From Pain in the Neck to Return to Work: A Disability Claims Story

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By John Agliata and Dr. James Kim

The first week of 2026 saw me in a much different place physically than I was a year prior. I was at work and not in constant pain.

In January 2025 I was in the middle of my second month of short-term disability leave from my job as Senior Writer with RGA, following a November 2024 neck fusion surgery. I took some comfort in knowing that I was not alone; back pain affects roughly 80% of adults at some point in their lives.1 For most, acute episodes resolve. For me and as much as 10% of backpain sufferers, it lingers and becomes chronic pain.2 In fact, back issues are second only to headaches as the most common cause of chronic pain globally.
 
I learned these statistics only after my return to work – from a seminar by Dr. James Kim, a medical consultant with RGA Canada and an expert on back and neck issues. This article combines his insurance medicine insights with, as an illustrative example, my personal journey through neck-surgery-induced disability leave.

The psychic had it right: A claim’s origin storyInsurers rightly pay close attention to back issues. They are a leading cause of workplace disability and lost workdays and create an estimated $200 billion in annual costs worldwide3 for patients, employers, and insurers.

Back issues are most commonly experienced by those in sedentary populations – such as writers who have spent their entire adult lives typing out witty prose designed to engage and delight their audiences. My posture while writing could best be placed somewhere on the “horrible” side of the scale, if such a scale existed. I try. I really do. I straighten myself up nice and tall, feet on the floor … only to find myself five minutes later slouched over my laptop like a child sitting in the timeout chair.

But that isn’t the main reason I was forced to undergo C3-C4 neck fusion surgery on November 18, 2024. A 2017 car accident exacerbated a back injury I gave myself in 2007 while swinging around my then-5-
year-old giggling son by his arms before he left for kindergarten.

Those two incidents are the most provable points of origin I have for my back troubles. That said, they were first predicted by a psychic about whom I skeptically wrote an article while leading a weekly newspaper in Ohio. When interviewing her about her life as a psychic who helped everyone from the
lovesick to the police, I asked if she had any predictions about my future. She paused, sighed deeply, and said, “You’re going to suffer from severe back issues most of your life.”

I thought she was crazy. It turns out she has been spot-on so far.

I went on short-term disability leave in mid-November 2024, thinking I would be back in two or three weeks. I was not even back to eating solid food by that point, let alone ready to conduct interviews and write articles for RGA. The surgery had gone fine, but I did not fully understand the impact it would have on everything else in my neck. To get to the offending disc, part of which needed to be carved out to free a pinched nerve, the doctor went through the front of my neck and sort of scooched everything in his way to the side. That left my vocal cords and esophagus very, very angry.

I wanted to go back to work. I loved and still love my job. But having neck fusion at age 50 took more out of me than ankle surgery did in my 30s, and sitting upright without strain, pain, and fatigue was impossible.

Thankfully, I had a doctor and an employer who were incredibly supportive of me taking the time I needed for the fusion to hold, and my disability claims specialist was collaborative and helpful. I returned to my job on January 13, 2025, and I am grateful to have been issue-free this past year. It is amazing how different the world is when constant pain is not a part of it.

What I went through and how my employer handled it exemplified some of the things Dr. Kim talked about in his training seminar.
 
Anatomy of back injuries — and back injury claimsMost chronic back pain sufferers are commonly aged between 30 and 60. Men and women are affected about equally. Those of lower socioeconomic status are hit harder. Risk increases alongside age and BMI, and there is growing concern for younger, desk-based/phone-dependent people because of their more sedentary nature on and off the job.

The spine – which acts as a load-bearing column – is long and complicated, which leaves plenty of opportunities for something to go wrong. The five most common “somethings” are:

• Cumulative microtrauma – Repetitive strain to discs, ligaments, and muscles from sustained poor posture or vibration exposure.
• Disc herniation or annular tear – Sudden or repetitive flexion and rotation increase pressure, causing nerve root compression.
• Facet joint impingement – Extension or load compresses posterior elements, producing localized axial or referred pain. This was the main issue that led to my surgery.
  
• Ligamentous and muscular strain – Rapid overload or improper lifting – such as when you spin your 5-year-old by the arms – causes microtears in soft tissue stabilizers.
  
• Degenerative overload – Age-related disc desiccation and facet arthropathy alter load transfer and heighten a person’s susceptibility to injury. This was another contributing factor to my surgery.

I literally had a pain in the neck. But these injuries span the entire length of a person’s torso and often radiate from the problem site into arms and legs. Once they become chronic, they also produce functional limitations, psychological barriers, and other associated issues.

Combined, it can all lead – as it did for me – to a disability claim.
 
How insurers can respondNot all back-related disability claims are created equal, and those who submit them are equally diverse. Some red flags for more challenging claims include:

• Symptoms that worsen despite stable imaging
• Refusal of physiotherapy or active rehabilitation
• Heavy reliance on passive treatments, such as temperature therapies or massage
• Frequent provider changes (doctor shopping)
• Inconsistent functional statements across sources

Regardless of any challenges, disability claims specialists play a vital role in promoting an environment in which someone with a back injury returns to work as soon as safely possible. Some keys to a successful approach:

• Early modified duties – In some cases, people are able to come back sooner to full-time employment if they are first able to return part time or with less strenuous responsibilities.
• Avoidance of prolonged passive therapies – There is only so long that the recovery process can be aided by hot or cold packs, ultrasound, massage, electrical stimulation, and/or acupuncture Passive therapies should be part of a broader plan that includes active exercise for long-term recovery.
• Coordinated employer-insurer-clinician communication – Earlier this year, I collaborated with a colleague in Australia and our behavioral science team on an article about how to promote return-to-work among those on disability. The resulting article is instructive. This research found that a collaborative approach that empathetically addresses a claimant’s true goals for recovery – which often have nothing to do with work – promotes a shorter leave of absence.

 
Conclusion: Nuance is necessaryIn many ways, I was lucky. The surgery worked and I was able and eager to get back to my job.

But for many, chronic pain leads to depression and further disability issues. For some, the first surgery does not work. For others, underlying on-the-job tensions or issues create an incentive – whether conscious or not – for the claimant to stay away from work for as long as possible, and to perhaps pursue permanent disability status.

This creates challenges for insurers. These can be simplified, however, by aligning clinical testing with imaging and function. The best approach is to work with the clinician and claimant to set clear lifestyle-driven goals and to encourage early return to function. If available, part-time hours or alternative duties can get the person back to work as soon and safely as possible.

Disability cases from back injuries can be incredibly nuanced. Claims specialists must balance self-reported pain with objective testing, be cognizant of the pull of secondary gains, and avoid misclassifying temporary setbacks or exacerbations as permanent disability.

The first surgery might not always succeed. Mental health and other comorbidities can come into play. But genuine empathetic concern and goal setting with the claimant, alongside the clinician, can create an environment in which the person is motivated to return to work.
 
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1 https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/back-pain-self-care-tips
2 https://hpi.georgetown.edu/backpain/
3 https://www.advancedautism.com/post/57-back-pain-statistics