Radiculopathy is a medical term that describes a set of symptoms related to compression, inflammation, or injury to the spinal nerve roots. These nerve roots exit the spinal cord and branch out to various parts of the body. When they are affected, it can lead to serious pain, muscle weakness, numbness, or tingling sensations along the path of the affected nerve. If you experience radiculopathy, you may suffer from intense and frequent symptoms that interfere significantly with your function, mobility, and ability to work, leading to long term disability.
Below, we’ll discuss important factors to consider when filing a radiculopathy long term disability claim and how an attorney can help you through the process.
Can I get long term disability for radiculopathy?
Yes, you can get long term disability for symptoms of radiculopathy. The impact of radiculopathy can be profound. If you experience lower extremity (lumbar) radiculopathy, your symptoms may radiate from the lower back down to the legs, affecting your mobility and ability to perform daily activities. In the case of upper extremity (cervical) radiculopathy, symptoms often involve the neck, shoulders, arms, and hands, which can hinder your physical functioning and ability to perform tasks requiring dexterity. If your radiculopathy significantly impairs you from performing the material duties of your occupation, you may qualify for long term disability benefits.
What conditions cause radiculopathy?
Radiculopathy, often referred to as a “pinched nerve,” is a condition that occurs when nerves in the spine become compressed or irritated. This compression can result from a number of conditions, not limited to but including:
- Herniated disc, which occurs when the soft, gel-like interior of a spinal disc protrudes through the outer layer and presses on a nearby nerve root;
- Spinal stenosis (the narrowing of the spinal canal), which can put pressure on the spinal cord or nerve roots, and may be due to aging, degenerative changes, or conditions like osteoarthritis;
- Degenerative Disc Disease, especially if it causes bone spurs or other changes that compress nerve roots;
- Spondylolisthesis, which occurs when one vertebra slips forward or backward in relation to another, leading to nerve compression and radiculopathy;
- Both benign and malignant tumors in the spinal cord or along the nerve roots;
- Physical trauma to the spine, such as from a car accident, fall, or sports injury, can damage the spinal nerve roots and result in radiculopathy;
- Infections such as spinal epidural abscesses;
- Inflammatory disorders like ankylosing spondylitis or rheumatoid arthritis, which can cause inflammation and compression of nerve roots;
- Diabetes, which can damage nerves throughout the body, including the spinal nerve roots; and/or
- Paget’s disease or rare genetic disorders
What are the disabling symptoms of radiculopathy?
Disabling symptoms of radiculopathy may vary depending on the location of the affected spinal nerve root and the underlying cause of your condition. However, there are several common and potentially debilitating symptoms associated with radiculopathy. These disabling symptoms may include:
- Severe pain, often described as sharp, shooting, burning, or stabbing, following the path of the affected nerves;
- Radiating pain into your extremities;
- Muscle weakness;
- Numbness and loss of sensation;
- Tingling sensations;
- Reduced reflexes;
- Limited range of motion; and/or
- Loss of bladder or bowel control.
Any of the above symptoms may prevent you from performing your job duties and cause long term disability. For example, if you experience lower extremity radiculopathy, pain may radiate from the lower back into the buttocks and down one or both legs. This can lead to difficulties with walking, standing, or sitting for extended periods. In contrast, upper extremity radiculopathy may cause pain in the neck and shoulders, often extending into the arms and hands. Gripping objects, performing fine motor tasks, or even typing on a keyboard can become challenging.
How do I get my radiculopathy long term disability claim approved?
Securing long term disability benefits for radiculopathy requires meeting the definition of disability in your policy. A diagnosis of the condition causing your radiculopathy alone is not sufficient. You must also demonstrate the severity of your symptoms and their effect on your ability to perform your job duties. This involves submitting your insurer comprehensive documentation, including medical and vocational evidence.
What medical evidence can I use to support my radiculopathy disability claim?
Comprehensive medical evidence plays a pivotal role in substantiating your claim for long term disability benefits due to radiculopathy. This documentation serves as the foundation for your case and provides your insurance company with a clear picture of your condition.
Examples of medical evidence for radiculopathy may include:
- Magnetic Resonance Imaging (“MRI”), which provides detailed images of the spine, including the spinal discs, nerve roots, and any potential causes of compression or irritation;
- Computed Tomography (“CT” Scans, which may be used to visualize the bony structures of the spine and can help identify conditions like spinal stenosis or spondylolisthesis;
- X-rays that can show the alignment of the vertebrae and any structural abnormalities, such as fractures or deformities;
- Nerve Conduction Studies (“NCS”), which measure the speed and strength of electrical impulses in the nerves to help identify nerve damage or dysfunction;
- Electromyography (“EMG”) results that assess the electrical activity of muscles;
- Records of diagnostic nerve root blocks or facet joint injections used to help pinpoint the specific nerve root causing symptoms;Top of Form
- Blood tests ordered to rule out underlying systemic conditions that could be contributing to radiculopathy symptoms, such as infections or inflammatory disorders;
- Office visit notes from your treating providers;
- Narrative letters from your treating providers that describe the extent of your symptoms, their impact on your ability to work, and any recommended treatments or accommodations; and/or
- Medication records, including any side-effects from prescriptions (such as drowsiness)
Can a Functional Capacity Evaluation help my claim?
To provide your insurer with more objective evidence of your radiculopathy’s impact on your functioning, consider undergoing a Functional Capacity Evaluation (“FCE”). Objective medical evidence will hold the most weight with your insurer when they assess your claim. Of course, doctors do not keep records for the purpose of establishing disability for insurers, and as a result they may not capture the full extent of your restrictions and limitations. The FCE is an opportunity to obtain additional objective evidence of your physical limitations.
During an FCE, a trained healthcare professional evaluates your strength, endurance, range of motion, and functional capabilities. The results of this assessment can offer insights into how radiculopathy impacts your ability to engage in various work-related activities, such as lifting, carrying, standing, and sitting.
Insurance providers often place significant weight on FCE results when evaluating disability claims. An FCE can help bridge the gap between subjective symptom descriptions and objective evidence, making it an invaluable tool in demonstrating the extent of your functional impairment caused by radiculopathy.
What vocational evidence can support my radiculopathy disability claim?
Vocational evidence to support your radiculopathy disability claim may include:
- Your resume;
- An official job description from your employer outlining the physical and cognitive requirements of your position;
- Witness statements from your supervisors and/or colleagues explaining the nature of your role and their observations on how your radiculopathy has affected your ability to perform your job duties;
- A personal affidavit explaining your educational and work history, details of your occupational demands and responsibilities, the onset of your radiculopathy, your treatment efforts, and how your symptoms impair you from working; and/or
- A vocational assessment conducted by a vocational expert who evaluates how your radiculopathy directly affects your ability to perform essential job duties.
Vocational evidence holds great importance in supporting your long term disability claim for radiculopathy. This evidence links the specific demands of your occupation to the limitations imposed by your condition. By providing a clear connection between your job and your radiculopathy’s impact on your ability to perform your duties, vocational evidence can strengthen your claim significantly.
How can a long term disability attorney help with my radiculopathy claim?
If you’re in the process of filing a long term disability insurance claim for radiculopathy or facing a claim denial or termination, the experienced ERISA disability attorneys at Riemer Hess can help. We’ve helped secure long term disability benefits for countless clients, many involving symptoms of radiculopathy.
For example, our client “Alan” was working as a partner attorney for a major law firm when he began developing cervical radiculopathy due to a progressive spinal condition. The cervical pain and numbness were worsened by sitting for extended periods as his role required. Eventually, Alan was forced to leave his work due to his condition. He had long term disability coverage through multiple insurance policies, both provided by his employer and purchased individually. When he filed his claims, one of his insurers denied his benefits. Alan retained Riemer Hess to handle his disability claims and the appeal.
Riemer Hess worked to obtain additional evidence, including a Functional Capacity Evaluation, narrative reports from Alan’s treating providers, and a vocational assessment. When this evidence was submitted with a detailed appeal letter, the insurer came back with their own non-examining medical paper reviewers’ reports rebutting the informed opinions of Alan’s treating providers. Riemer Hess quickly coordinated with Alan’s providers to refute these medical paper reviewers and submitted this along with additional treatment records and assessments. In turn, the insurer ultimately approved Alan’s claim going forward.
Separately, Alan had both a group and individual claim with another insurer, which were initially approved. However, after receiving benefits for two years, the insurer alleged that Alan could work part-time (though no such requirement was in either policy) and threatened to terminate his claims. Riemer Hess succeeded in getting the insurer to continue benefits under the group policy, but they terminated the claim under the individual policy. As a result, Riemer Hess helped Alan sue Unum for reinstatement of his benefits.
Riemer Hess successfully established to the court that Alan’s condition, including symptoms of radiculopathy, meant he could not even work part-time, let alone perform at full capacity. Ultimately the judge sided with Alan, determining that Unum owed him back payment of benefits, including interest and attorneys’ fees, in a total victory for our client.