While cardiovascular disease remains the number one claimed disability in America, neck and back claims come in a close second. Number three is migraine headache. Although one might think a “back or neck” claim would be easy to support because of the existence of specific objective evidence to prove such a disability, unfortunately, that is not the case. Migraine headache is regarded as “subjective” from the beginning.
The truth is, neck and back claims are the most aggressively investigated claims by disability insurers. While it is true that back and neck conditions can be diagnosed from X-rays, MRIs, CAT scans etc., these disabilities involve “pain”, which is considered to be “subjective” and there is no objective test to prove its intensity or existence. When someone tells you he/she has pain at 7 on the pain scale of 10, insurers only have their word for it – and, that’s a problem for insurance companies.
In my experience, neck and back claims are too often supported, and documented wrongly. Those who send in disability forms (insureds, or physicians) giving cause of disability as “Chronic Pain” is not going to do themselves any favors. (And, in fact, it’s wrong to do that!) Cervical and Back claims should always give the CAUSE of pain as the primary diagnosis, such as: Disk herniation, Radiculopathy etc. rather than the symptom of “chronic pain”.
I’m sure someone will write to me and say, “But, I have chronic pain (FMS) and there is an ICD-10 code for that, and that’s true, but the primary diagnosis should still be Fibromyalgia, and not CHRONIC PAIN. Trying to support a claim for chronic pain as the primary diagnosis is an exercise in futility, in my humble opinion. I’m not saying you don’t have the chronic pain, but I am suggesting that you not identify it as your primary diagnosis.
Remember, “chronic” means “ongoing” such that it would be the primary reason why someone couldn’t work long-term. You can’t do it. You may in fact have chronic pain, but the documented source of the pain should be the primary diagnosis causing the pain. If there is no source, in other words no objective evidence, insurers will want to know where the pain is coming from. If there is no immediate identifiable source, the claim may be in trouble.
Also recall that “pain” is relative, meaning one person’s severe disabling back pain is another person’s “crook in their back.” One person might be able to continue working with pain on the level of 6, while another would need to be home in bed. No one experiences pain in the same way.
Over the years, I’ve had many insureds complain to me that they are able to live with their pain so well that they do not get the support of family and friends who think, “there’s nothing wrong with him, he t doesn’t look like he’s in pain, and just doesn’t want to work.” Well, insurance companies have the same problem, especially when conducting surveillance and observing hours of pain-free activity.
Therefore, it is extremely important to know how to support cervical and back disabilities and the symptom of chronic pain. Again, while there is objective evidence to prove you are disabled from cervical and back issues, it is extremely important to know how to “position” that information in your favor, especially when there is chronic pain keeping you from returning to work. This is also true for SSDI applications as well.
For insurers, migraines are pretty easy to deny since there ARE NO objective tests that prove migraines, or the intensity of the pain, or frequency. Migraines are most often diagnosed by a neurologist after a considerable history of consultation and treatment.
Another problem with a supported migraine claim is that “headaches” are sudden, unexpected and can come up at any time. Unfortunately, the one thing that defines migraines as cause for disability, is also the one thing that insurers use to discredit it.(Unexpected and Variable) Although migraines are extremely painful and unannounced, unfortunately, they are not well supported by disability insurance companies.
I recommend to insureds that they always keep a journal of the frequency, intensity, and how long their migraines last. Copies of the pages from the journals can be extremely useful for both disability and SSA reporting. Insurance companies are also known for alleging migraines are “subjective” and deniable after 24 months.
And, be careful what you say! A claimant once had a migraine claim denied because he documented on an update form he needed to wear sunglasses when outside. Surveillance proved he didn’t wear sunglasses outside, so his claim was denied.
Cervical and back claims are also difficult to support, even when they appear straight forward and easy to document because of the objective evidence available. In addition, back claims are the most surveilled claims of any other insurance impairments, simply because insureds claim, “I have good days and bad days.” Well, even healthy people have good and bad days, so that won’t work.
The bad news is that once an insurance company observes you going beyond your R&Ls, it is presumed you can continue the activity, and you can work. You engage in an activity ONCE, you can do it ALWAYS. The same goes for migraines.If you tell an insurance company you have migraines every day, they shouldn’t see you engaging in activities 3 days in a row.”
I hope this article gives you a bit more understanding about neck, back and migraine disabilities as well as the part chronic pain plays. If you have any questions, please feel free to contact me.
