Insider Tips to Win Long-Term Disability Benefits for Chronic Pain

Getting long-term disability benefits for a chronic pain condition can be extremely difficult.  Insurers tend to heavily scrutinize these claims – often alleging there is no proof and the pain is simply “self-reported.”  Winning long-term disability benefits for chronic pain will take careful planning, preparation, and documentation.  Review these insider tips to get started on a winning path.

Tell Your Doctor About the Frequency, Severity, and Quality of Your Pain

Communication with your doctor is key.  If you don’t give your doctor details about your chronic pain, your doctor may be unsure or unwilling to comment on whether your pain condition is disabling.  This is critical because you’ll need your doctor’s support to win your claim. 

Start by consistently reporting the frequency, severity, and quality of your pain to your treating doctor during each visit. Be sure to detail the activities that exacerbate your pain, as well.  This will help familiarize your doctor with your chronic pain condition and its impact on your everyday life.

Keep a Chronic Pain Diary

Keep a chronological diary of your chronic pain and its impact on your daily life.  Ultimately, you can give the diary to your insurer and/or your doctors.  Having this written log of your symptom will help your doctors and/or the insurer better understand the frequency, severity, and limiting impact of your pain.

Sample entries:

10/17/19: Very restless night due to widespread pain; worst in lower back.  Slept only 4-5 hours due to tossing and turning.  Pain rated at 7/10 when I awoke.  Attempted to stretch after getting out of bed.  Stopped because it was making pain worse.  Canceled plans to visit my daughter and her 4-year-old son because I couldn’t handle the 15-minute drive. I was also embarrassed that I wouldn’t be able to play with or pick up my grandson.  I spent the day alternating positions between the couch and bed.  Took pain meds and napped in the afternoon for 1 hour. Drowsy the rest of the day from side-effects.

10/18/19:  Woke up feeling a little better today, but still with significant pain.  Accompanied wife to my daughter’s house, but I couldn’t stay long due to worsening back and shoulder pain throughout the day.  Widespread aches and pain developed by 2pm and we had to leave.

Explain the Cognitive Impact of Your Chronic Pain

Severe pain can prevent you from effectively performing cognitively demanding tasks at work.  Distracting pain can make it very difficult to pay attention, multitask, or concentrate on your work.  You may also be severely fatigued, “foggy,” or “slow” due to lack of sleep. These are all things that you must explain to the insurance company and your doctor.  If you don’t explain the cognitive aspects of your pain, the insurer will only focus on the physical aspects. 

Emphasize the Impact of Your Medication Side-Effects

Pain medications can cause a whole host of awful side-effects.  These may include drowsiness, sleepiness, upset stomach, etc.  Depending on the nature of your work, medication side-effects alone may be disabling. 

Be sure to report any specific medication side-effects to your doctor and the insurer.  Don’t assume that your insurer will “connect the dots” just because you’re taking a medication with known side effects.   If you don’t report medication-related issues, your insurer is unlikely to take them into consideration.

Help the Insurer Understand Some Days are Worse than Others

The severity and nature of your chronic pain may vary from day to day.  It’s very common for individuals with chronic pain conditions to experience some days that are much worse than others.  The type of day you’ll have may also be very unpredictable.  If your insurer doesn’t understand this, your insurer may only consider what your “average” days are like.

Take action to ensure your insurer “gets it.”  When your insurer asks you to describe your abilities and daily activities, give two different responses for an “average day” and a “bad/worse day.”  Describing your days in this manner will give the insurer a better snapshot of your life with chronic pain.  If your pain is unpredictable, be sure to mention that too.

Explain How Your Chronic Pain Impacts Your Energy and Stamina

Your chronic pain may have a significant impact on your energy and stamina.  This may be particularly true if you’re often tired out by the afternoon and need to rest.  Why is this relevant?  Well, you need enough energy and stamina to consistently sustain a full-time work activity.  If your chronic pain prevents you from handling a full-time schedule without long afternoon rest breaks or naps, that is something that your insurer should consider.

Treat Consistently

Your insurer will want to see that you’re receiving consistent and appropriate treatment for your chronic pain condition.  In the insurer’s eyes, less frequent treatment often means less severe symptoms.  Don’t let the insurer attack your credibility due to infrequent treatment.  Regularly follow-up with your medical providers in accordance with their recommended treatment plan.

Create a Disability Narrative

Inevitably, your insurer will want to know why you were able to work one day and not the next.  You can address this by creating a disability narrative that explains what happened. 

For example, if you were experiencing progressively worsening pain and eventually just reached a tipping point, provide examples of your increasing struggles at work before you went out on disability.  Alternatively, if an incident, such as a medical procedure or new treatment, caused an exacerbation of your pain, describe the event that led to you going out of work.

Get Your Doctor’s Support

Your doctor’s support will be a key part of the puzzle.  Talk to your doctor to be sure he or she supports your long-term disability claim for chronic pain.  Knowing whether your doctor supports your claim may save you a lot of grief, stress, and uncertainty. 

Conclusion

Winning a long-term disability claim for chronic pain is difficult, but certainly possible with careful planning.  An experienced long-term disability attorney can give you a specific, personalized action plan to win your claim.