The prevalence of herniated discs does not make them any less debilitating. Treatment can range from physical therapy to surgery, and anytime a condition impairs you from working for a long period, you can file a claim with your disability insurance provider if you have this coverage.
Obtaining disability benefits for a herniated disc through a group disability plan can be challenging and frustrating. You might feel overwhelmed by your disabling injury, and you might not know how to successfully navigate the disability claims process.
You should never hesitate to help to obtain these benefits. Speak with a disability insurance attorney to get started.
What Is a Herniated Disc?
You can suffer a herniation when there is an injury or as you age. When one of the rubbery discs between your vertebrae is damaged by breaking open, you will most often experience a herniation in the lower back. Still, it can happen anywhere along your spine. Herniated discs go by several names, including bulging discs, slipped discs, or ruptured discs.
Symptoms of Herniated Discs
Herniated discs are complex because they can show no symptoms, have flare-ups or cause chronic pain. Many people live with herniated discs and experience no symptoms
For those three million people in the United States who do, symptoms often include:
- Muscle spasms
- Severe pain
- Muscle weakness
- Overactive reflexes
- Burning sensation
- Pins and needle pain
- Limb numbness
Treatment Options Available for a Herniated Disc
Herniations have varying symptoms, are considered self-limiting, and usually resolve independently. In minor cases, the symptoms will subside within three months. Treatment options vary by the severity and the location of the injury.
For some herniations, you will require additional treatment like:
- Ice and heat
- Physical therapy
- Anti-inflammatory medications
- Chiropractic adjustments
If the condition does not improve, there are more invasive options available. Prescribing medication does not fix your disc but alleviates some of the symptoms. However, some drugs affect your quality of life. Medicine does not qualify you for disability benefits but can be a consideration if it affects your residual functioning capacity.
Common medications to treat herniations are:
- Narcotics: Used for pain with side effects like confusion, fatigue, and inability to drive or operate heavy machinery.
- Steroids: Injected directly into the epidural space to relieve swelling with side effects like anxiety, fever, decreased immunity, non-positional headaches, or high blood sugar.
- NSAIDs: Reduce inflammation and have side effects like heartburn, nausea, acid reflux, and kidney problems.
Medication might do little to address the symptoms of your herniated disc. You might continue to feel such pain that you cannot perform your job.
If you continue to experience weakness, pain, movement restrictions, or loss of bowel or bladder control, you might need to undergo a lumbar decompression surgery if nothing else alleviates your pain. Surgeons might remove part of your protruding disc and may need to conduct a bone graft for a spinal fusion.
The recovery time for spinal surgery is extensive. You will have highly restricted movement for months or longer, and the surgery might not even be successful at managing your symptoms. You often cannot even qualify for surgery until doctors have tried other courses of treatment for some time, so you might be in pain and/or out of commission for years.
Overall, herniated discs can seriously affect your abilities for a long time, and treatment might not be effective. Even if you are eligible for surgery, it is an invasive procedure that leaves you immobile, and it might not even help you heal. Many people with herniated discs must be out of work for some time, and they need financial support from disability insurance coverage.
Herniated Disc Work Restrictions
Returning to work is necessary to survive and thrive in the world. Unfortunately, your herniated disc can prevent you from completing your job duties. Some employers can adjust your role or place you in another position while you recover. In other cases, you are completely unable to work, meaning you must seek disability benefits.
Walking is a major motor function, and when you experience trouble walking or standing straight, it can impact your work routine. You can experience muscle weakness, severe pain, and reduced motor function that affect your walking and working ability. You might not complete your usual work tasks to the point where you need to stay home from work entirely.
Industries that you cannot work in with herniated discs may include:
These industries require employees to lift, bend, and carry, which worsens the pain of a herniated disc. Standing for extended periods also impacts your mobility, and you might require a stool or chair to complete your job tasks. If you are taking medication that causes fatigue or dizziness and you work with heavy machinery, you must take time off.
Many people hesitate to stop working because it cuts off their major source of financial support. However, you might not have a choice. If you cannot keep working through the pain or your herniated disc disables you to the point you cannot perform your job, you will need to take time off work.
You might have limited paid time off, but after that, you will not have compensation while you are away, and you might be out of work for an extended time.
Financial Stress When You Cannot Work
Disabilities are a leading cause of financial stress for individuals and families. When a disabling illness or injury prevents you from working, your household loses significant financial support. Whether you live alone or help support a family, your disability can take a toll on your financial situation.
The resulting stress from not having your usual income stream can be overwhelming.
You might worry about how you will cover your:
- Mortgage or rent
- Car payments
- Food and clothing
- Medical services
If you have a family, you also want to provide for your children, including birthday or holiday gifts, fees for athletics and extracurriculars, and much more.
Financial stress can go beyond practical concerns, as it can affect your health. You might experience depression, anxiety, and other mental health issues. You might forgo necessary medical appointments due to concerns about cost, which can worsen or extend your disabling condition. Some people use unhealthy coping methods like substance abuse, which can worsen the entire situation. Chronic financial concerns can lead to additional chronic health problems.
You always want to do whatever possible to ensure you have maximum financial support when you cannot work. If you have disability coverage, you should explore this option as soon as you realize your disability will prevent you from working. The claim process can take time, so you do not want to put off starting your claim.
Many people do not know where to begin when applying for disability benefits, and this is when you should seek help from a skilled disability insurance lawyer. It costs you nothing to consult with an attorney and learn how they can help you.
Qualifying for Disability for Herniated Discs
Since herniated discs can affect each person differently, obtaining disability benefits presents huge challenges.
You must prove:
- You have a medically diagnosed condition that causes a disability that is eligible for benefits under your policy
- Your disability prevents you from working (either your own job or any job, depending on your policy)
You might think your disability and its effects are obvious, but the insurance company will not agree. Your insurer requires proof of the above facts, including extensive medical documentation. You will need to provide objective medical evidence of your disability to qualify, and many people provide insufficient evidence if they do not have legal help during the process.
You can expect disability insurance companies to find any technicality so they can deny a claim. Even if you provide medical documentation, they can utilize their own medical consultants to refute your evidence. Their consultants might examine you and come to a different conclusion than your own treating physician with whom you have a long-term relationship. The insurer might rely on its consultant’s findings to assert you can work and deny the claim.
The insurer might ask for your entire history of medical records to search for anything they can find to deny your benefits. They might have investigators surveil you or stalk your social media to see if you are doing anything that indicates you are healthy enough to work. You should not have to fight against your insurer or allow them to violate your privacy. Seek help from a disability claims lawyer immediately.
You might have no doubt you deserve disability benefits, but you can still receive a denial. You would not be the first person – by far – in this position, as denials are common. For the best chance of success right out of the gate, have a trusted lawyer assist you with your claim.
Appealing a Denial
When you learn that your disability claim resulted in a denial, it can be extraordinarily disheartening. It only adds to your stress in an already stressful time. However, the denial is only the initial decision, and you have the right to appeal.
The important thing is to act immediately by contacting a disability appeals attorney. If you delay, you can easily miss your window to appeal. Employer-sponsored disability plans fall under the Employment Retirement Income Security Act (ERISA), so your appeal must follow the requirements and procedures set out in the law.
- You only have a limited time to begin the appeal process
- You must exhaust your administrative appeal options first
- If you need to challenge your denial in court, it must be in federal district court since ERISA is a federal law
Contact a lawyer immediately, so you do not miss the appeal deadline. Your attorney will review the reasons for your denial and develop the best strategy to prove your eligibility for benefits.
You must start with an administrative appeal, which means the insurer that issued your denial will be reviewing your claim file again. Your lawyer can identify additional evidence you need to present to prove your claim. You must provide everything you have at this stage of the appeal, as ERISA prevents you from adding to your claim file once your case goes to court.
If the insurance company upholds its denial on appeal, and your attorney agrees that you should qualify for benefits, they can file your case with the appropriate federal court. An ERISA disability lawyer will know all of the applicable federal court procedures to follow.
Hopefully, with the right legal representation, you can end up receiving the disability benefits and financial support you need for your herniated disc.
Consulting With a Disability Claims Attorney
If you are suffering from a disability, do not expect your disability insurer to take your word for it and provide you the benefits to which you are entitled. The disability process is arduous, and most people will face denials of benefits for their conditions.
One way to circumvent a denial is to speak with an experienced disability claims lawyer as early as you can in the process – preferably before you even start your claim. In the event that the insurance company has already denied your claim, you should retain legal representation immediately and certainly before you start the appeals process.
Disability insurers have one priority: their bottom line. As a result, they will do everything they can to not provide you with the benefits that you have dutifully paid for since you purchased your policy. Furthermore, they do this every day, putting you at a significant disadvantage when it comes to asserting your rights – all while you are dealing with the physical and emotional pain and suffering that comes with suffering from a disability.
The most effective thing you can do to ensure that you obtain the full value of your long-term disability benefits as quickly as possible is to retain a lawyer today.
Following graduation from Loyola Law School in New Orleans in 1990, Price McNamara served as a Federal Judicial Law Clerk to the Honorable John M Shaw, Chief Judge, United States District Court Western District of Louisiana.
Mr. McNamara founded J. Price McNamara ERISA Insurance Claim Attorney, and began putting his past experience to work for the injured and disabled clients he now represents against the insurance companies in personal injury and long term disability and other insurance disputes in both federal and state courts