Objective Evidence In Long Term Disability Claims


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Objective Evidence To Support a Long Term Disability Claim

As a claimant, the burden is on you to prove you suffer from a physical or mental condition which negatively affects your ability to continue in your career. Most insurance policies require proof of objective evidence before they will pay you benefits on your LTD insurance claim.

Here at the Disability Legal Center, we help LTD insurance claimants by compiling and effectively presenting objective evidence to support your LTD claim. We understand how to find and present medical and other documentary evidence that will hold up in court.

What is Objective Evidence, and Why is it Needed in LTD Claims?

Objective medical evidence is evidence that can be independently evaluated. Contrast this with subjective evidence which cannot be evaluated and you must rely on the credibility of the person presenting the evidence.

For example, if a patient reports they have a headache, that is a subjective complaint and is subjective evidence. There is no way to examine or evaluate it. You must believe (or not believe) the patient when they say they have a headache.

However, if the doctors run a CT Scan (Computed Tomography) on the patient’s head, and find something such as excessive fluid buildup in the brain, that is objective evidence. You can take the actual CT Scan image and present it to a room full of qualified doctors who can all evaluate the image. That is objective medical evidence.

This is why objective evidence is usually needed to prove you suffer from a debilitating disability. You want to dump a mountain of objective medical evidence on the insurance claims representative’s desk, so they have no choice but to approve your application for benefits.

Even if they deny your application, you want the evidence so overwhelming a judge is more likely to overturn the insurance company’s denial.

Objective evidence is especially useful in proving disabilities normally diagnosed based on the claimant’s subjective complaints, such as fibromyalgia, chronic pain syndromes, chronic fatigue syndromes and chronic back pain conditions. These conditions are usually met with a lot of skepticism.

Types of Objective Evidence Typically Seen in LTD Insurance Claims

Objective medical evidence includes medical signs and laboratory findings.

Medical Signs

Medical signs are objective indications of some medical fact or characteristic observed by a physician before or during a physical examination. Elevated blood pressure is a medical sign of some sort of condition. Multiple signs are usually required to confirm a diagnosis.

Medical signs can be anatomical, physiological, or psychological. The signs may be revealed by medically acceptable clinical diagnostic techniques. Such as an irregular heartbeat revealed by a doctor using a stethoscope.

Laboratory Findings

Laboratory findings are revealed using medically acceptable laboratory diagnostic techniques and tests. Laboratory findings are very compelling objective evidence. Laboratory findings include blood testing, diagnostic imaging tests such as X-Rays, MRI’s, and CT Scans. They can be electrophysiological studies such as electrocardiograms (EKG), electromyogram (EMG) and nerve conduction studies (NCS). The list of laboratory tests is endless, but as long as the lab used acceptable laboratory techniques, the findings themselves are rarely questioned.

Psychological and neuropsychological testing are sometimes helpful objective tests used to combat the insurance company’s stance the claimant is malingering or falsifying/exaggerating their disabling condition.

What if Objective Evidence is Not Available to Prove a Long Term Disability

There are impairments that cannot be confirmed by objective testing. Insurance companies are not allowed to require objective medial evidence for conditions that is subjective in nature, and for which the medical field has not developed any tests. Some examples of these are tinnitus, chronic fatigue, headaches and migraines.

In these situations, it is unreasonable for the insurance company to require objective test results (because none exist), but they can require objective evidence proving impairment prevents you from working.

Subjective Complaints Are Not Ignored

This entire article discusses how great and wonderful objective medical evidence is, but subjective evidence is still important. Your complaints must be given sufficient attention and weight by the plan administrator in its review of your disability claim. They cannot dismiss complaints which are merely subjective, such as pain or headaches.

Under ERISA, if the administrator dismisses your subjective complaints for any reason, it must provide, in writing, their reasons for doing so. That way you may adequately prepare your appeal to rebut these reasons.

If you have questions regarding your claim for disability benefits, or if your disability claim has been denied by any disability insurance company, contact the Disability Legal Center for a free consultation.