought into a disability insurance claim to analyze the full extent of functional limitations caused by the medical condition. Depending on the terms of the policy, the vocational expert may need to decide if the claimant could perform the tasks required in the claimant’s job in light of his or her functional limitations. 

Some policies may also require an analysis of whether the claimant could perform other available jobs, as well. That depends on whether or not the policy contains “Any occupation” or “Own occupation” provisions. 

What is orthopedics? 

The American Academy of Orthopedic Surgeons or AAOC sheds light on the field of orthopedics and the kinds of medical problems treated. Orthopedics encompasses the broad area of musculoskeletal conditions. According to AAOC, orthopedic surgeons are “devoted to the diagnosis, treatment, prevention and rehabilitation of injuries, disorders and diseases of the body’s musculoskeletal system … include[ing] bones, joints, ligaments, muscles, nerves and tendons.” 

Orthopedic problems may include: 

  • Bone dislocations or fractures
  • Bone deformities
  • Joint injuries
  • Repetitive motion injuries like carpal tunnel
  • Spinal conditions or injuries like scoliosis, scoliosis, disc rupture, disc degeneration or nerve compression
  • Arthritis
  • Radiculopathy like pinched or diseased nerves
  • Birth defects causing deformities such as in the hands or feet
  • Bunions
  • Osteoporosis
  • Strains, sprains, pulled muscles and similar soft tissue injuries
  • And others

Orthopedic treatments 

AAOC says that there are both surgical and nonsurgical treatments for orthopedic impairments and conditions. Nonsurgical treatments may include “medications, exercise and other rehabilitative or alternative therapies.” 

Orthopedic conditions often affect the spine and joints like the knee, hip, shoulder and others. An orthopedic surgeon may recommend any of a wide range of surgical procedures, including: 

  • Repair of bone deformities and bone fractures, including fusion and fixation techniques like the use of pins to foster proper placement and healing
  • Arthroscopic surgical techniques to repair joints
  • Joint replacement or
  • Repair of soft tissue injuries like those to cartilage, ligaments or tendons
  • Carpel tunnel repair
  • Spinal repair or disc fusion
  • ACL reconstruction and repair 

Impact on LTD claims 

Orthopedic injury and disease can cause serious movement and motor restrictions, pain, weakness and mobility impairment. Recovery from surgical treatment can last weeks or months, depending on the procedure and patient. It is crucially important to a long-term disability insurance claim that the unique injury and the impacts of treatment, medication side effects and surgical intervention carefully considered in light of the patient’s ability to perform or sustain work activity. 

If you have suffered an orthopedic injury and cannot work, contact our office before filing a disability claim to ensure that your rights are protected. Call us at 877-LTD-CLAIM (877-583-2524).

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