People who suffer from chronic pain syndrome face questions at work and home. You do not look sick, so it is not immediately or always obvious what’s wrong. It is a condition that cannot be cured, has no specific lab tests, and may occur with other ailments that involve long-term pain, including certain cancers, fibromyalgia, endometriosis, and inflammatory bowel disease (IBD).
The disability insurance company’s red flag gets raised when a disability claim comes in with a chronic pain diagnosis. Malingering is often suspected, and the insurance company begins making numerous requests for medical records to document the condition and see what additional information supports or refutes the claimed impairment.
While medical authorities report that chronic pain syndrome is likely linked to abnormalities in the interaction between certain glands and the nervous system, known as a type of stress axis, the typical response which is seen is that someone is just too sensitive or needs to toughen up. Those who work in this field know that claimants’ pain is real, and while cannot be measured by a device, often is disabling, physically, cognitively or emotionally.
At Frankel & Newfield, PC, our New York disability insurance attorneys have worked with many claimants across the country suffering from chronic pain syndrome. We know it is a real illness that can completely turn your world upside down. We also know the last thing you want to do while suffering from this syndrome is battle the disability insurance company. That’s our job.
Chronic pain can be due to any number of disabling medical conditions and, in many cases, cannot be measured in the same methods as a visible injury. Chronic pain encompasses hundreds of types of conditions. Some of the most common types of chronic pain include the following.
It is important to keep in mind pain is subjective. Depending upon the type of injury or medical condition, what one individual feels can be quite different from another’s experience in pain levels and disabling conditions.
The CDC reports roughly 51 million people (21 percent of U.S. adults) in 2021 experienced chronic pain, with 17 million (6.9 percent) coping with high-impact chronic pain. While living with chronic pain is a reality for many people, proving it is a laborious process. To do so, you must show definitive proof your chronic pain is disabling with qualifying evidence.
Disability insurance claims for chronic pain conditions are commonly denied based on insufficient objective evidence or poorly prepared medical records. Despite the challenges of the lack of objective proof, the medical records must document clinical evidence and findings to support the chronic pain suffered. It also must provide details on how and why the chronic pain impacts the claimant’s ability to perform the tasks and duties of their occupation.
Medical records must demonstrate consistent and ongoing medical treatment for pain by a medical specialist whose practice focuses on pain and pain management to enhance the quality of your claim’s support. Primary care physician reports are often insufficient to provide the necessary support in such claims.
To improve your chances of having comprehensive medical evidence and records for treatment:
Basically, you want to create a solid paper trail with details to describe your chronic pain and how it impacts your daily living and ability to work.
If your doctor prescribes pain medication, this is another crucial metric to keep track of to help prove your chronic pain case. You can save empty prescription bottles and note how many OTC medications you take. Finally, keep a diary to track your pain and how frequently you take your prescription and OTC medications.
It is important to document what you are doing to try to cope with pain so you can attempt to participate in your daily activities. This, along with medical documentation from providers, diagnostic tests taken (e.g., x-rays and MRIs), and any severe pain or side effects you suffer, can help to build a stronger case for a long-term disability claim.
The short answer is yes, you should hire an attorney as soon as possible. Hiring an attorney can help in your claims process because an experienced disability insurance lawyer is knowledgeable about the legal process and can help you meet crucial deadlines. The attorneys at the disability law firm of Frankel & Newfield understand what will need to be proved for your case.
Our experienced New York disability lawyers have worked with people suffering from chronic pain as a result of orthopedic injuries and diseases like CRPS, failed back surgery syndrome, fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and lupus, among other conditions. Our attorneys know the strategies used by disability insurance companies to deny these claims.
When we are brought in early in the claims process to advocate for the claim, typically before the claim has been filed, we work with the treating physician to protect the claim by confirming that the medical records are properly prepared and well-supportive of the issues and functional deficits. We encourage objective documentation, including medical tests for chronic pain that are unfamiliar to many doctors. These tests support your claim by objectively documenting how pain impacts the person’s ability to function.
You can expect self-reported chronic pain claims without robust medical records to be denied by the disability insurance company. In many disability insurance policies, any self-reported condition may fall into a limited time period for benefits, another reason why a chronic pain claim needs to be substantiated by a treating physician and supported by hard evidence.
The challenge of a chronic pain claim is tying the pain to an objective and measurable medical issue. There are certain illnesses known to create severe and disabling pain. Objective diagnostic tests to substantiate these illnesses will be needed.
Orthopedic injuries leading to chronic pain can be as challenging as auto-immune diseases because there is not always a clear relationship between the amount of musculoskeletal damage and the degree of pain or inability to function. The nature of the pain is, by necessity, subjective, making chronic pain a challenging claim.
There is some evidence in the medical canon that chronic pain is sometimes associated with mental disorders and substance abuse, which is problematic for a disability claim. Someone who is depressed may be more likely, for example, to be living with chronic pain. It calls into question whether they are depressed because of the chronic pain or if the pain is unrelated.
In cases like these, the challenge is to prevent the disability insurance company from re-categorizing the claim from one of a physical disability to a mental/nervous claim, which limits benefits to 24 months. Claims that might otherwise carry a longer benefit may be characterized as a special condition (mental health) to limit benefits.
For claimants seeking alternative treatments for chronic pain, another challenge emerges. Someone who finds relief from pain through weekly acupuncture treatments may find their treatment considered too unusual, even though most medical professionals now accept the efficacy of alternative treatments in general and acupuncture specifically. What might be good treatment might not constitute “appropriate” care and treatment by your insurance.
Time is essential when filing a disability claim for chronic pain. Contact our attorneys to begin your free consultation.
Are you or a loved one suffering from chronic pain from an injury or impairment? You do not have to suffer alone. Chronic pain disability benefits claimants can benefit from the assistance of an experienced long-term disability insurance attorney. Frankel & Newfield has successfully represented many individuals who suffer from chronic pain. Our clients are able to focus on managing their disability instead of battling with a giant disability insurance company.
Our law firm represents clients nationwide who are pursuing long-term disability benefits. When you work with Frankel & Newfield, PC, you will work directly with one of our partners, and we’ll take on the burden of fighting with the insurance companies so you can focus on getting better. We are also equipped to manage your entire claim from beginning to end. To schedule a free case evaluation, call us at 877-583-2524.
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