Was your Disability claim based on Chronic Pain denied?
Chronic Pain, regardless of whether the cause is unidentified or linked to specific diagnoses, is often misunderstood. The impact it can have on your life, including the ability to maintain gainful employment, can be devastating. Unfortunately, those grappling with chronic pain often find themselves confronting denials and obstacles when pursuing the financial support they are entitled to through long-term disability (LTD) benefits.
Insurance companies, especially those governed by ERISA, are financially incentivized to find ways to deny even righteous disability claims.
At Kantor & Kantor, we recognize the intricacies of chronic pain claims and the hurdles individuals encounter in convincing insurance companies of the legitimacy and severity of their conditions. Our commitment is rooted in the belief that all claimants, especially after years of hard work and dedicated employment, should receive the benefits to which they are rightfully entitled. Contact us at 818-886-2525 for a free case consultation.
Do not give up when you receive a denial for a claim based on chronic pain. Get help from our trusted attorneys at Kantor & Kantor. Call 818-886-2525 today for your free 30-minute consultation.
Understanding Chronic Pain Conditions
As chronic pain sufferers are well aware, chronic pain can manifest locally, affecting specific areas like the head, back, or joints. Alternatively, chronic pain patients may experience widespread discomfort, affecting muscles or nerves throughout the body. The origins of chronic pain can at times be linked to an injury or illness; sometimes, there might be no clear explanation for its onset, leading to frustration and anxiety as patients and their healthcare providers seek elusive answers.
Diagnoses of pain disorders or disorders causing chronic pain are common. Some prevalent examples include:
- Paraneoplastic Syndrome
- Chronic Fatigue Syndrome (CFS)
- Chronic Regional Pain Syndrome (CRPS)
- Migraines
- Tension or Cluster Headaches
- Degenerative Disc Disease (DDD)
- Fibromyalgia
- Irritable Bowel Syndrome (IBS)
- Lyme disease
- Neuropathy pain (nerve damage)
- Rheumatoid Arthritis (RA)
- Osteoarthritis
- Psoriatic Arthritis
- Reflex Sympathetic Dystrophy (RSD)
- Sciatica
- Shingles
- Thoracic Outlet Syndrome
- Sjogren’s Disease
- Grave’s Disease
- Long Covid.
If chronic pain is hindering your ability to work, you may be eligible for long-term disability (LTD) benefits. We are experienced at fighting claim denials for a range of chronic pain issues our clients face. For example, learn about one of our winning cases related to migraines and disability insurance.
Our team at Kantor & Kantor knows how to fight insurance claim denials successfully in even the most complex cases.
Chronic Pain and LTD Insurance
While some individuals managing chronic pain can sustain employment, others face symptoms so severe that maintaining work becomes impossible. This situation not only has profound financial implications but can also contribute to a decline in mental health, fostering conditions such as anxiety and depression.
For those covered by LTD benefits, the prospect of receiving compensation to offset lost income arises when the ability to work is compromised. However, securing these benefits can prove challenging as LTD claims stemming from chronic pain frequently encounter denials. Insurers often demand irrefutable evidence of disability, citing the necessity for “objective evidence.”
This emphasis on objective evidence poses several dilemmas. First, LTD policies typically do not stipulate the requirement for objective evidence; rather, they mandate compensation when disability obstructs work ability, regardless of the ability to verify the condition objectively. In this respect, claims related to chronic pain face similar challenges as those arising from mental health conditions such as depression and anxiety.
Another obstacle is the subjective nature of chronic pain, making it unverifiable through traditional diagnostic tools like X-rays, MRIs, or blood tests. Chronic pain, characterized by its enduring nature beyond typical recovery periods, is often labeled as an “invisible disability.”
Complicating matters further, doctors may struggle to identify the exact source of chronic pain. While some cases may have an underlying cause, like a fracture or nerve impingement, more often than not, the persistence of pain lacks a straightforward explanation even after the resolution of the initial medical issue. When doctors cannot pinpoint the cause, LTD insurers are less inclined to approve claims.
The complexity of treating chronic pain adds another layer of difficulty, with LTD claims sometimes denied on the grounds of failure to engage in “appropriate treatment.” However, consensus among medical experts on what constitutes suitable treatment for chronic pain is lacking. Common interventions include physical therapy, psychological counseling, acupuncture, massage, injections, or a combination of modalities, with opiate-derived medications being a common yet highly addictive option.
A pervasive challenge in chronic pain-related insurance claims is skepticism. Insurers may be reluctant to provide benefits for a condition that could theoretically be exaggerated or fabricated. Consequently, many LTD claims for chronic pain face denials rooted in skepticism, even though this may not be explicitly stated as the reason.
How to Appeal a Denial of Your Claim for LTD Benefits Due to Chronic Pain
Dealing with a denied LTD claim due to chronic pain can be disheartening, but it is important to remember that the journey does not end there. The appeals process provides an opportunity to challenge the denial and present a compelling case for reconsideration. Some insurance companies offer two appeals — If you decide to pursue your first appeal without the assistance of an attorney, here are some helpful tips:
- Understand the Denial Reasons: Carefully review the denial letter to understand the specific reasons for the denial. Identify any discrepancies or misunderstandings that need to be addressed in the appeal.
- Gather Additional Medical Evidence: Work closely with your healthcare providers to obtain updated and comprehensive medical records documenting the extent of your chronic pain and its impact on your ability to work. Review the records you receive to make sure they contain accurate and complete information. You have the right to ask your provider to correct inaccurate information in your medical records.
- Consult With Experts: If necessary, seek opinions from medical specialists or vocational experts who can provide additional insight into the nature and limitations of your chronic pain. Their professional opinions can strengthen your appeal.
- Review the Insurance Policy: Thoroughly examine your LTD insurance policy to understand the criteria for disability and any specific provisions related to chronic pain. Ensure that your appeal aligns with the terms outlined in the policy.
- Prepare a Detailed Appeal Letter: Craft a detailed appeal letter addressing each reason for denial. Clearly articulate how your chronic pain meets the criteria for disability, and provide supporting documentation. Be factual, concise, and persuasive in presenting your case.
- Utilize the Insurance Company’s Internal Appeal Process: Follow the specific procedures the insurance company outlines for internal appeals. Submit all required documents within the specified time frame, and keep copies of everything you send.
- Seek Legal Assistance: Consider engaging the services of an experienced LTD attorney. Our expertise in chronic pain claims can provide valuable guidance, ensuring your appeal is comprehensive and well-prepared.
Why Choose Kantor & Kantor?
Your Best Option for a Claim Based on Chronic Pain Denial Attorney
Living with chronic pain conditions can be physically and emotionally debilitating, affecting every aspect of your life. Choosing the right attorney is crucial when seeking legal representation to secure the insurance benefits you deserve for your chronic pain condition. We have successfully helped thousands of clients. Please take a look at what some clients have said about our services.
Kantor & Kantor attorneys are unparalleled in our knowledge, experience, and reputation. Here are some reasons why Kantor & Kantor will be your best choice as your legal advocate for your chronic pain insurance denial.
Winning Record
You can trust that you will have the full capabilities of our team at Kantor & Kantor behind you. Our attorneys have exceptional expertise and experience. Our record of victories speaks for itself.
Specialized Expertise in Insurance Law
One of the most compelling reasons to choose Kantor & Kantor is our specialized expertise in disability insurance law. When a company unfairly denies a claim related to chronic pain, our knowledge of state and federal laws can be an asset to your case. We also have a successful record of winning hundreds of cases when LTD benefits were denied.
Tailored Approach to Each Case
At Kantor & Kantor, we recognize that every case has unique circumstances and challenges. We will have a personalized approach to your case. We will dedicate all the time and resources necessary to understand your situation. This meticulous attention to detail ensures that we tailor our legal strategy to address the nuances of your case. This approach has won hundreds of cases and will maximize your chances of a favorable outcome.
Compassionate and Empathic Practice
Living with chronic pain can be an isolating experience, and you need more than just legal expertise — you need compassionate advocates who genuinely understand your struggles. You can count on us to be at your side in every respect. At the end of the day, we are people helping people. That is why our chronic pain insurance denial lawyers will provide you with empathy and sensitivity as they help you fight your insurance company.
When you work with Kantor & Kantor, you are not just another file number. You are treated with respect and care. We understand the stresses and challenges you face. We take seriously our power to alleviate that and to get your insurance claim paid.
The Legal Journey of a Chronic Pain Insurance Denial
Navigating the legal landscape when dealing with chronic pain conditions can be overwhelming. At Kantor & Kantor, we are committed to helping you through every step of your legal journey:
- Claims Denial: If your insurance claim for disability benefits for chronic pain has been unjustly denied, our team will tirelessly work to ensure your rights are upheld and you receive the benefits you are entitled to.
- Appeals: We have a strong track record of successfully appealing denied claims, ensuring you have the financial support necessary to cope with your chronic pain condition.
- Litigation: In cases where negotiations with insurance companies or other liable parties fail, Kantor & Kantor is prepared to take your case to court. Our history of victories at trial is long. Insurance companies know this and fear us. Trials are costly for insurance companies, so when they see Kantor & Kantor as your legal representation, you can expect an outcome you deserve rather than a paltry sum.
- ERISA Claims: If your insurance is provided through work, our expertise will be your best weapon in fighting your chronic pain claim denial. We have extensive experience in handling claims under the Employee Retirement Income Security Act (ERISA), which controls private employer-sponsored disability and health plans. ERISA is a highly specialized, complex area of law, and our expertise and track record is unparalleled in this area.
Other law firms law firms may want to take the quick route and will accept a low settlement offer to close your case and move on. With Kantor & Kantor, you will have advocates who fight for the full benefits you deserve, even when that means going to court.
How Our Claims Based on Chronic Pain Insurance Denials Attorney Can Help You
We understand the challenges individuals encounter when navigating the LTD claims process, especially when dealing with complex conditions like chronic pain. Our dedicated team of attorneys advocates for individuals who have been unfairly denied the benefits they are entitled to receive. Here is how we can help with your case once you entrust in us:
- Comprehensive Case Assessment: When you choose Kantor & Kantor to represent you, we begin by thoroughly assessing your case. We understand that chronic pain can be difficult to prove objectively and may not always be fully appreciated by insurance companies. Our team meticulously reviews your medical records, gathers supporting documentation, and consults with medical experts to build a compelling case on your behalf.
- Strategic Advocacy: Our attorneys are well-versed in the nuances of chronic pain claims and have the know-how to advocate for your rights. We work tirelessly to present your case in the strongest possible light, emphasizing the debilitating effects of chronic pain on your ability to work and carry out daily activities. Depending on your insurance coverage, the appeals process for a chronic pain claim denial may vary a bit. If your employer sponsors your insurance plan, ERISA laws govern your case. An appeal of your claim denial will be required before you can proceed to court. How your appeal is handled and what evidence you can offer is also unique.
- The added complexity of a disability-based case does not deter us. Rather, our experience gives us all the more confidence to handle your appeal. If you have an insurance policy you secured individually, we will take you through every step of the appeals process. Our history of success in appeals at all levels will be your asset. We handle filing appeals with insurers but also have court experience.
- Communication With Insurers: Our team handles all communications with insurance companies on your behalf. We engage in negotiations, provide persuasive arguments, and leverage our knowledge of insurance practices to advocate for the approval of your LTD benefits. Once your benefits are approved, we continue to represent you in order to keep your benefits in force.
- Litigation Support: In cases where litigation becomes necessary, we will provide strong legal representation every step of the way. If litigation requires us to go to the next level, we will be prepared to take your case to Appellate Court. Our history of winning in federal district courts illustrates our unique capabilities. You can rely on us to give you the best legal representation possible.
Chronic Pain and Mental Health Insurance Claim Denials
An often overlooked issue is how chronic pain patients suffer from related mental health conditions. Chronic pain can lead to depression, which may require psychological and psychiatric treatment. This may include medications to help fight these additional health challenges. Our discussion of a report issued by Mental Health America gives insight into just how many people who suffer from chronic pain suffer from mental health issues, too. While the detailed data about several mental health conditions diagnosed in chronic pain patients, one is shocking: almost 80% of chronic pain patients suffer from depression.
Often, insurers unfairly limit claims to two years by labeling chronic pain, or other invisible disabilities, as mental health issues. That is why our attorneys fight claim denials for mental health treatment for our chronic pain clients. We believe claimants should not be afraid to seek mental health treatment while also pursuing benefits through their chronic pain-based claim. Here is an example of an LTD case we won for a client suffering from back pain who also suffered from depression.
Contact Our Chronic Pain-Based Insurance Claim Attorney in California Today
Chronic pain is a relentless adversary, and an insurance claim denial may leave you feeling hopeless and lost. You do not have to give up, and you do not have to face it alone. Kantor & Kantor is here to provide the legal support and advocacy you need to regain control of your life. Our law firm is unstoppably dedicated to getting you the full insurance benefits you deserve.
Let Kantor & Kantor be your powerful advocate. Let us get started now. Call us today at 818-886-2525 to discuss your chronic pain insurance claim denial.
