Pain. Although most of us endure the occasional aches and pains of tension headaches, bumps, thumps, bruises, strains and sprains, there are many others who suffer daily chronic pain, that cannot be lessened with over-the-counter remedies such as Tylenol or Advil. Ongoing, chronic pain without a light at the end of the tunnel is one of the most difficult aspects of disability to live with.
Many chronic pain individuals eventually file disability claims only to become misunderstood and accused by the insurance industry of malingering, or exaggerating pain in order to receive benefits. Since pain is an unseen or immeasurable result of physical “brokenness” within the body, it is considered by disability insurers to be “subjective” and “self-reported.”
Therefore, in their haste to remove the liability for chronic pain claims, most disability insurers adopt the philosophy that “if it cannot be measured, we can’t pay.” The idea that there are no diagnostic tools to measure levels of pain, in addition to the presumption that pain does not exist, or at best is exaggerated, meets the profitability needs of insurers when claims are not paid.
To further complicate the issues of pain is the fact that each individual has their own threshold. What would be described as chronic, unbearable pain to one person is another person’s tension headache. Further complications include the fact that physicians are often unable to identify why pain exists in the body and where it’s coming from.
Unexplained pain is an easy “hit” for denial, since insurers always want to know the cause of the insured’s pain. If one accepts the notion that “pain is a signal that something is physically wrong”, then it makes sense for insurers to continue searching for physical reasons why insureds are reporting pain.
Disability insurers generally do not attempt to distinguish between thresholds of pain, which is a major flaw in the disability claims review process. Once insurers accept the notion that pain is “self-reported”, it is very easy to build internal protocols based on the companies’ own self-interests to allege claims are non-compensable. The presumption that all chronic pain claims are fraudulent is a deliberate misrepresentation of medical facts that DO support the fact that chronic pain actually exists.
What disability insurers often forget (deliberately) is that pain hurts, and long-term pain becomes impairment when insureds are no longer able to manage severe uncomfortableness sufficient to continue working. After all, pain requires an individual’s full attention, which is not conducive to performing well on-the-job. Someone who is in pain generally thinks of nothing else BUT the pain.
Human beings are physically made to withstand moderate levels of pain for short periods of time. Women can endure the pains of childbirth because they know the pain won’t last forever. Although a broken leg is extremely painful, it can be fixed and the pain alleviated. Pain, even at its most severe levels can be endured for short periods of time. It’s the chronic nature of pain that can never be removed that eventually becomes a disability precluding anyone from working.
In addition, chronic or predictable pain such as in migraine headaches, is long lasting with no expected light at the end of the tunnel. Individuals who have chronic pain on a daily basis eventually become exhausted, worn down, and depressed at the idea of having perpetual pain, sometimes for the rest of their lives.
What constitutes credible proof for disability is not only the reported existence of chronic pain, but also the after effects of longstanding daily management of chronic pain. The longer insureds endure pain at their own threshold level, the more “impaired the individual becomes for disability purposes.” While it is important for physicians to actually determine the CAUSE of chronic pain, for some, pain continues to exist whether the source is identified or not. Insurers often don’t get it!
Unpaid by insurers for pain, the actual claimed primary disability then becomes fatigue, depression, exhaustion, and despair caused by secondary pain, which is really a symptom of something else. Many insureds find it helpful to seek out counseling or pain management as an aid to managing levels of pain that interferes with everyday life.
Insurers have no interest in recognizing that pain hurts, and those who suffer pain for extended periods of time can occasionally lose their threshold of tolerance and have a meltdown described, by me, as “a total loss of one’s ability to endure any level of pain in combination with a release of emotion as a result of enduring high levels of pain for long periods of time.” Insurers generally DO NOT pay claims for reported pain when a cause in not identified.
Some time ago, one of my clients described himself in the Emergency Room in tears because his migraine medication wasn’t working. Once insureds begin to experience a pain meltdown they will usually go anywhere, do anything they can, to make the pain go away. Today, ER physicians are required to contact treating physicians for information about levels of prescribed pain medications. While insureds may walk out of the ER with a few pills, it is never a long-term solution to chronic pain.
Finally, I can’t tell you how many insureds have told me that they are deserted by family and friends who say, “You look pretty good. There really isn’t anything wrong with you. Go back to work and support your family.” The emotional devastation added to pain endurance is one of the hardest things to manage. It is often heartbreaking when families, friends and neighbors fail to accept disability for pain.
While disability insurers need to reconsider and change their protocols and perspectives toward paying chronic pain claims by looking beyond the “subjective” definition to other symptoms caused by pain, insureds are left to medication management, some of which is highly dangerous in combination, such as Oxycontin and Fentanyl.If an insured is diagnosed with depression and is further prescribed anti-depressants, frequent physician management will be required.
Insureds who have chronic pain, regardless of the source, should always mark their levels of pain on a visual analog scale and keep a pain journal. Other symptoms resulting from pain such as fatigue, exhaustion, loss of temper, irritation, inability to think clearly or concentrate, should be clearly documented in the journal, in addition to restrictions of “Activities of Daily Living” and lack of functionality.
And remember, it’s OK to have a meltdown once in awhile. The longer a person endures and attempts to manage pain, the more impaired he/she becomes for disability purposes.
Those of us who give in to an occasional Tylenol cannot imagine the pain levels some people have to endure, often for the rest of their lives. It’s time disability insurers change their archaic views regarding pain and place credibility on the totality of dysfunction caused by chronic pain rather than classifying pain as “self-reported” in order to avoid payment.
