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Long-Term Disability Benefits and “Objective Medical Evidence”: What Does Your Disability Policy Require?

Objective Medical Evidence Attorney

In one capacity or another, we all have insurance. Whether it’s car insurance, health insurance, homeowner’s insurance, or disability insurance, it’s there for the “just in cases” of life. Most of us insurance policyholders are honest, hardworking Americans. However, under the guise of defending against insurance fraud—but really to just save money—your individual or group long-term disability insurance company may delay, deny, or terminate your valid claim.

If you break your leg and can’t deliver the mail, an X-ray will prove you’re telling the truth. However, what if your injury or illness isn’t easily proven or capable of proof with objective medical evidence?

Objective medical testing, such as radiology reports, blood panels, or nerve testing, can’t diagnose fibromyalgia, which is a legitimate disabling condition characterized by whole body pain and fatigue. Unfortunately, these “soft proof” claims open the door for your individual or group long-term disability insurance company to delay, deny, or terminate the benefits of those who suffer from fibromyalgia, migraines, chronic fatigue, mental-nervous and even some back or neck claims.

Illnesses or injuries that objective medical evidence can’t prove are commonly referred to as “self-reported” or “soft” disabilities. How your individual or group long-term disability carrier deals with self-reported disabilities often controls how you should try to fill out your claim application form.

Proper claim information is why you should take advantage of your free individual and group long-term disability policy analysis and free claim consultation with the award-winning individual disability lawyers and nationally renowned group ERISA attorneys at DarrasLaw. Call today at 800-898-7299 or contact us online.

Overview of Long-Term Disability Insurance Benefits

In general, individual or group long-term disability benefits serve as income replacement insurance. If you suffer from an injury or illness that prevents you from performing the material and substantial duties of your occupation, you may qualify for individual or group long-term disability benefits. Some of the most common disabling injuries and illness in the United States are:

  • Neck, back, and spinal injuries
  • Heart disease
  • Diabetic complications
  • Car accident injuries
  • Cancer
  • Broken bones, strains, and sprains

Your treating physician can diagnose and prove each of these conditions with objective medical evidence. For example, an MRI will show a slipped disc. Blood tests will prove you have diabetes or cancer, and X-rays will show broken bones. When you apply for individual or group long-term disability benefits, you’ll have to submit legally sufficient medical evidence and supporting restriction and limitation statements from your treating doctor.

Your individual or group long-term disability provider will then compare the medical records describing your disabling condition with the important duties of your occupation. For example, if you’re required to work on a computer all day but your neck injury prevents static posturing; this may qualify you for individual or group disability benefits.

Individual or Group Long-Term Disability Benefits and Self-Reported Conditions

What happens, however, when the medical evidence isn’t objective, and your injury or illness is only proven based on you reporting your symptoms? These self-reported conditions commonly include, but are not limited to:

  • Fibromyalgia: Chronic pain throughout your whole body, leading to fatigue and mental disturbances. Some doctors use an 18-point test to diagnose fibromyalgia, which means putting pressure on 18-points throughout your body to determine the presence of pain. However, you’re still reporting the existence and level of your pain, and there is no test for whether it’s truly there.
  • Chronic fatigue: Various sleep disorders that result in mental fog can cause chronic fatigue. Even some sleep tests may not provide truly objective evidence as to the cause of your inability to fully rest.
  • Depression/anxiety: Doctors and counselors often diagnose these conditions by their symptoms—discouragement, panic attacks, and pervasive sadness, for example. However, most psychologists and psychiatrists can only make educated guesses at the brain chemistry that cause these conditions, as there is no blood test for most forms of depression or anxiety. Patients may have to try a variety of medications before they find one that works and that usually also means side effects.
  • Post-traumatic stress disorder: This condition is characterized by nightmares, anger, and extreme situational anxiety triggered by a trauma. While doctors and psychologists can diagnose PTSD if you experienced a trauma and present lasting symptoms, there’s no objective PTSD test.
  • Nerve damage: Neurologists can perform tests to diagnose certain nerve degeneration. However, tingling and numbness are hard to diagnose even though they can interfere with your ability to perform the important duties of your occupation with reasonable continuity and in the usual and customary way.
  • Migraines: Some brain tests can record abnormal brain activity—but they will only diagnose a migraine if it is in progress. Unfortunately, migraines are unpredictable, and objective medical evidence is difficult to obtain.
  • Mental health disorders: Serious mental health conditions can always prevent the reliable performance of the important duties of your occupation. However, these are among the hardest conditions to diagnose, and there is almost no common, objective mental health testing.

If you’re suffering from a self-reported condition that prevents you from working, you’ll have to submit compelling medical evidence and proof to your individual or group disability insurance provider. This may include witness affidavits, accident reports, your treating physician’s chart notes along with complete medical records and testing, pharmacy records, and your treating doctor’s detailed opinion on why you are unable to work physically and mentally.

Limitations on Individual and Group Long-Term Disability Benefits

Every individual and group long-term disability insurer has ways to delay, deny, and terminate valid claims under the guise of preventing self-reported disability fraud. Some individual or group long-term disability insurers require objective medical evidence, and if you can’t produce it, you don’t qualify for benefits.

Other long-term disability insurers limit your benefits for self-reported conditions. Most insurers will only provide benefits for self-reported conditions for 12, 18, or 24 months, and this is during your lifetime. For example, if you claimed depression benefits for 24 months in 2001, you can’t claim six more months of fibromyalgia benefits in 2010 if you maintained the same disability insurance.

Contact America’s Top-Rated Individual and Pre-eminent Group Long-Term Disability Insurance Attorneys Today

Claiming individual or group long-term disability benefits without objective medical evidence can present tremendous challenges. If you need to claim individual or group disability benefits for a self-reported condition, don’t do it alone. Long-term individual or group disability insurers commonly delay, deny, or terminate valid claims for self-reported conditions and claimants also make fatal claim application mistakes.

The stellar individual disability attorneys and nationally experienced group ERISA lawyers at DarrasLaw know what goes into a successful self-reported disability claim. DarrasLaw has fought for—and won—benefits for people with self-reported disabilities against every major individual and group long-term disability insurer in the country.

To schedule your free disability policy analysis and free claim consultation, call us today at 800-898-7299 or contact us online.

DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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