ASK A LAWYER: Chronic Pain Claims
Chronic Pain Claims

I am a boilermaker. I have suffered from chronic pain for almost eight years. It has gotten to the point where I can’t work anymore. I am considering applying for long-term disability benefits through my union’s group plan, but I have heard that insurance companies are skeptical of chronic pain claims. Do you have any tips for me to improve my chances of being approved?

In a chronic pain case claim, where you have been working with chronic pain for a lengthy period of time, it is important to explain why you are unable to work now and to provide the medical evidence to substantiate that. This is not an easy thing to provide but you should try to get the help of a treating physician or health care professional to provide information from a medical perspective to explain what has changed to result in total disability.

I have been diagnosed with fibromyalgia. I was denied my LTD benefits for chronic pain because the insurance company said I don’t meet their definition of total disability. I disagree, and my doctors disagree! How can I overturn the insurer’s decision?

Once the insurer has reached a decision it can be very difficult to overturn their decision through their appeal process. Unless there is some additional information that is dramatically different from what you have already provided, the likelihood of the decision being reversed is not great. When such a claim has been denied, you should consult a lawyer or law firm with specific experience in dealing with disability claims.

I submitted my LTD application over five months ago and my insurance company still hasn’t provided me with an answer. I have no income and no benefits. What should I do?

If getting a decision has been put off without any indication of a decision by a specific date, then you should contact a disability lawyer to consider taking further action. Often, no decision is really a denial hiding behind delay tactics. All claims have deadlines and if it is pretty clear that your insurer is just stalling, do not delay seeking legal advice as you want to ensure that you don’t miss out on being able to pursue your claim as a result of missing an important deadline.SP

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