Spinal and Back Injuries
Spinal and back injuries are among the most common areas of disputes between policyholder and insurer and, due to the complex nature of both treatment and diagnosis, also a major area for bad faith claims handling. The truth is, the more difficult the diagnosis, the more loopholes are available to the insurer. The back presents some of the most unique challenges for doctors and therapists alike, so both the margin for error and the chance of discrepancy are great.
In some cases unfair claim denial is intentional, and in others the decision may be a matter of inaccurate determinations, lack of information, incorrect assessments by so-called “independent” medical examinations (IMEs), claim form or documentation errors, or variations in medical or policy language. Insurance company employees are paid to err on the side of the insurer—especially in cases where treatment may be a lifelong necessity, because denials of these types of claims brings huge profits for the company. Many disabled consumers simply do not have the energy to appeal and fight the decisions.
At Bourhis Law Group, PC, we specialize in helping disabled consumers overcome these obstacles. We have the energy to fight for your rights, and we back it up with decades of expertise. We understand your hardships, and we will assist you through every step of the process.
Over the past 30 years we have assisted 1,000s of consumers obtain benefits and awards for disabling damage to the spine, back and neck area.
More about Back Injuries:
Disability Determination
Injuries of the back and spine often affect function of other areas of the body, including limbs, organs, tendons, and muscles – as well as mental health and acuity. This wide range of symptoms can easily result in multiple diagnoses. Thus, the insurance claim and documentation must be prepared properly to avoid a claim denial due to technicalities, such as a perceived pre-existing condition, a questionable determination or prognosis, missing or incomplete tests or procedures, or contradictory diagnoses.
To avoid these risks and pitfalls, we invite you to contact us for a free case evaluation before you file your claim.
Denial of Treatment Benefits
Due to the unique nature of every back injury, individually-tailored treatment is often recommended. Therefore, a consumer’s medical documentation is more prone to insurance company disputes and stalling tactics, incorrect pre-existing condition assessments, and the labeling of a procedure as “experimental,” in order to disqualify the insured from coverage.
Because diagnosis and prognosis are often determined after treatment, your insurer may even receive contradictory information from your medical practitioners. This is another reason to consider requesting the assistance of an expert before filing your claim or, especially, your appeal.
Understanding back pain, injury and diagnosis
- Cervical vertebrae: seven vertebrae – upper spine
- Thoracic vertebrae: 12 bones between the neck and the lower back
- Lumbar vertebrae: five vertebrae lower back between the chest and hips
- The sacrum and coccyx: bones at the (tailbone) base of the spine.
Diagnostic Procedures
Since the back is affected by, and affects, all other parts of the body, your doctor or lab may perform series of tests unique to your symptoms. These tests may include analysis of vital organs and general health. The variety of tests conducted may result in inaccurate assumptions by your insurance company – which can, in turn, cause your claim to be denied.
- X-rays, which can be used to provide detail of the bone structures in the spine and to check for instability (such as spondylolisthesis, see below), tumors, and fractures.
- CT scans, which can identify specific conditions, such as a herniated disc or spinal stenosis.
- MRI scans of the discs and nerve roots.
- CT scans, which can identify specific conditions, such as a herniated disc or spinal stenosis.
Types of Back Injury
- Spondylolisthesis: Vertebra slippage, normally at the base of the spine
- Spondylolysis: defect or fracture of a vertebra, may include vertebrae slippage.
- Cervical Radiculopathy: damage to nerve, including compression.
Co-existing/Multiple Conditions
Spondylolithesis may be the result of any one, or any combination of, conditions and events. With Spondylolithesis damage, a vertebra might be:
- Defective from birth
- Broken by trauma or a stress fracture.
- Damaged by infection or disease.
- Damaged during sport or athletic activities
Overlapping Symptoms of Spondylolithesis
As with other types of back injuries, Spondylolithesis may display symptoms that are easily confused, or even combined with, other causes, including:
- Lower back pain
- Muscle tightness and stiffness
- Pain in upper leg and buttocks
- Radiating Pain