Carpal Tunnel Syndrome (CTS) is a medical condition caused by the compression of the median nerve as it travels through the carpal tunnel in the wrist. The carpal tunnel is a narrow passageway on the palm side of your wrist, made of bones and ligaments. The median nerve, along with tendons that control finger movement, passes through this tunnel. This nerve controls sensation in the thumb, index finger, middle finger, and part of the ring finger. When the median nerve is compressed or irritated, it can lead to the development of carpal tunnel syndrome.

Causes of Carpal Tunnel Syndrome

Carpal tunnel syndrome is often linked to a combination of factors that increase pressure on the median nerve. Some of the most common causes include:

1. Repetitive Hand Movements: Repetitive tasks that involve flexing and extending the wrist, such as typing, using a mouse, or playing musical instruments, can contribute to swelling and irritation in the tendons of the wrist, which in turn compress the median nerve.
2. Anatomical Factors: Individuals with smaller carpal tunnels, possibly due to genetics or bone structure, may have a higher risk of developing CTS. Additionally, fractures or dislocations in the wrist may alter the size of the carpal tunnel.
3. Medical Conditions: Certain conditions such as diabetes, rheumatoid arthritis, hypothyroidism, and obesity can lead to increased swelling and inflammation in the wrist, which may contribute to CTS.
4. Pregnancy: Fluid retention during pregnancy can lead to swelling in the carpal tunnel, which may cause temporary carpal tunnel syndrome. This typically resolves after childbirth.
5. Other Risk Factors: Smoking, a sedentary lifestyle, and being female (as women tend to have smaller carpal tunnels) are also associated with higher rates of CTS.

Symptoms of Carpal Tunnel Syndrome

The symptoms of carpal tunnel syndrome generally develop gradually, starting with occasional numbness or tingling in the hand. Common symptoms include:

1. Numbness or Tingling: A common early symptom is a tingling or numb sensation in the thumb, index, middle, and part of the ring finger. This may worsen at night and can cause disrupted sleep.
2. Hand Weakness: As the condition progresses, weakness in the hand can occur, making it difficult to grasp objects or perform fine motor tasks, such as buttoning a shirt or holding a pen.
3. Pain or Discomfort: Pain in the wrist, palm, or forearm may occur. In some cases, the pain can radiate up the arm and into the shoulder.
4. Clumsiness: People with CTS may feel as though their hand is clumsier than usual, dropping objects more frequently or having difficulty with precise tasks.

Diagnosis

Diagnosing CTS usually involves a physical examination, medical history review, and several specific tests. Some of these include:

• Phalen’s Test: The doctor may ask the patient to flex their wrist for a minute to see if symptoms such as tingling or numbness are triggered.
• Tinel’s Sign: The doctor taps on the median nerve at the wrist to see if it produces any tingling or pain in the fingers.
• Electromyography (EMG): This test measures the electrical activity in muscles and can help determine if muscle weakness is related to nerve compression.

Treatment Options

Treatment for carpal tunnel syndrome can vary based on the severity of the condition. Common treatments include:

1. Rest and Activity Modification: Avoiding activities that aggravate symptoms, such as typing or repetitive hand movements, can help manage the condition.
2. Wrist Splinting: Wearing a wrist splint, especially at night, can keep the wrist in a neutral position and reduce pressure on the median nerve.
3. Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Medications like ibuprofen can help reduce pain and inflammation in mild cases of CTS.
4. Corticosteroid Injections: For more severe symptoms, injections of corticosteroids into the carpal tunnel can reduce inflammation and relieve pressure on the median nerve.
5. Surgery: If conservative treatments are ineffective, surgery may be necessary. The most common surgical procedure for CTS is called carpal tunnel release, where the ligament pressing on the median nerve is cut to relieve pressure.

Prevention

Preventing carpal tunnel syndrome involves reducing strain on the wrist and hand. Some preventative measures include:

• Ergonomics: Adjusting the height of desks, chairs, and keyboards to avoid awkward wrist positioning.
• Frequent Breaks: Taking regular breaks from repetitive tasks that involve the hands.
• Hand and Wrist Exercises: Strengthening and stretching the muscles in the hand and wrist to reduce tension and pressure in the carpal tunnel.

Conclusion

Carpal tunnel syndrome is a common and often painful condition caused by compression of the median nerve in the wrist. Early diagnosis and treatment can prevent permanent nerve damage and help alleviate symptoms. Awareness of risk factors and preventive measures can help reduce the likelihood of developing CTS, especially for those whose work or hobbies involve repetitive hand movements.

Why Do Insurance Companies Deny Claims for Carpal Tunnel Syndrome?

Insurance companies may deny claims for carpal tunnel syndrome (CTS) for several reasons, often rooted in the policies, legal requirements, and complexities surrounding the condition itself. Since CTS can develop from multiple causes, ranging from work-related activities to underlying health conditions, insurance providers often scrutinize claims closely before providing coverage. Below are some of the most common reasons for denial and the rationale behind insurance companies’ decisions.

1. Pre-existing Condition Exclusion

Many insurance policies, particularly disability or health insurance policies, contain a pre-existing condition clause. This clause stipulates that the insurer is not obligated to cover medical expenses or disability benefits for conditions that existed before the policy took effect. If an insurance company determines that the claimant had symptoms or was diagnosed with carpal tunnel syndrome prior to obtaining coverage, the claim may be denied.

• How this impacts CTS claims: Carpal tunnel syndrome often develops gradually over time, and individuals may experience mild symptoms for months or even years before seeking medical attention. If an insurer uncovers medical records showing that the claimant had prior symptoms of CTS or received treatment before the insurance policy began, they may argue that the condition is pre-existing, justifying a denial.
• The good news is that pre-existing conditions are not excluded forever. Typically during the first, 12 to 15 months of coverage. 

2. Lack of Medical Evidence

Insurance companies frequently deny claims for CTS due to insufficient medical evidence. To successfully receive benefits, claimants must prove that they have been diagnosed with carpal tunnel syndrome and that the condition significantly impairs their ability to fulfill occupational duties.

• Medical documentation requirements: Insurers expect comprehensive medical documentation, such as:
  • Results from diagnostic tests like electromyography (EMG) or nerve conduction studies (NCS) to confirm the diagnosis.
  • Medical records from treating physicians outlining the severity of the condition.
  • Detailed information about the treatment plan (e.g., physical therapy, medications, wrist splinting).

If claimants fail to provide sufficient evidence showing how CTS affects their ability to perform their job or daily tasks, their claim may be denied on the grounds that the condition is not severe enough to warrant benefits.

3. Disputed Work-Relatedness

In workers’ compensation cases, insurance companies may dispute whether CTS was caused by the claimant’s job duties. Many CTS claims are work-related, especially in occupations involving repetitive hand motions, such as typing, assembly line work, or using hand tools. However, since CTS can also develop from non-work-related factors like diabetes, pregnancy, or genetic predisposition, insurance companies may argue that the condition is not directly caused by work.

• How this impacts claims: Insurers may assert that the employee’s job did not significantly contribute to their CTS or that the condition developed due to lifestyle factors or underlying medical conditions. If an employer or insurer can prove that the work environment did not play a substantial role in causing or worsening CTS, the claim may be denied.

4. Failure to Meet the Policy’s Definition of Disability

In the case of long-term or short-term disability insurance, a denial may occur if the insurer believes the claimant does not meet the policy’s definition of disability. Policies often require that the claimant is unable to perform the duties of their occupation for a certain period of time. If the insurer determines that the claimant is still capable of working, either in their current job or in a different role, they may deny the claim.

• Evaluating functional limitations: Insurers often look at the functional limitations imposed by CTS. For instance, some claimants may be able to work with accommodations like modified workstations or assistive devices, even if they have CTS. If an insurer believes that the claimant can continue working with reasonable accommodations, the claim might be denied.

5. Inconsistent or Incomplete Claims

An insurance claim for CTS may be denied if there are inconsistencies in the paperwork or the claimant provides incomplete information. In some cases, claimants may fail to submit all the necessary medical records, miss deadlines, or provide conflicting details about their symptoms, job duties, or treatment.

• Importance of accuracy: Insurance companies are known to scrutinize claims for any discrepancies, such as inconsistent medical reports or conflicting descriptions of how the injury occurred. If the insurer detects errors, they may deny the claim, arguing that the claimant has not provided sufficient, credible information.

6. Failure to Follow Treatment Protocols

If a claimant fails to follow the recommended course of treatment, such as attending physical therapy, taking prescribed medications, or wearing a wrist splint, the insurance company may deny the claim. Insurers often argue that if the claimant is not adhering to treatment plans, they are not doing everything possible to mitigate the condition, and thus, the condition may not be as severe as claimed.

Insurance companies may deny claims for carpal tunnel syndrome for a variety of reasons, ranging from pre-existing condition exclusions to insufficient medical evidence. Often, these denials stem from the complexities of proving the exact cause and severity of CTS, as well as inconsistencies in paperwork or a failure to meet strict policy definitions. To improve the likelihood of having a claim approved, claimants should provide thorough medical documentation, adhere to treatment protocols, and report their condition promptly. Legal or medical guidance can also help claimants navigate the appeals process if their claim is denied.

How Can An Attorney Help You Win Your Long-Term Disability Claim for Carpal Tunnel Syndrome? 

Filing a long-term disability (LTD) claim for carpal tunnel syndrome (CTS) can be a challenging and complex process. Insurance companies often scrutinize claims for CTS due to the subjective nature of the symptoms, the variety of potential causes, and the ability of some individuals to continue working despite the condition. This is where an experienced disability attorney can make a significant difference. Attorneys understand the legal and medical nuances involved in disability claims and can guide claimants through the process, increasing their chances of securing benefits.

Here’s how an attorney can help you win your LTD claim for carpal tunnel syndrome:

1. Assessing the Validity of Your Case

A skilled attorney will begin by reviewing your case to determine its strength. They will look at your medical records, work history, and insurance policy to assess whether your condition qualifies for long-term disability benefits. This step is crucial because many insurance policies have specific criteria for what constitutes a disability and what medical evidence is required. Attorneys can help ensure that your case meets these standards, giving you a better chance of success.

2. Gathering and Organizing Medical Evidence

Medical evidence is critical in any LTD claim, particularly for conditions like CTS, where symptoms may not always be visible or easily measured. An attorney will help you:

• Obtain comprehensive medical records: This includes diagnostic tests like electromyography (EMG), nerve conduction studies, and physician reports detailing your symptoms and how they limit your ability to work.
• Collect statements from healthcare providers: An attorney may work with your doctors to write detailed letters explaining the severity of your condition, its impact on your job performance, and why you are unable to continue working.
• Document functional limitations: They will ensure that your medical evidence reflects how CTS affects your day-to-day activities, such as your inability to grip objects, perform fine motor tasks, or work for extended periods without pain.

3. Building a Strong Argument Based on Policy Language

Disability insurance policies often contain complex and restrictive language regarding eligibility for benefits. An attorney will carefully analyze your insurance policy and:

• Interpret policy terms: They can identify key terms like the definition of “disability” or “own occupation” to determine what evidence is needed to prove your claim.
• Address pre-existing condition exclusions: If your insurer is trying to deny your claim based on a pre-existing condition, your attorney can argue against this by providing evidence that your CTS worsened due to work-related activities or other factors covered by your policy.

4. Handling Communication with the Insurance Company

Insurance companies often employ tactics to delay or deny claims, such as requesting additional information or requiring claimants to undergo independent medical examinations (IMEs). An attorney will:

• Manage correspondence: They will handle all communication with the insurer to ensure that deadlines are met, and that the insurer does not misinterpret or manipulate information.
• Prepare you for an IME: If the insurer requests an IME, your attorney can prepare you for what to expect, ensuring you present your symptoms clearly and consistently.

5. Appealing a Denied Claim

If your LTD claim for CTS is denied, an attorney is essential in filing a strong appeal. Insurers often deny initial claims, but a well-prepared appeal with additional evidence can lead to a reversal. Your attorney will:

• Review the denial letter: They will carefully review the reasons for the denial and address them with additional evidence or arguments.
• File the appeal on time: LTD policies often have strict deadlines for filing appeals, and missing one could result in the permanent denial of benefits. An attorney will ensure your appeal is timely and complete.

6. Representing You in Court

If all administrative appeals fail, your attorney may file a lawsuit against the insurance company to secure your benefits. In court, your attorney will present a compelling case based on the medical evidence and policy terms, arguing that the insurer has wrongfully denied your claim.

Hiring an experienced disability attorney for your long-term disability claim due to carpal tunnel syndrome can greatly improve your chances of winning. Attorneys understand the complexities of both medical evidence and insurance policy language, enabling them to build a strong case, manage communications with insurers, and handle appeals if necessary. By ensuring that every aspect of your claim is addressed correctly, an attorney can help you secure the benefits you deserve.

If your carpal tunnel syndrome disability claim has been denied call Jonathan Feigenbaum 617.934.7488 today for a complimentary review of your claim.