Herniated Disc and Long-Term Disability Benefits in Canada

Living with a herniated disc can be a challenging experience, impacting mobility, comfort, and overall quality of life. For individuals facing long-term disability due to herniated discs, accessing disability benefits is crucial for financial stability and obtaining necessary medical care. Understanding how herniated discs intersect with long-term disability (LTD) benefits is essential in navigating the complex process of securing and maintaining financial support.

Understanding Herniated Discs

A herniated disc, also known as a slipped or ruptured disc, refers to a condition where the soft inner material of a spinal disc protrudes through the tough outer layer. This can result from age-related degeneration, sudden injuries, or repetitive strain on the spine. Herniated discs often lead to symptoms such as localized or radiating back pain, numbness, tingling sensations, and muscle weakness in the affected area or along the nerve pathways.

Cervical Spine (Neck Region):

Herniated discs in the cervical spine can compress nearby nerves, leading to symptoms such as neck pain, radiating shoulder pain, arm pain, numbness, tingling sensations, and weakness in the arms or hands. In severe cases, cervical disc herniation can cause difficulty with fine motor skills and grip strength.

Thoracic Spine (Upper and Mid-Back Region):

Herniated discs in the thoracic spine are less common than in other regions. Symptoms may include localized back pain, discomfort in the chest area, and occasionally, radiating pain along the ribs. Numbness, tingling, or weakness may also occur in the abdomen or areas supplied by affected nerves.

Lumbar Spine (Lower Back Region):

Lumbar disc herniation is more prevalent and can cause lower back pain, buttock pain, sciatica (radiating pain down the leg), numbness, tingling, and weakness in the legs or feet. Depending on the severity and location of the herniation, individuals may have trouble standing, walking, or performing activities requiring bending or lifting.

Sacral Spine (Base of the Spine):

Herniated discs in the sacral spine are relatively rare compared to other areas. Symptoms may include lower back pain, radiating pain into the buttocks and thighs, numbness, tingling, and weakness affecting the legs or feet. Bowel and bladder dysfunction can occur in severe cases involving nerve compression in the sacral region.

Herniated Discs and Long-Term Disability

Herniated discs can significantly impact an individual’s ability to perform work-related tasks, especially in occupations requiring physical exertion, prolonged sitting, or repetitive movements. Symptoms like severe back pain, limited range of motion, and nerve-related issues can interfere with job performance and productivity, potentially leading to long-term disability.

To diagnose a herniated disc, a physician would want to know about your medical history, including any previous injuries, medical conditions, or activities that might be related to the current symptoms. They will also then conduct a thorough physical examination, to assess reflexes, muscle strength, sensation, and range of motion in the affected area (such as the neck, back, or limbs). Diagnosis may also require some imaging studies, like an MRI, CT scan, or X-rays. Finally, they may also order an EMG, or nerve conduction study, to test electrical activity in muscles and assess nerve function, helping to identify nerve compression or damage associated with a herniated disc.

Are Herniated Discs Covered by my LTD Policy?

Whether herniated discs are covered by your LTD policy depends on the specific terms, definitions, and criteria outlined in your insurance contract. Most LTD policies cover disabilities that prevent individuals from performing the material duties of their occupation or any gainful occupation for which they are reasonably suited based on education, training, and experience.

Herniated Disc Disability Benefits

To support your herniated disc disability claim, you will typically need:

Medical Documentation:

Detailed records confirming the herniated disc diagnosis, severity, treatment history, imaging results (such as MRI or CT scans), and functional limitations resulting from the condition.

Treatment Plan Details:

Documentation outlining prescribed treatments, therapies, medications, and any surgical interventions related to managing the herniated disc and associated symptoms.

Functional Assessments:

Reports from healthcare providers or vocational experts assessing how the herniated disc impacts your ability to perform work-related tasks safely and effectively, considering physical limitations and pain management needs.

Can My Herniated Disc Benefits Be Denied?

Herniated disc LTD benefit denials can occur due to various reasons, including:

Insufficient Medical Evidence:

Lack of detailed documentation regarding the herniated disc diagnosis, severity, ongoing treatment, functional impairments, and limitations impacting work capacity.

Occupational Definitions:

Interpretation differences between “own occupation” and “any occupation” definitions in LTD policies concerning job roles and associated physical requirements related to the herniated disc condition.

Pre-Existing Condition Exclusions:

Some policies may exclude coverage for pre-existing herniated disc conditions or impose waiting periods before benefits become payable for such conditions.

Why Are Herniated Disc LTD Claims Denied?

Herniated disc LTD claims may be denied due to challenges in proving the severity of the condition, demonstrating functional limitations that impact work capacity, or facing policy-related restrictions or exclusions. Insurers may also scrutinize the necessity of treatments, accommodations, or interventions required for managing herniated disc-related symptoms in a work setting.

What To Do If My LTD Benefits Have Been Denied?

If your LTD benefits for herniated discs have been denied:

Review Your Policy:

Understand your LTD policy terms, appeal procedures, and timelines outlined in the denial letter.

Get Your Denial in Writing:

Many insurance companies will communicate their denial of benefits over the phone. Once your claim has been denied, be sure to get the denial in writing, as it’s important to have a record of when and how the company communicated it to you, as well as their clearly stated reasoning, which you can later appeal.

Gather Strong Documentation:

Compile comprehensive medical records, treatment plans, functional assessments, imaging results, and any correspondence related to your claim and denial reasons.

Appeal with Support:

Submit a detailed appeal with robust medical and vocational evidence supporting your disability claim. Address concerns raised in the denial letter and provide additional context or explanations as needed.

Seek Legal Assistance:

Consult with an LTD disability lawyer specializing in herniated disc-related claims. A lawyer can review your case, provide legal guidance, advocate during the appeals process, and escalate the case if necessary to secure the benefits you deserve.

Contact a Disability Lawyer About Your LTD Denial Today

Navigating LTD benefit denials for herniated discs can be complex, but legal assistance can make a significant difference in challenging denials, advocating for your rights, and obtaining the financial support needed for your ongoing medical care and financial well-being. Contact our law firm today to discuss your situation and take proactive steps towards appealing and resolving your LTD denial.