If you suffer from chronic pain, you know well that the pain, itself, is not your only problem. The pain may prevent you from exercising, from taking care of your home and family, and — importantly — from doing your job. But these limitations from pain are only part of the story. The other problem chronic pain sufferers often face is that doctors, employers and others may not believe how bad the pain is. There is, after all, no simple way to measure your experience of pain. This can reasonably make you worry that you will not be able to get time off work or disability benefits for chronic pain.
The good news is that medical diagnosis and tests are getting better at confirming self-reported pain caused by many things from fibromyalgia to Chronic Fatigue Syndrome to other injuries and illnesses. The bad news is that insurance companies still often deny employee disability claims based on chronic pain, since it is harder to measure or prove than more obvious illnesses and injuries.
If you are an employee who is unable to work because of pain, you may apply for long-term disability benefits (LTD benefits) through your employer’s LTD policy. Knowing how LTD policies and insurers address chronic pain claims will increase your chances of having your claim approved. Given how hard it can be to successfully show you can’t work because of chronic pain, you should also consider getting the help of an experienced long-term disability benefits attorney.
Chronic Pain as a Disability
What is chronic pain? It is often defined as pain that continues longer than normally expected after a major illness or injury — roughly more than 3-6 months. Chronic pain can be local; showing up in specific body parts such as the head, back, or joints. Alternatively, chronic pain suffers may experience pain in the muscles, or nerve pain all over the body. It may be related to an injury or illness, or there may be no clear explanation as to the cause. In these cases, sufferers and their doctors may share frustration and anxiety as they work to find answers that can be elusive.
You can be diagnosed with a pain disorder, or, you may have a disorder that causes chronic pain. Some common examples of chronic pain conditions include, but are certainly not limited to:
- Amyotrophic Lateral Sclerosis (ALS)
- Benign chronic pain syndrome
- Cancer pain
- Cervical/Neck Pain
- Chronic Fatigue Syndrome (CFS)
- Chronic Regional Pain Syndrome (CRPS)
- Cluster, Tension, or Migraine Headaches
- Degenerative Disc Disease (DDD)
- Irritable Bowel Syndrome (IBS)
- Joint Pain
- Lyme Disease
- Neuropathy pain (nerve damage)
- Psoriatic Arthritis
- Reflect Sympathetic Dystrophy (RSD)
- Rheumatoid Arthritis (RA)
If chronic pain is keeping you from doing your job, you may qualify for long-term disability (LTD) benefits. But applying for benefits is not quite as easy as saying, “my pain is so severe that I can’t work.” Here are some of the reasons it is difficult to get LTD benefits for chronic pain — and things you can do to increase your chances of being approved for benefits.
LTD Limitations on “Self-Reported” Pain Symptoms
Tests such as X-rays, MRIs, and CT scans can show that you have an injury, but they do not show the actual pain that you feel. In addition, the experience of pain from a similar condition or injury can vary from one person to another. So proving whether you are in pain — and how bad that pain is — often has to be based on “subjective” or “self-reported” symptoms. In other words, your doctor simply has to believe you when you explain where it hurts and how badly it hurts. It is always important to report your pain to your doctor.
For obvious reasons, disability insurance companies are often suspicious of claims for self-reported conditions. They reason: how can they really know that your pain is so bad it stops you from doing your job? What if you’re lying about your pain just to get benefits? So, when you file a disability claim for a self-reported condition like chronic pain, it is very likely that your initial claim will be denied. Insurance companies are more likely to employ “fraud” tactics in chronic pain cases, like hiring private investigators to follow you around for a few days to see if you’re really as limited as you claim.
Even if your claim is approved, benefits for disabilities based primarily on self-reported symptoms may be limited to 24 months, even if the symptoms are a result of a proven illness or injury. Even if your claim is approved, some policies have specific limits on how long you can receive benefits for disabilities based primarily on self-reported symptoms. It is important to read your own policy — or get legal help in reviewing your policy’s terms — to see what limits apply to your situation.
LTD plans usually have a non-exhaustive list of what the plan considers self-reported symptoms. Some common examples include headaches, pain, fatigue, stiffness, soreness, ringing in ears, dizziness, numbness and loss of energy. If you file a claim for disability benefits on these kinds of symptoms, it is very important to have enough medical evidence to show that your symptoms are real.
Making Your LTD Case for Chronic Pain
When you claim LTD benefits for chronic pain, LTD claims examiners look at your physical and mental limitations to determine whether your disability limits you so severely that you are unable to work full-time. Unfortunately, the claims examiners often don’t trust that an employee is telling the truth about self-reported pain conditions. Another problem is that doctors who diagnose or treat disability applicants commonly do a bad job of documenting a patient’s levels of pain in their treatment notes or stating what the effects might be on the patient’s ability to work or do normal daily activities (this is especially true for doctors who utilize electronic medical records that often report no symptoms unless your visit is explicitly scheduled to discuss that problem). So how do you go about proving your pain?
Credibility is King
The believability of the patient generally becomes the driving force behind the approval or denial of a disability claim based on chronic pain. The disability insurance company, of course, considers the doctors’ opinions, clinical notes and records, physical examinations, diagnostic imaging, and the type of treatment you have received. But often a claims examiner, and the reviewing nurses who help them, put a lot of thought into whether the patient is credible — that is, if he or she seems to be telling the truth — when the patient describes how bad the pain is. The consistency of the complaints and reasonable connection to the underlying disease or injury is critical to this analysis.
Continuous Medical Treatment
Receiving continuous medical treatment is very important to establish your credibility. Your disability insurance carrier will doubt that you have been in severe pain if you have not received treatment for your pain on an ongoing and continuous basis. Treatment may include medical as well as non-traditional methods of pain relief such as massage, physical therapy, acupuncture, exercise, nutrition, herbal supplements, yoga, and meditation. It is not necessary to seek narcotic pain medications to be taken seriously. It is, however, absolutely critical not to give up on getting medical help, even if it seems like there’s “nothing else to do.” Be sure to document everything you do to relieve your pain in your application for disability benefits.
Keep a Pain Journal
Keeping a pain journal can help you record important facts about your chronic pain over time; after all, only you can know when and how much it hurts. When keeping a pain journal, the following details can be important depending on the kind of chronic pain:
- Date and time the pain occurs
- Severity of pain (scale of 1-10)
- Type of pain: sharp, dull, achy
- Location of pain
- Duration of pain
- Possible causes of pain: physical activity, particular movements, over exertion
- Additional or related symptoms
- Pain management: limit activities, medication, massage, psychotherapy, etc.
- Effects of current treatment
- Changes in treatment
- Changes in underlying medical condition associated with chronic pain
- Lifestyle factors that can affect pain: diet, exercise, quality of sleep
- Emotional and psychological effects of pain, such as depression and changes in mood
It is important to pay close attention to how your chronic pain limits your physical and mental activities. Can you stand or walk for an hour or less, but only by clenching your fists against the pain? Do you have to lie down or put your feet up periodically? Do you find it difficult to learn or remember new information because you are distracted by pain? Or maybe it is hard to get along with supervisors and coworkers because your pain makes you irritable and impatient? When documenting your pain, you need to be realistic about how your pain might limit you in a full-time job. If you can only stand for an hour at a time by suffering a tremendous amount of pain, chances are you probably won’t be able to stand for an hour every day to do a job. Share your pain journal with your doctor and make sure that it is part of your medical chart that gets sent to the LTD insurer along with your long-term disability claim.
Getting Help with Your LTD Claim
Because it can be so difficult to prove total disability based on chronic pain, we recommend working with an experienced attorney. The long-term disability attorneys at Bross & Frankel are highly knowledgeable about chronic pain claims and familiar with the tactics disability insurance companies like use to deny benefits. For a free consultation with a lawyer about your disability claim, contact Bross & Frankel today.
To learn more about chronic pain, check out the following sites:
American Chronic Pain Association
U.S. Pain Foundation
American Pain Society