Sometimes insurance companies are dismissive if you don’t have a confirmed medical diagnosis or the diagnosis is not one known to cause debilitating pain. If you are filing a disability claim with largely subjective symptoms, including chronic pain or overwhelming fatigue you may face an uphill battle to get paid the benefits your paid for and earned.
Keeping a daily pain worksheet is one of the ways to help prove your case. Another is to keep a calendar and document the time you sleep during a normal workday.
Here are other factors insurance companies look at:
Pain’s Cause and Severity
Is it reasonable that your diagnosis produces the pain you report?
Is your medical diagnosis reasonably expected to cause the type of pain you report?
Are your reported daily activities consistent with your reports of pain?
Do you have a firm medical diagnosis?
Your Credibility
You need to prove that your pain is real. Remember there is no machine that tests for pain. It’s always self-reported. A pain worksheet to document your pain may boost your credibilty. Other factors used to determine your trustworthiness include
- your reported daily activities
- the medical opinions of treating or examining physicians.
- whether you consistently seek out medical treatment
- the frequency, duration, and intensity of your reported pain
- the nature of the pain therapies you’ve attempted, including medication, injections, physical therapy, and surgery
- the strength of your work history, and
- statements of third parties (family members, friends, co-workers) about limitations you have that they’ve observed
Be Realistic When Rating Your Pain
Pain’s Cause and Severity
Is it reasonable that your diagnosis produces the pain you claim to have?
If your condition can be expected to cause the type of pain you report?
Insurance companies love documents. Track the persistence and intensity of the pain and the functional limitations it causes and share your experience with the insurance company.
Your Credibility
A pain worksheet adds to your credibility. Other factors used to determine credibility include:
- your reported daily activities
- the medical opinions of treating doctors
- consistency of medical treatment.
- some people plateau and frequent doctors visits are a waste of resources so if your doctor can make that point in her notes, she should.
- the frequency, duration, and intensity of your reported pain
- the nature of the pain therapies you’ve attempted, including medication, injections, physical therapy, and surgery
- statements of third parties (family members, friends, co-workers) about limitations you have that they’ve observed
Ask for Opinions From Your Treating Physicians
Your treating physician should address your issues with pain and how it impacts your ability to do your job.
A Pain Worksheet is a helpful tool. Documenting your pain helps in persuading the insurance company that your is real, not exaggerated of fraudulent.
Use this Pain Worksheet to document:
- Start Time End Time of Pain
- Activity Effected
- How was Activity Changed?
- Went to Bed? Y or N
- MEDS + helped – worse * no change
- Cause of Pain
When your insurance company unfairly denies your claim, I’m here to protect your rights.
In one complimentary call I’ll:
- Analyze your claim.
- Assess your prospects for getting paid.
- Help you cut red-tape.
- Provide you with legal advice.
Have questions?
Call me at 617-357-9700 or send an email to jonathan@erisaattorneys.com
