Long-Term Disability Claims for Back Pain & Musculoskeletal Disorders
You’re not “just sore.” You’re in chronic, debilitating pain, and it’s made your career impossible. So why did your disability insurer deny your claim?
Musculoskeletal disorders—including chronic back pain, degenerative disc disease, spinal stenosis, and failed back surgery syndrome—are the number one reason Americans file for long-term disability. The pain is real, your limitations are real, and your doctor agrees that you cannot work.
Despite this, these claims are also among the most frequently denied by insurance companies. Insurers are skeptical of conditions based on pain and limitations they cannot “see.” They will use a specific playbook to deny your claim, invalidate your experience, and protect their profits. Understanding this playbook is the first step to fighting back.
Why Chronic Back Pain is Genuinely Disabling
An insurance adjuster sitting at a desk cannot understand the reality of chronic spinal pain. They don’t understand that your “sedentary” desk job is agony, or that your physically active career is now impossible.
Your condition isn’t just “discomfort.” It prevents you from working by causing:
- Inability to Maintain a Position: You may be unable to sit *or* stand for more than 15-20 minutes at a time, making any standard 8-hour workday impossible.
- Chronic, Distracting Pain: Severe, constant pain shatters the concentration needed for complex tasks, managing budgets, writing code, or focusing on any detailed work.
- Medication Side Effects: The narcotics and nerve blockers required to manage your pain often cause severe drowsiness, cognitive fog, and nausea, making it unsafe and unproductive to work.
- Physical Limitations: Herniated discs or spinal stenosis can lead to radiculopathy, causing numbness, weakness, and loss of function in your hands, arms, or legs. This can prevent you from lifting, carrying, typing, or even walking.
The Insurer’s Playbook: Why They Deny Musculoskeletal Claims
Insurance companies deny valid back pain claims every day using a predictable set of tactics. They are betting you won’t know how to fight back.
Tactic 1: “No Objective Evidence” of Disabling Pain
This is their favorite argument. The insurer will look at your MRI or X-ray and say, “The findings on this scan do not support the level of pain you are reporting.” They will argue that millions of people have bulging discs and still work. They deliberately ignore the fact that the *severity* of pain and limitation does not always correlate perfectly with a scan. They dismiss your pain as “subjective” and “self-reported.”
Tactic 2: The “Sedentary Work” Fallacy
If you have a desk job, the insurer will argue that your condition doesn’t prevent you from performing “sedentary” work. They will ignore your doctor’s report stating you can’t sit for more than 30 minutes. They will hire a “vocational expert” to say you can work as a “surveillance monitor” or a “ticket taker,” completely disregarding your education, experience, and salary.
Tactic 3: The “Paper-Only” Medical Review
Your claim will be sent to an in-house nurse or a third-party doctor who has never met you. This “paper-only” reviewer will look at your file and write a report claiming your condition is “not that severe” or that you are “exaggerating” your symptoms. The insurance company will then use this biased report to deny your claim, prioritizing it over the opinions of your own treating orthopedic surgeon or pain management specialist.
Tactic 4: Video Surveillance
Insurers often hire private investigators to film you. They will wait for a “good day” and film you carrying a single bag of groceries from your car. They will then use this 30-second clip as “proof” that you are not disabled, ignoring the fact that you were in bed for the rest of the day paying for that one small activity.
How We Build a Winning Appeal for Back Pain (The ERISA Trap)
When your insurer denies your claim, you have one chance to appeal. This appeal, governed by a federal law called ERISA, is your one and only opportunity to build your case. You cannot add new evidence later if you have to go to court. This is why hiring an experienced ERISA attorney is non-negotiable.
We don’t just write a letter; we build a trial-ready case. Here is how we fight back:
1. We Gather the *Right* Objective Evidence
We counter their “no objective evidence” tactic by commissioning the *right* tests. A **Functional Capacity Evaluation (FCE)** is a multi-hour test with a physical therapist that produces objective data on your true limitations: how long you can sit, stand, walk, lift, carry, and more. This report is powerful evidence that cannot be easily dismissed.
2. We Get Medical Opinions That Matter
We work with your treating doctors to write detailed narrative reports. These reports don’t just state “you are disabled.” They directly connect your MRI findings to your FCE results and your reported pain, explaining *why* these factors make your specific job impossible.
3. We Prove Your “True” Occupation
We hire a vocational expert to dismantle their “sedentary work” argument. This expert will write a detailed report on the *actual* demands of your job—not just the physical, but the cognitive and mental demands that your chronic pain makes impossible.
Your Pain is Real. Your Claim is Valid.
You are not just a case number, and your pain is not “all in your head.” We have fought and won against every major disability insurer on behalf of clients just like you. The insurance company is counting on you to give up. We are here to make sure you don’t.
If your long-term disability claim for chronic back pain or a musculoskeletal disorder has been denied, contact us today for a free, confidential consultation. Let us take on the fight so you can focus on your health.
New Jersey Office