Shoulder Pain and Disability Insurance: A Claimant’s Guide
Shoulder pain is incredibly common: about 18–26% of all adults will experience it in their lifetime. While some of us will recover relatively quickly, many people with shoulder problems experience chronic, disabling symptoms.
At Bryant Legal Group, we help people with shoulder pain and dysfunction receive the disability insurance benefits they deserve. In this article, we explain the essentials of a disability insurance claim involving shoulder pain.
What Causes Shoulder Pain?
Your shoulder is one of the most complex joints in your body. Thanks to the shoulder’s robust structure and wide range of motion, you’re able to lift, push, pull, carry, reach, and move your arm in all directions.
However, when something happens to the bones, ligaments, muscles, and joint capsule that make up your shoulder, you can suddenly find yourself unable to perform even simple tasks, like brushing your hair or picking up a bag of groceries.
There are many causes of shoulder pain:
- Arthritis or degenerative joint disease: A lifetime of wear and tear can lead to degenerative changes in your shoulder, including thinning of tissues, bone spurs, loss of cartilage, and swelling.
- Bursitis and tendinitis: When structures in your shoulder, like the bursa or tendons, become swollen and irritated, it can cause severe shoulder pain.
- Frozen shoulder: Also called adhesive capsulitis, this condition occurs when the connective tissues in your shoulder thicken or tighten, making it difficult to move. You typically develop a frozen shoulder after the joint has been immobilized for a long time, such as after surgery.
- Labral tears: Your labrum is a cuff of cartilage that keeps your shoulder joint in place. SLAP lesions and other labral injuries can be very painful and may limit your use of the shoulder.
- Rheumatoid arthritis: As your immune system attacks your tissues, you may experience swelling, bone erosion, and contractures in your shoulders and other joints.
- Rotator cuff injuries: Your rotator cuff stabilizes your shoulder and allows for the joint’s broad range of motion. If any of the muscles that make up your rotator cuff are damaged, you may experience severe pain and limitations.
- Shoulder instability: Because your shoulder is the most moveable joint in your body, it can dislocate relatively easily. However, once you’ve suffered a shoulder dislocation, you may experience chronic instability, which means your arm bones can slip out of place.
Some professionals face a higher risk of shoulder issues than others. If you frequently have to lift heavy weights, push, pull, carry, work above shoulder height, work in awkward positions, or take the force of vibrations, you’re more likely to experience shoulder pain. And shoulder pain isn’t just for blue-collar workers: surgeons, dentists, nurses, and athletes also report high levels of shoulder pain.
RELATED: Dentists and Long-Term Disability
Can I Get Disability Insurance Benefits for Shoulder Pain?
Yes. However, your eligibility for disability insurance benefits will depend on a series of factors:
- The severity of your shoulder condition
- How long you’ll be unable to work due to your shoulder issues
- Your work experience and education
- Your disability insurance policy’s terms and conditions
If you need help assessing your eligibility for short-term or long-term disability insurance benefits, you should consult an experienced disability lawyer.
3 Ways to Strengthen Your Shoulder Pain Disability Claim
Even if you have an obvious shoulder injury, you might have a hard time collecting the disability insurance benefits you deserve. Here are three things you can do to strengthen your application for short-term or long-term disability.
1. Understand Your Disability Plan’s Terms and Conditions
Every disability insurance plan has different terms and conditions that can affect your right to benefits. First, look at how your plan defines “disability.” If you have an “own occupation” policy, you only need to prove that you cannot perform your actual job. However, if your plan has an “any occupation” definition of disability, you’ll need to show that you cannot perform any type of work.
Even if you have an “own occupation” policy, the insurance company might try to redefine your job. For example, suppose you’re a cardiothoracic surgeon with chronic shoulder pain. You file for long-term disability, but the insurance company argues that you can still work as a family physician, telehealth provider, or healthcare administrator. To fight back, you’ll need a skilled disability insurance lawyer and testimony from a vocational expert.
Second, look out for your policy’s limitations and exclusions. You may have a significant waiting period before you become eligible for disability benefits. Or, your plan might deny coverage for specific conditions, especially if you have a private disability insurance policy.
You can review your plan’s exact terms in the Plan Document or Summary Plan Description. If you’re having a tough time understanding all the legalese, contact Bryant Legal Group for help.
2. Get Consistent Medical Treatment
Shoulder injuries are notoriously slow to heal and difficult to treat. If you don’t have consistent, ongoing treatment, the insurance company might argue that your symptoms have improved, that you’re capable of working, or that your pain isn’t substantiated by objective medical evidence. You’ll be in a much stronger position if you have medical records, including MRI and CT scans, that track your progress, document your symptoms, and outline the root causes.
3. Speak With a Disability Insurance Lawyer
Filing a short or long-term disability insurance claim requires attention to detail and extensive legal and medical knowledge. Unlike an adjuster, who works for the insurance company, a disability insurance lawyer will be on your side.
At Bryant Legal Group, we help our clients navigate their shoulder-related insurance claims, ensuring that they meet strict filing deadlines, build strong evidentiary records, and avoid being taken advantage of by unscrupulous insurance companies.
Bryant Legal Group: Knowledgeable and Respected Disability Insurance Lawyers
If you or a loved one live with shoulder pain, the team at Bryant Legal Group can help you understand your legal options. We’ve been helping people with serious shoulder conditions for decades, and we understand the challenges you face. As one of Illinois’ premier disability law firms, we can also help you regain control.
Linaker, C. H., & Walker-Bone, K. (2015). Shoulder disorders and occupation. Best practice & research. Clinical rheumatology, 29(3), 405–423. https://doi.org/10.1016/j.berh.2015.04.001
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.