It is often difficult to get a disability insurance company to accept liability of the claim, when a claimant suffers from a condition that is not readily diagnosed by objective testing. Insurance companies frequently target conditions such as fibromyalgia, chronic fatigue syndrome, depression, chronic migraine headaches, and even multiple sclerosis, rheumatoid arthritis, and back conditions for denial based on a lack of objective evidence. Even where there is clear objective evidence of the condition, such as a herniated disc that appears on MRI suggesting degenerative disc disease or white matter in the brain indicating multiple sclerosis, insurance companies will often challenge the claim for disability, arguing that there is not objective evidence of functional impairment indicating a disability from work.
If a claimant has a condition characterized largely by subjective complaints such as pain, fatigue, lack of stamina or energy, and/or cognitive impairments, it is essential that their treating physician strongly advocate for the claimant and provide well documented clinical findings, restrictions and limitations, and thoroughly explain how the subjective complaints are consistent with the objective clinical findings. Often treating physicians do not fully document clinical findings or make the connection between the claimant's subjective complaints and the diagnoses on each office visit, allowing insurance companies to deny the claim. At Disability Insurance Law Group, we closely work with our client's attending physicians, explaining the policy terms, the common insurance company tactics to deny such claims, and explain how imperative it is to carefully document clinical findings each office visit.
Some disability policies contain language requiring objective medical evidence to support a claim. However, the majority of policies do not contain such provisions and/or are not as strict as the insurance companies suggest when denying these claims. Despite this, many insurance companies simply inject the requirement unilaterally when a claim is filed, wrongly imposing an impossible to meet standard for the claimant to satisfy. Subjective symptoms are difficult to demonstrate objectively. Accordingly, the insurer is able to deny the claim, asserting that the claimed restrictions and limitations are not supported or are self-limited.
Many courts, however, have required insurance companies to consider a claimant's subjective complaints when deciding upon the validity of the claim. Likewise, where a policy requires objective evidence, many courts have found that if there is objective evidence of a condition (example: herniated disc or white matter found on an MRI), the insurance company cannot require objective evidence of the disabling subjective symptoms (example: pain, fatigue, or cognitive impairments).