Personal Injury Law
Disability lawyers
Personal Injury Law
Chronic Pain Lawyers
Sometimes, the pain you acquired as part of an injury or illness lingers on for many months and years. Many insurance policies now include this condition, known as chronic pain, in their list of covered conditions. If you are suffering from a similar pain well beyond the recovery period, you can file for a long-term disability claim with the help of our personal injury lawyers.
At Nanda and Associate Lawyers, for more than 20 years, our personal injury lawyers have helped numerous clients obtain maximum compensation in their personal injury cases, allowing them to rebuild their lives after an accident, illness or injury. We are well-known for our ‘No Win, No Fee’ policy, which lets our clients focus on their recovery without worrying about the legal expenses. Connect with our personal injury lawyers today.
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(Neck, Back, Whiplash & Spinal Cord Injuries) - Sports Injury
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What is chronic pain?
Acute pain refers to the high levels of pain the patient will suffer from because of an injury, serious tissue damage, or a recent surgical incision. Acute pain will persist in the patient for several weeks until the injury or illness resolves. Chronic pain, on the other hand, continues beyond this usual recovery period. It could last for many months or years. In some cases, it will accompany a chronic medical condition like arthritis. The pain might completely disappear, only to come back a couple of days later. The constant presence of pain in the patient’s life will affect his quality of life and interfere with various activities, like sleep, exercise, or even eating.
What causes chronic pain, and how can I claim disability benefits for it?
In the case of a chronic medical condition like cancer, it is clear that as long as the condition remains, you will suffer from chronic pain. However, in many cases, chronic pain, originating from an injury or illness, persists even after it has fully healed. The nerve cells continue to send pain signals to the brain. Obviously, a patient suffering from this condition will not be in a condition to work and will require long-term disability benefits to get through this difficult period and pay for the expenses.
Most insurance companies now include chronic pain as a covered medical condition in their policies. If your chronic pain comes from an underlying condition for which you have already received benefits under the policy, the insurance company might reject further claims. It is best to check if your condition qualifies as a long-term disability as per the policy criteria. Should the insurance provider raise a dispute, you may need to engage an independent medical examiner to validate your claim.
The independent medical examiner will examine the nature of your pain, its duration and intensity, how it affects your work and daily life, and the effects of pain medications and therapies on it. Typically, if your pain persists beyond six months after your expected recovery, it will be considered chronic pain. The examination will also include other effects of your chronic pain, like depression, insomnia, dependence on pain medications, and any side effects you might be suffering from the medication. To qualify for the long-term disability benefits, you must prove that your chronic pain impairs your ability to perform your duties at work.
How can our disability lawyer help you?
Helping you with the application process
Chronic pain disability claims are often difficult to prove since the pain persists after your injuries have already completely healed. It is, therefore, advisable for you to consult an experienced personal injury lawyer to help you with the application process from the very beginning. Your lawyer will help you arrange all the supporting documents necessary to substantiate your claim.
Legal guidance in case of rejection:
In case your application is rejected, you will definitely need the assistance of an experienced personal injury lawyer to help you with the appeals process. You need to first exhaust the internal appeals process with the insurance provider. After you have exhausted these options, your lawyer will advise you on the next course of action.
You may approach a regulatory authority, such as the OmbudService for Life and Health Insurance (OLHI), with your complaint. Another resort is to approach the court with a ‘bad faith’ civil suit against the insurance provider. In a ‘bad faith’ lawsuit, you are essentially contending that the insurance provider failed in their duty to consider your insurance claim validly.
How We Can Help
Contact our personal injury lawyers for any legal assistance or guidance in your chronic pain disability claim. Schedule an appointment with our personal injury team for a consultation today.
Frequently Asked Questions
What are some of the reasons for denying a disability claim?
- “Your condition does not meet the definition of Total Disability”. This is one of the common replies many applicants receive when their long-term disability claim is rejected. This means that the insurance company considers your condition manageable through medication and therapies without affecting your work. You need to demonstrate that your condition meets the criteria for Total Disability.
- Lack of medical evidence. You must submit the diagnosis reports, test results, treatment plan, and a letter from your doctor, all of which clearly demonstrate that you have been suffering from chronic pain for the claimed duration and how it has affected your work.
- Pre-existing conditions. If your chronic pain stems from a condition you already had before the start of the policy, your claim is likely to be rejected.
- You did not follow through with the prescribed treatment. You must follow the doctor’s prescribed treatment plan already submitted to the insurance company. It can be frustrating when your pain persists despite treatment. But before you switch to a different treatment plan, consult with your lawyer to make sure that this does not disqualify your benefits claim.
- Errors in your application. You have to double-check all the entries in your application. It is best to let your lawyer review it thoroughly before you submit it. Any errors or inaccurate information in your application might lead to rejection.
- Failure to meet deadlines: Your policy document will specify the timelines you must follow when submitting the forms and the supporting documentation for your claim. Stick to these deadlines to avoid automatic disqualification of your claim.
What are the types of compensation you can claim?
The benefits you will receive depend on the terms and conditions mentioned in the policy document. This might include the following:
- Income replacement: You will receive income replacement benefits for the duration of your disability as per the terms mentioned in the policy. Depending on the nature of your condition, you can apply for short-term disability benefits or long-term disability benefits until your recovery. For example, some policies cap this at 60% of your pre-disability employment income.
- Medical, therapeutic, and rehabilitation expenses: Chronic pain can lead to severe suffering, sleeplessness, and depression. The patient might have to undergo counselling, therapeutic interventions, and rehabilitation to be able to live with constant pain and other side effects. Typically, most policies will cover these expenses.
- Expenses for employment rehabilitation: Most policies offer coverage for any training you have to undergo for any new line of work more suited to your current physical condition.
What are your options in case of a rejection?
Since chronic pain typically results from an injury that has already healed, your application may initially face rejection. Your application’s success then depends on an independent medical expert’s testimony. Although the average layperson may find it difficult to understand, the medical community recognizes and treats chronic pain as a long-term disability. Our legal team will also help you submit your appeal against the rejection before the deadline. If necessary, you also have the option to file a lawsuit against the insurance provider for rejecting your genuine claim.
Can I claim both short-term and long-term disability benefits for the same condition?
Only if you are planning to make use of the short-term disability benefits while awaiting the processing of your long-term disability claim, in other words, you cannot receive both payments at the same time. Typically, your short-term disability benefits, which will be approved quickly, will transition into long-term disability benefits when your insurance provider finally approves your application.
What is the ‘any occupation’ test?
If you are receiving long-term disability benefits, this means that you were able to prove that your medical condition has impaired your ability to perform your current job. However, after a period of 2 or 3 years, you will be required to prove that your condition has made it impossible for you to perform any occupation suited to your qualifications and experience. This is often referred to as the ‘any occupation’ test in the policy document. If you fail to meet this criterion, there is a good chance that your long-term disability benefits will be discontinued.
What is the typical duration of long-term disability benefits?
This will depend on the terms and conditions of the coverage mentioned in the policy document. There are insurance providers offering 10 to 15 years of long-term disability benefits coverage. Some policies offer coverage until the age of retirement at 65 years. However, the definition of disability will change after two or three years, when you will be required to prove your inability to perform any job suited to your qualifications and experience. In other words, there is a chance that your long-term disability benefits will only last until then if you fail this ‘any occupation’ test.
