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Chronic Pain Disability Benefits: Why Insurers Deny Claims

Chronic pain is a constant battle for 20.4 percent of adults in the United States. About 7.4 percent of this population suffer even more as their pain hinders their daily activities and even limits their work opportunities

In an ideal world, you would be compensated by your insurance policy if you suffer from chronic pain, more so if you’re unable to go to work because of it. But insurance companies must look out for their business’s profitability as well as their clients’ needs, hence their denial of claims that do not fulfill their strict standards or criteria for granting compensation.

If your insurance company denies your chronic pain and long-term disability claim, you’ll need a knowledgeable lawyer who can help you file another, and this time irrefutable, claim.

What Is Chronic Pain?

According to the Centers for Disease Control and Prevention (CDC), chronic pain and high-impact chronic pain are most common among adults 65 years old and above. Seniors are the most vulnerable to illnesses and diseases whose symptoms include some form of chronic pain.

By definition, chronic pain is pain that lasts for more than six months and has a profound effect on a patient’s emotional, physical, and mental well-being. Examples of conditions that result in long-term pain are:

  • Arthritis
  • Chronic fatigue syndrome
  • Fibromyalgia

Pain that doesn’t have physical manifestations like bruising or some obvious form of handicap is difficult to prove to insurance companies. They may conclude that the pain the client feels is subjective and therefore doesn’t merit coverage.

Here’s where our chronic pain and long-term disability attorneys can help. They know what evidence to gather to prove the existence and debilitating effect of chronic pain, and that it is covered in the client’s insurance policy.

Reasons for Denying Chronic Pain and Disability Claims

Besides unconvincing testimony, what other reasons can lead to claims denial?

  • Lack of credible medical documentation – When you don’t have convincing and official documents that prove you’re experiencing high-impact pain, your lack of documentation can be interpreted as a lack of medical necessity.
  • Lack of medical necessity – Speaking of this, insurers can use lack of medical necessity as a justification for denying your claims. This can happen if you have two treatment options and want to take advantage of the more expensive treatment. They could reason that just because the treatment has a higher rate of success doesn’t mean the less expensive option is not.
  • Mistakes in filing – Small, technical mistakes in filing benefits claims (e.g., missed deadlines, missing requirements) are enough for insurers to deny a claim. It’s a waste of time and resources and must be prevented at all costs. You can avoid filing mistakes by hiring attorneys who specialize in them from the get-go.

Hire Trustworthy Personal Injury Attorneys to File Your Claims

Working with a seasoned attorney in filing insurance benefits claims increases your chances of getting approved. For one thing, they can help you assemble an irrefutable claim; and for another, they will assess where your application went wrong and will correct what needs correcting if your initial claim gets denied.

We work hard to ensure you enjoy the benefits of chronic pain and long-term disability benefits, such as:

  • Salary compensation for when you can’t work due to debilitating pain.
  • Coverage for medicines and long-term treatment.
  • Coverage for mental health treatment.

You may be entitled to more benefits according to your policy. We can help you determine the full extent of the coverage you deserve.

Increase your chances of getting approved for chronic pain and long-term disability claims. Consult with Haffner Law today.

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