By Jennifer Hess and Samantha Wladich, Riemer Hess LLC

Living with chronic pain usually means adapting—again and again. People adjust schedules, modify tasks, try new treatments, and push through symptoms over and over. Many continue working not because they are well, but because they are trying to hold things together.

When work finally becomes unsustainable, the long-term disability (LTD) process can feel confusing and discouraging. Pain conditions are frequently misunderstood in insurance reviews, and the way claims are evaluated often fails to reflect what daily life with chronic pain actually looks like.

This article offers a general, educational look at how long-term disability claims are commonly evaluated for people living with chronic pain—and why those claims can be so difficult.

Important note: This article is for general educational purposes only. It is not legal advice and is not a substitute for guidance specific to an individual’s situation or insurance policy.

Hear more from these experienced attorneys during a FREE webinar, “Preparing for Your Long-Term Disability Claim,” at 1 p.m. ET on Tuesday, March 10. Register today.

Why Chronic Pain Disability Claims Are So Often Challenged

One of the biggest problems in pain-related disability claims is that pain often does not behave the way insurers expect disability to behave.

Chronic pain can:

• fluctuate
• worsen with activity
• improve briefly and then return
• limit endurance, not just strength

Insurance reviews, however, often look for steady decline, clear-cut test results, or visible impairment. When those markers are missing or unclear, insurers may conclude—incorrectly—that someone is still able to work.

This disconnect is one reason long-term disability claims involving chronic pain often face higher scrutiny.

A Common Scenario: When Working Through Pain Stops Working

Consider this example, which reflects a pattern many people with pain will recognize.

A professional living with chronic spinal pain continues working while undergoing physical therapy, medication changes, and injections. At first, they shorten their workday and recover at night. Over time, therapy triggers flares instead of relief. Medication causes brain fog. Recovery stretches into the next day. Sleep deteriorates.

From the outside, it looks like they are still “functioning.” On paper, treatment is ongoing. But behind the scenes, the effort required to work becomes unsustainable.

When work finally stops, insurers often ask:
Why now?
Why stop work if treatment was ongoing?

Without context, the timing can be misunderstood.

Function Matters More Than Diagnosis in Long-Term Disability Claims

In most long-term disability claims, the diagnosis itself is not the deciding factor. Insurers focus instead on function.

For people living with chronic pain, that usually means questions like:

• How long can you sit, stand, or walk?
• How often do symptoms flare?
• What happens after physical or cognitive exertion?
• How much recovery time is needed?
• Can this be repeated day after day?

Someone may be able to complete tasks in short bursts and still be unable to meet the demands of regular, full-time work. Disability evaluations do not always capture that distinction unless it is clearly documented.

Why ‘Trying Harder’ Isn’t the Same as Capacity

A recurring theme in pain-related claims is the assumption that effort equals ability.

In reality, chronic pain often limits:

• duration
• frequency
• consistency
• recovery

People may push through pain at work for many reasons—financial pressure, professional identity, fear of losing benefits. That effort can later be misread as proof that work was sustainable.

Understanding the difference between what can be done briefly and what can be done reliably is central to understanding disability in chronic pain-related cases.

Variability Is Normal in Chronic Pain — Not a Red Flag

Many people with chronic pain have good days and bad days. That variability is often used against them.

Insurance reviewers may interpret fluctuating symptoms as:

• inconsistency
• exaggeration
• improvement

In reality, variability is often one of the defining features of chronic pain. Short periods of relief do not mean the condition has resolved, especially when those periods are followed by flares or prolonged recovery.

Clear explanation of symptom patterns over time helps prevent this misunderstanding.

Why Baseline Function Matters When Disability Follows Treatment

For many people, disability does not begin at diagnosis, or at the onset of undiagnosed symptoms or pain. It begins later—after months or years of treatment attempts and symptom progression.

A baseline helps show:

• what functioning looked like earlier
• how endurance declined
• how treatment affected symptoms over time

This matters because insurers often assume that treatment leads to improvement. When work ends after treatment begins, baseline documentation helps explain that disability developed despite care, not because care was avoided.

Objective Evidence and Chronic Pain: What Insurers Look For

In the disability context, “objective evidence” generally means information beyond self-report alone, such as:

• imaging
• exam findings
• functional testing
• documented observations by providers

This does not mean pain must show up clearly on a scan to be real. Many pain conditions do not lend themselves to definitive test results. Still, insurers often weigh claims more heavily when some objective support exists—especially when policies scrutinize conditions labeled as “subjective,” which is often the case for pain-related diagnoses.

Objective evidence is most effective when paired with clinical explanation and functional context.

Treatment Does Not Always Mean Recovery

Many people living with chronic pain are deeply engaged in treatment long before disability becomes an issue. Insurers sometimes interpret continued treatment as proof that improvement should follow.

In reality, chronic pain treatment often focuses on:

• management
• symptom reduction
• preventing decline

Ongoing treatment does not guarantee restored work capacity. Modifying or stopping treatment can also be medically appropriate, particularly when side effects outweigh benefits or progress plateaus.

The Question Disability Claims Are Really Asking: Sustainability

Whether a policy applies an “own occupation” or “any occupation” standard, the real question is the same: Can this person work reliably and sustainably over time?

For people living with chronic pain, the answer often hinges on endurance, recovery, and consistency—not whether isolated tasks are possible.

Final Thoughts

Long-term disability claims involving chronic pain are often difficult—not because pain is unclear or insignificant, but because the claims process does not easily account for fluctuation, fatigue, and limited endurance.

Understanding how insurers evaluate these claims can help individuals better navigate the process and recognize where misunderstandings tend to arise.

Because every claim depends on individual facts and specific policy terms, there is no one-size-fits-all approach. In some situations, consulting with an experienced long-term disability attorney may be helpful.

About the Authors:

Jennifer Hess, Partner, Riemer Hess LLC

Jennifer Hess is a Partner at Riemer Hess LLC, a New York-based law firm whose practice includes ERISA and long-term disability matters. She has more than 10 years of experience in disability law. Her current practice is devoted to representing professionals and executives in long-term disability claims, administrative appeals, and related litigation.

Jennifer regularly lectures on disability law topics and is a co-author of ERISA Disability Claims and Litigation. She has authored and contributed to publications on long-term disability and ERISA matters, including books and scholarly articles published by the American Bar Association, the New York State Bar Association, and the American Association for Justice.

Samantha Wladich, Associate, Riemer Hess LLC

Samantha Wladich is an Associate at Riemer Hess LLC. Since joining the firm in 2022, she has assisted individuals in navigating the long-term disability benefits process. Her practice focuses on ERISA long-term disability insurance matters, including claims filing, administrative appeals, benefit protection strategies, severance review, early exit considerations, and related litigation.