One of the fundamental requirements of a claim for long-term disability benefits is to prove the existence of the disability. One of the most common reasons cited by short-term and long-term disability insurance companies for denying claims is a lack of objective evidence of a disability.
“Objective” evidence is evidence that is quantifiable and can be confirmed using diagnostic tools. For example, an MRI showing a lumbar disc herniation. “Subjective” evidence is evidence that cannot be independently measured, such as self-reports of pain or depression.
Some conditions are easier to prove by objective evidence, such as a biopsy detecting cancer. However, other conditions are harder to verify through objective evidence. For example, chronic migraines, cluster headaches, and tension headaches cannot be detected by an MRI, x-ray, or blood test. Many conditions are characterized primarily by subjective symptoms, or symptoms that cannot be independently measured such as fatigue and pain, such as:
Insurance companies are not free to simply ignore a claimant’s subjective evidence when assessing a disability claim. However, this is all too common because insurance companies count on disabled claimants not being able to maneuver the confusing claims process and properly challenge their wrongful claim denials.
Also, insurance companies often intentionally ignore objective evidence supporting conditions primarily characterized by subjective symptoms. For instance, insurance companies frequently deny claims based on Fibromyalgia, asserting that there is no objective evidence to support the claimants’ subjective complaints of cognitive impairments, fatigue, and full-body pain. However, while the common symptoms of Fibromyalgia are subjective in nature, a diagnosis of Fibromyalgia is often supported by a clinical tender point examination, which is objective evidence. Similarly, Insurance companies will often assert that while there may be objective evidence of a person’s back condition (i.e., an MRI showing multiple cervical disc herniations), there is no objective evidence of claimant’s disabling pain.
In a 2007 disability claim case known as Oliver v. Coca-Cola Co., the 11th U.S. Circuit Court of Appeals ruled that Coca-Cola’s denial of an injured worker’s claim for long-term disability benefits was wrong and unreasonable. The appellate court explained that Coca Cola was not permitted to ignore Oliver’s subjective symptoms of pain, especially in light of the fact that there was objective evidence to support his condition which is known to cause chronic pain. Some insurance policies cap benefits for disabilities with subjective symptoms, usually 24 months. Often, insurance companies abuse these provisions and wrongfully deny claims that do not fall under the definition. Understanding your policy terms is essential when filing a claim or appealing a denial.
At Disability Insurance Law Group, our attorneys represent clients at all stages of the disability insurance process – from application through litigation. We have extensive experience in representing claimants with disabilities characterized primarily by subjective symptoms. We have successfully obtained millions of dollars for our clients in disability insurance benefits.
Our attorneys at Disability Insurance Law Group have helped many clients obtain disability benefits even when their symptoms were allegedly subjective. We look forward to evaluating your case and devising a proven strategy in support of your disability claim.
To schedule a free consultation, contact one of our experienced insurance claims attorneys today at 954-989-9000 or send a message, and we will respond promptly.
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