Back Pain and Long-Term Disability Benefits in Canada

Back pain is a common health issue that can range from mild discomfort to severe, debilitating pain affecting daily activities and work capacity. For individuals experiencing chronic back pain that significantly impacts their ability to work, seeking long-term disability (LTD) benefits may be necessary for financial stability and access to necessary medical care.

Unfortunately, navigating the process of applying for and securing LTD benefits for back pain can be complex, and denials are not uncommon. Understanding the nuances of back pain, disability benefits, and the appeals process is crucial for individuals in this situation.

If back pain is affecting your ability to work, our experienced long-term disability lawyers can help. Contact Preszler Injury Lawyers today to learn how we can support your claim and help you access the benefits you deserve.

Understanding Back Pain

Chronic back pain is a prevalent health condition that can significantly impact an individual’s quality of life and ability to perform daily activities. Understanding the main causes of chronic back pain is essential for proper diagnosis, treatment, and management. Some main causes of chronic back pain include:

• Muscle or Ligament Strain: Overstretching or tearing of muscles or ligaments in the back, often due to improper lifting techniques, sudden movements, or repetitive activities, can lead to chronic back pain. Poor posture and weak core muscles can also contribute to muscle strain.
• Herniated or Bulging Discs: The intervertebral discs in the spine can herniate (rupture) or bulge due to age-related degeneration, trauma, or repetitive stress. This can result in compression of nearby nerves, leading to chronic back pain, sciatica (leg pain), numbness, or weakness.
• Degenerative Disc Disease: As people age, the discs between the vertebrae can degenerate, lose hydration, shrink in size, and develop tears. Degenerative changes in the discs and facet joints can cause chronic back pain, stiffness, and reduced spinal flexibility.
• Spinal Stenosis: This condition involves narrowing of the spinal canal or nerve openings in the spine, often due to age-related changes like bone spurs, thickened ligaments, or herniated discs. Spinal stenosis can compress spinal nerves, causing chronic back pain, leg pain with walking (neurogenic claudication), and numbness or weakness.
• Spondylolisthesis: This condition occurs when one vertebra slips forward or backward in relation to an adjacent vertebra, typically due to degenerative changes, fractures, or congenital abnormalities. Spondylolisthesis can lead to chronic back pain, spinal instability, and nerve compression symptoms.
• Osteoarthritis: Degenerative joint disease, or osteoarthritis (a form of arthritis), can affect the facet joints in the spine, leading to inflammation, joint degeneration, bone spurs, and chronic back pain, especially with movement or prolonged sitting or standing.
• Traumatic Injuries: Accidents, falls, sports injuries, and other traumatic events can cause fractures, sprains, strains, and disc injuries in the spine, resulting in chronic back pain and functional limitations.
• Structural Abnormalities: Congenital spinal abnormalities such as scoliosis (abnormal curvature of the spine), kyphosis (excessive forward rounding of the upper back), or lordosis (swayback curvature of the lower back) can contribute to chronic back pain, especially if they cause spinal misalignment or nerve compression.
• Medical Conditions: Certain medical conditions such as fibromyalgia, ankylosing spondylitis, spinal infections, tumours, and inflammatory conditions like rheumatoid arthritis can cause chronic back pain as a symptom of the underlying disease process.
• Obesity and Poor Physical Fitness: Excess body weight, lack of regular exercise, weak core muscles, and sedentary lifestyles can increase the risk of developing chronic back pain due to added strain on the spine, poor posture, and reduced spinal support.

It’s important to note that chronic back pain can result from a combination of factors, and individual experiences of pain may vary widely. Proper diagnosis by healthcare professionals, including physical examinations, imaging studies (X-rays, MRI scans), and sometimes specialized tests like nerve conduction studies or discography, can help identify the underlying causes of chronic back pain and guide appropriate treatment strategies. These may include physical therapy, medications, injections, lifestyle modifications, and in some cases, surgical interventions.

Factors such as poor posture, repetitive movements, heavy lifting, obesity, age-related changes, and underlying medical conditions can also contribute to the development or exacerbation of back pain. Symptoms may include:

• Localized pain
• Radiating pain to the legs (sciatica)
• Stiffness
• Limited mobility
• Muscle weakness
• And more

Back Pain and Long-term Disability

When back pain becomes chronic and significantly impairs a person’s ability to perform essential job duties for an extended period, applying for LTD benefits may be necessary. LTD benefits can provide financial support and access to healthcare resources for individuals unable to work due to their back pain. However, securing these benefits can be challenging due to stringent criteria, documentation requirements, and potential disputes with insurance providers.

LTD benefits for back pain typically require:

• Substantial medical evidence demonstrating the severity of the condition
• Functional limitation assessments
• Ongoing treatment efforts
• A demonstrated impact on work capacity
• And more

You might be able to provide this evidence through medical records, diagnostic imaging results, specialist evaluations, treatment history, functional assessments, and healthcare provider opinions supporting the inability to perform substantial gainful work due to back pain. Ultimately, it will be up to your provider and the details of your policy to determine whether you’re eligible for LTD benefits. Individuals who qualify may receive up to 70% of their regular income while they’re unable to work.

Can My Back Pain Long-term Disability Benefits Be Denied?

Unfortunately, insurance companies may deny initial LTD claims for back pain due to various reasons:

• Insufficient Medical Evidence: Lack of comprehensive medical documentation or conflicting medical opinions regarding the severity and disabling nature of the back pain condition.
• Policy Limitations: Coverage limitations, waiting periods, exclusions, or discrepancies between policy definitions of disability and the individual’s functional impairments.
• Dispute Over Disability Status: Insurance companies may dispute the extent of the disability, ability to perform alternate work tasks, or the claimant’s compliance with treatment recommendations.

Having your disability benefits denied can create an additional amount of mental and financial stress, on top of the physical pain you are also having to contend with.

What to Do If Your Back Pain LTD Benefits Have Been Denied?

If your LTD claim for back pain has been denied, taking prompt and strategic action is crucial. You should:

• Review Your Denial Letter: When your LTD claim is denied, your insurer will need to provide a letter detailing the reasons for their decision. Carefully review the denial letter to understand the reasons for denial, appeal deadlines, required documentation, and appeal procedures outlined by your insurance provider. You can also ask you provider to speak with the claim’s handler in charge of your case.
• Gather Additional Evidence: Work with your healthcare providers to gather and submit additional medical evidence supporting the severity and disabling nature of your back pain condition, functional limitations, treatment history, and ongoing impairments. If your claim has been denied, it’s important to ask your doctor or specialist if they agree with the insurance company’s decision. If not, have them put their objection in writing. This document should clearly explain why you are unable to perform the duties of your, or any, job.
• File an Appeal: Follow the specific appeals process outlined by your insurance provider, including submitting a detailed appeal letter, supporting documentation, and any relevant legal arguments or opinions from healthcare professionals.

Contact Our LTD Lawyers About Your LTD Benefit Claim For Back Pain

Navigating an LTD claim denial for back pain can be complex, and seeking legal representation from an experienced LTD lawyer can significantly improve your chances of a successful appeal. At Preszler Injury Lawyers, our long-term disability lawyers can:

• Provide legal expertise in disability insurance laws, policies, and appeals processes.
• Review your case, medical documentation, and denial reasons to develop a strong appeal strategy.
• Advocate on your behalf during appeals, negotiations, or potential litigation if necessary.
• Ensure your rights are protected, and you receive fair consideration for your back pain disability claim.
• And more

By partnering with our legal team, you can navigate the challenges of securing LTD benefits for back pain with confidence. To discuss your situation, schedule a free consultation today. You can contact us online or call 1-800-JUSTICE® now.