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

The spine is a complex system that supports the entire body, with more than 33 bones (vertebrae) connected by tissue, and acting as a protective enclosure for the spinal cord. Between each vertebrae is an intervertebral disk (cartilage band) that acts as a shock absorber to the heavily-worked backbone. These vertebrae, as well as the cushioning disks, affect functions throughout the body, and are also exceptionally prone to damage. There are several types of vertebrae, each susceptible to specific types of damage. They include:
  • 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.

When it comes to the back, there are no set rules. Some of the tests you might expect (and which should be included in ANY insurance policy you purchase) are:
  • 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.
These and other imaging tests may be used to prepare both diagnosis and treatment, and to evaluate effectiveness of treatment and long-term prognosis.

Types of Back Injury

Types of back injury include:
  • 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

Broad, Shared, and Unique Treatments

Spondylolisthesis is treated with the strengthening of supportive abdominal and back muscles through physical therapy. Other treatments for severe pain include surgical fusion (arthrodesis,) but in most cases physical therapy is a required precursor.
Among other spine and back injury treatments, steroids, traction and pain medication may be prescribed. Surgery remains an option in most cases.
Since most adults have, at one time or another, been active in sports, engaged in heavy activities such as moving or lifting objects, have had some type of medical history (and all adults are naturally aging), the cause of back injuries may often be under dispute. If you have any pre-existing condition, or any health issue that was realized before, or during, your back therapy, the documentation related to this issue may affect the outcome of your claim.
Disabling back injuries are almost always lifelong conditions that must be treated over a long period of time to achieve reasonable comfort and mobility. Once a patient has suffered a back injury, it may be a long time before he/she is able to move about, and even longer before reintroduction to social, public and outside-home activities is possible. The patient may or may not walk again. Learning to re-involve yourself in the outside world is known as reintegration, and should be included in your long-term prognosis as a vital, covered, health expense – much as a wheelchair, cane, and physical therapy.

We Can Help

At Bourhis Law Group, PC we have successfully assisted clients with spinal injuries to recover their policy benefits for over 30 years. For a free consultation, please call our TOLL FREE number our fill out the simple online form and our intake specialist will contact you.
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