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Denied Long-Term Disability for Back Pain?

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Disability Lawyers for Back Pain & Disc Injuries Serving Ontario

Chronic Back Pain & Long-Term Disability Benefits

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Has Manulife, Sun Life Financial, Great-West Life, Desjardins Insurance, Empire Life, Canada Life, Industrial Alliance, RBC Insurance, La Capitale, SSQ Insurance, or Beneva denied your long-term disability benefits for back pain? If so, we urge you to read on.

Back pain, especially stemming from disc injury or disc degeneration, can impact an individual’s life by restricting movement and causing persistent pain. This condition involves the intervertebral discs — the cushion-like pads between the vertebrae that act as shock absorbers — deteriorating or breaking down.

Factors like aging, strain, or injury can lead to the discs losing their flexibility, elasticity, and shock-absorbing characteristics.

As the discs deteriorate, they can cause severe discomfort, reduced mobility, and can impact an individual’s ability to perform everyday tasks and maintain employment, necessitating a difficult assessment of work capability against health and quality of life. Degenerative disc disease can start with or without damage to the spine and can lead to serious osteoarthritis and other permanent neurological issues. 

If you work in either a physical job or a more sedentary type of employment, the brutal pain of degenerative disc disease can be enough to stop you from performing both the mental and/or physical duties of your job. If you cannot work due to degenerative disc disease, you may qualify for long-term, disability benefits so long as you meet the definition of total disability as set out in your long-term disability policy.

Disc Degeneration and Severe Back Pain

Disc degeneration disease is a very common cause of both neck pain and lower back pain. It refers to either damage or wear and tear on the spinal discs in between your vertebrae which in turn cause pain. The rubbery discs are fibrocartilage-based structures that give your spine the flexibility and support that it needs.

It can also be compared to a load-bearing shock absorber in between your vertebral bones. As a person ages or suffers back trauma, their spine can show signs of wear and tear as the spongy discs are either damaged, shriveled or they can dry out. These changes could relate to arthritic conditions, disc herniation, and/or spinal stenosis.

The disc can be compared to looking at a tire. There is an outside in and inside. The outside is called the annulus in the inside is called the nucleus. A disc becomes herniated when a fragment of the nucleus is pushed out of the annulus, or surrounding barrier, into the spinal canal through either a tear or a rupture and compress surrounding nerves.

The nucleus can also dry out and shrink. The nucleus is made of approximately 85% water. As you age, your discs slowly lose water and flexibility, which constrains the annulus, thus leading to disc herniation. Your discs can also get thinner as you age which in turn, reduces the size of the shock absorber between your vertebral bones, leading to neural compression.

If you suffer from degenerative disease in your lower back, you may very well feel severe pain, which may or may not radiate in one or both of your legs and buttocks. Sciatica is a condition caused by either herniated discs or bone spurs, or severely degenerative discs. Sciatica causes a shooting pain that begins in the lower back and radiates through the buttock down the back of the leg. Chronic sciatica may require surgery.

Traumatic Injury and Debilitating Back Pain

Traumatic Injury to the back, especially from incidents like motor vehicle accidents, can significantly injury and damage to the discs in your spine.

As mentioned, the discs in your back act as cushions between your vertebrae, helping your back stay flexible and absorb shocks. When they’re damaged, it can lead to pain, discomfort, and mobility issues.

What Types of Trauma can Cause a Serious Back Injury?

  1. Direct Impact: In a car accident, your back might suffer a direct blow. This can cause immediate and severe damage to the discs, potentially leading to ruptures or herniations where the inner gel-like core of the disc pushes out through a tear in the outer layer.
  2.  Whiplash: This is a common injury in rear-end collisions. The sudden forward and backward motion can cause the neck and upper back to extend beyond their normal range, putting intense pressure on the discs. This can lead to tears or ruptures, especially in the cervical (neck) region.
  3.  Compression: If the trauma is severe enough, such as in a rollover accident, the spine might be compressed. This can cause the discs to burst or become compressed, leading to long-term back problems.

What areas of the Back are Most Prone to Injury?

The lower back, or lumbar region, is the most common area affected by disc trauma. It bears the weight of the upper body, making it more susceptible to injury, especially during high-impact events like car crashes. The cervical spine is also at risk, particularly from whiplash injuries.

How Damage Occurs:

In a motor vehicle accident, the force of the impact can cause the spine to bend and twist in unnatural ways. This can lead to several types of disc damage:

  1. Herniation: The trauma can cause the disc to bulge outwards, pressing against nearby nerves. This can cause pain, numbness, or weakness in the affected area.
  2.  Rupture: A more severe impact might cause the disc to rupture, releasing its inner material and leading to inflammation and nerve irritation.
  3.  Fractures: In extreme cases, the vertebrae themselves might fracture, leading to instability in the spine and further damaging the discs.

Is Chronic Back Pain Stopping you from Working?

The answer is that it depends. Severe back pain resulting from disc degeneration or disc injury can profoundly impact an individual’s ability to work.

Firstly, chronic back pain can drastically reduce an individual’s mobility and flexibility. The spine’s compromised state can make it difficult to perform simple movements such as bending, twisting, or even sitting for prolonged periods. This limitation is particularly debilitating for those whose jobs involve physical labor, driving, or extended periods at a desk. The constant pain and inability to move freely can decrease productivity, increase the likelihood of errors, and even lead to further injury.

Secondly, severe back pain can lead to significant psychological effects, including depression, anxiety, and sleep disturbances. The constant discomfort and the stress of coping with a chronic condition can affect an individual’s mental health, reducing their focus and cognitive function. This mental strain can decrease work performance, affect decision-making, and increase absenteeism, as individuals may require frequent medical visits or time off to manage their condition.

Thirdly, the management of severe back pain often involves a comprehensive treatment plan, including medication, physical therapy, and possibly surgery. The side effects of pain medication, such as drowsiness or dizziness, can impair job performance and alertness, while the time commitment for therapy and recovery from surgery can lead to extended absence from work. In some cases, despite treatment, individuals might not regain their former functional capacity, necessitating a career change or early retirement.

This loss of function and independence can trigger depression, while the constant struggle and concern over health can fuel anxiety. Moreover, the chronic nature of back pain can lead to sleep disturbances, exacerbating mental health issues and decreasing cognitive functions like concentration and decision-making.

These mental health challenges can form a vicious cycle with the physical pain, each intensifying the other, potentially leading to increased absenteeism, decreased productivity, and, in some cases, complete work cessation as individuals find themselves unable to cope with the demands of their job while managing their pain and mental well-being.

Can I get Long-Term Disability Benefits for Back Pain?

The answer is that it depends if your condition satisfies the definition of “Total Disability” as defined in your long-term disability policy.

Oftentimes, severe back pain can significantly hinder an individual’s ability to perform the substantial duties of their “own occupation,” meaning the specific tasks, responsibilities, and functions essential to the job they were doing at the time the disability began.

If after 24 months, your back pain continues to be so chronically disabling that it prevents you from performing the duties of any occupation for which you may be reasonably suited by way of education training, or experience – you may then in fact qualify for long-term disability until the age of 65.

Remember it’s not enough that you say that you are in pain. Most disability policies require you to participate to the full extent you are able, in a treatment program and follow medical protocol.

Why do Disability Benefits get Denied for Back Pain?

Canadian long-term disability companies may deny disability benefits for back pain for several reasons, often related to the nature of back pain itself and the specifics of the claim:

  1. Lack of Objective Evidence: Back pain, particularly when related to conditions like disc degeneration or soft tissue injuries, can be challenging to quantify and objectively prove through medical imaging or tests. Insurers often look for concrete medical evidence, and in the absence of clear, objective findings, they may be skeptical of the claim’s validity.
  2.  Vague or Inconsistent Medical Documentation: If the medical documentation provided is vague, lacks detail, or is inconsistent with the claimant’s reported symptoms and limitations, insurers might question the severity of the condition and its impact on the individual’s ability to work.
  3.  Definition of Disability: The policy’s definition of disability can be strict. Many policies require that the claimant be unable to perform the duties of their “own occupation” or any occupation for which they are reasonably suited by education, training, or experience. Insurers may argue that while the claimant cannot perform their current job, they could perform other work.
  4.  Surveillance and Social Media: Social media is what we call “case killers”. Insurers sometimes use surveillance or social media monitoring to gather evidence on claimants. If observed activities seem to contradict the reported level of disability, this can lead to a denial.
  5.  Previous Medical History: Insurers might attribute the back pain to pre-existing conditions or argue that it’s a typical life discomfort that doesn’t rise to the level of a disabling condition.
  6.  Duration of Pain: Some insurers expect a specific treatment duration before accepting that the condition is long-term and disabling. They might deny initial claims expecting that the condition might improve with time and further treatment.
  7.  Not Following an Approved Treatment Program: If you’re not following prescribed treatment plans or attending medical appointments, the disability insurers may argue that the individual is not sufficiently trying to mitigate their condition.
  8.  Policy Exclusions or Limitations: Some policies have specific exclusions or limitations for conditions related to the back or spine, or they may have a limited pay period for certain conditions.

When facing a denial, claimants must understand their policy’s specific terms, gather comprehensive medical evidence, and, if necessary, speak to our Hamilton Disability Lawyers to contest the insurer’s decision effectively – and remember, we represent disability claimants all over Ontario.

Have you Been Denied Long-Term Disability Benefits? Our Hamilton Disability Lawyers can help. Get your Free Disability Consultation Today. We Serve all of Ontario.

If you have been denied long-term disability for back pain it’s not the end of the road. As you navigate the complexities of being denied long-term disability benefits for back pain, remember that Lalande Personal Injury Lawyers are committed to advocating for your rights and securing the compensation you deserve.

With a deep understanding of Canadian disability law and a relentless commitment to our clients, we stand ready to help you challenge unjust denials and reclaim your life. Don’t face this battle alone; contact us locally in Southern Ontario at 905-333-8888 or Nationwide at 1-844-LALANDE for your free consultation. Alternatively, you can send us a confidential message through our website. We are here to help guide you through your legal journey to justice and recovery.

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Article FAQ

What qualifies as back pain for long-term disability benefits in Ontario?

In Ontario, to qualify for long-term disability benefits due to back pain, the condition must significantly impair your ability to perform your regular work duties. Chronic conditions like herniated discs, degenerative disc disease, or severe sciatica that are medically documented and impact your daily functioning may be considered.

How do I apply for long-term disability benefits for back pain in Ontario?

To apply for long-term disability benefits in Ontario, you must first obtain medical documentation of your back pain from a healthcare professional. Submit these along with any required medical evidence to support your claim.

Can a disability lawyer help with my back pain disability claim in Ontario?

Yes, a disability lawyer can be instrumental in guiding you through the complex process of filing for long-term disability benefits. They can help ensure your application is thoroughly completed, represent you in appeals if your claim is denied, and help you understand your rights and the benefits you’re entitled to.

How long does it take to receive long-term disability benefits for back pain in Ontario?

The time frame can vary significantly depending on the complexity of your case, the speed of the medical documentation process, and the efficiency of the insurance company. Generally, it might take several weeks to receive a decision.

What should I do if my long-term disability claim for back pain is denied in Ontario?

If your claim is denied, don’t lose hope. Review the denial letter to understand the reasons. It’s advisable to consult with a disability lawyer who specializes in long-term disability law to help strengthen your appeal and guide you through the process.



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