Long Term Disability Claims for Chronic Pain – Unfortunate, Yet Common

Medical professionals face a unique set of challenges when it comes to long term disability (LTD) insurance claim denials. Disability insurance companies tend to target medical professionals’ claims due to their high salaries and benefits.

Our client, Roger (not his real name), suffered from an extreme case of chronic pain disability triggered by his laminectomy surgery. His claim story and his symptoms are scary, as you’ll read below, for a number of reasons. 

Chronic cervical and thoracic pain, post laminectomy syndrome, trigger finger, and radiculopathy diagnoses like Roger’s are a common cause of long term disability and can disable a physician from working. Facing disability from work can be terrifying, and it can happen to anyone. 

Disability insurance companies commonly deny these claims, but you can appeal the denial and win if done carefully.

Long Term Disability Claim Denials for Chronic Pain – Shocking, but Also Common 

Roger’s treating physicians told him that he was absolutely unable to work as an emergency room physician as he would be putting himself and his patients at risk. Yet Prudential Insurance Company ignored their opinions and denied his claim for disability benefits claiming that Roger could still do portions of his specialty and was therefore not disabled, nor entitled to benefits under the policy. Prudential further claimed that the evidence he presented was insufficient to prove his case, despite his treating and pain management physicians’ unwavering opinion that he was physically disabled and could not work.

Being accustomed to a steady (and high) wage, Roger was scared to death about losing everything. He never imagined having to fight Prudential Insurance Company for the benefits he purchased to protect himself, all while going through the unrelenting pain of his condition.

Learning Roger’s Whole Story to Help Appeal the Bogus Claim Denial

We worked closely with Roger to help him build his claim carefully and systematically with new, undeniable evidence far beyond what he had presented to Prudential before they denied his claim. 

In helping Roger gather evidence to build his case, we needed to learn all the details of his story. As we did, we quickly realized that his story of multiple surgeries, cervical fusions, severe disc degeneration, and post laminectomy syndrome, was the most extreme we had ever heard. He had tried almost every treatment modality under the sun. Roger simply needed to tell his story more vividly and effectively to the insurance company in his appeal.

A Fast Paced Emergency Room Physician

For years Roger worked and thrived in the fast paced emergency room environment. He loved his work as a highly paid (over $300,000 per year) Emergency Medicine Physician. He worked really hard and kept long hours. He was highly valued by the medical facility who employed him and loved by the staff and his fellow physicians.

Life Changing Operations and Failed Results

Roger underwent several surgical procedures for his cervical degenerative discs followed by a shoulder acromioplasty and debridement. During this time, he was supposed to have a rotator cuff repair and was shocked to find out his rotator cuff tear was found irreparable. He proceeded to undergo several interventional procedures by pain management with variable results, but due to unrelenting pain, requested a second opinion. 

A surgical decompression of his cervical spine was recommended with hope that this would relieve the pressure on his spinal nerves and improve his pain. However, this procedure worsened his symptoms and a new weakness in his arm and leg presented. A laminectomy and fusion was then performed. However, similar to all the other treatments, his symptoms did not improve and continued to worsen. 

Roger’s symptoms had become so severe that his duties were given to other emergency medicine physicians. Essentially, he was incapable of performing his job. His physician and employer finally told him that he needed to apply for long term disability and that they had to let him go. 

How Roger Won His Case: Obtaining Medical Support and Presenting His Story Effectively to Appeal the Claim Denial

With Roger’s help, we were able to speak with some of his treating physicians and create detailed physician notes. These physician notes were made into formal signed statements. We were also able to create a much more vivid detailed statement for Roger’s signature describing his symptoms and physical limitations. We presented this and other new overwhelming evidence that was not part of Roger’s initial denied application to Prudential Insurance Company.

Thankfully, presented with undeniable new evidence in Roger’s appeal along with court opinions our case law research found where judges had awarded benefits under fact scenarios similar to our client’s case, Prudential Insurance Company finally did the right thing. They paid him for all past due benefits as well as began paying him the $10,000 per month that was owed to him under the policy going forward.

Victims Of Disability Should Always Appeal Unfair Claim Denials

In the end, because he continued to fight, appealing the insurance company’s denial of his disability claim rather than just accepting it as the final word, Roger was able to maintain his financial security while he took some much-needed time to pursue further treatment and focus on healing. 

Unfortunately, disability insurance companies unfairly deny legitimate claims every day, but anyone faced with an unfair claim denial should continue to fight and appeal the denial. These unfair denials can be overturned with stronger evidence, properly presented. 

Roger deserved the benefits he had paid premium for over the years, and it was an honor to help such a wonderful physician and person overturn such an unfair claim denial.

Results may vary. Every case is different, and no outcome can be guaranteed.