Is Objective Evidence the Only Way to Prove Your Short or Long-Term Disability?
Objective evidence is based on unbiased, quantifiable, and independently confirmed factual evidence. Subjective evidence is based on opinion and self-reporting.
When suffering a disability and looking to file a short or long-term disability claim, your insurance company may want to see more objective evidence than subjective information. People ask, is that the only way to prove your disability claim?
No, but it is the best way to get paid.
Getting objective evidence, however, is often more difficult. Even so, many Employee Retirement Income Security Act of 1974 (ERISA) group claims require objective evidence as a policy requirement. To help you get the evidence you need to support your short and long-term disability claim, speak with a skilled disability claim denial lawyer.
Start With Your Policy
Your insurance policy will guide you on whether and how much objective evidence, if at all, may be required. Not all long-term disability policies require you to provide objective evidence. If your policy does require it and you do not provide it, your insurance provider will reject your claim for a lack of objective evidence.
The Social Security Administration (SSA) may also require objective evidence for claims submitted to them. The SSA also states that the objective evidence must be from an acceptable medical source that establishes you have a medical disability. Getting objective evidence for the SSA or your short or long-term disability insurer requires certain medical procedures, testing, thorough and comprehensive exams, functional capacity testing and correlated subjective complaints.
Types of Objective Evidence
Objective medical evidence of your disability usually means some sort of diagnostic medical exam and tests. These medical procedures can establish objective, fact-based evidence of a disability that prevents you from working. The great thing about these tests is that they are quantifiable and verifiable so your insurer can authenticate the results.
Common examples of objective evidence include:
- CT scans
- Lab test results
- Spinal tap
- Peer-reviewed functional capacity exams
These types of medical testing and procedures can produce objective evidence of physical, neurological, and cognitive disabilities. Even if your insurance policy does not require objective evidence of a disability, these tests can provide nearly indisputable evidence that you have a disability and deserve monthly insurance benefits from your short or long-term disability policy.
Remember, not all disabilities yield truly objective evidence. Ongoing back pain, for example, is a debilitating condition that affects nearly 65 million people nationwide. Back pain varies from extreme to mild. Some people struggle to walk while others can mostly go about their daily activities, maybe with the help of some over-the-counter medication.
Nearly 40 million people in America suffer from migraines. If you suffer from migraines, you know just how debilitating these severe and painful headaches are. Some people can manage them with over-the-counter medications and others have to spend their time in a dark and quiet room, simply waiting for the migraine to pass with powerful medications.
Unfortunately, there are no tests for these self-reported disabilities. No CT scan, MRI, or lab test can objectively state with medical certainty that a person suffers from back pain, migraines, or a host of other self-reported disabilities.
In these situations, insurance companies often find it very easy to allege that your condition is not really credible and reject your claim. If you suffer from extreme back pain that makes it difficult or impossible for you to reliably work, you need the benefits you’re entitled to under your long-term disability policy.
In these cases, you will need to support your claim with credible subjective evidence. The closest item you can get to objective evidence is thorough, up-to-date comprehensive and descriptive medical records. When you suffer from ailments without objective tests to confirm them, speaking with your doctor frequently to describe your symptoms in detail will prove invaluable. Your doctor will hopefully keep detailed records and this documentation can help prove your disability.
Help your doctor keep records of:
- The frequency, intensity and severity of your pain
- How your pain limits your ability to go about your daily activities and work demands
- The location of your pain
- How long your pain lasts
- Any medication you take that helps your pain or causes fatigue, focus or concentration issues
- Any treatments that have worked to ease your pain or make it more manageable or that have not worked
- How your pain causes sleep disruption
- Medication side effects on your physical and cognitive demands
What You Can Do Now
These subjective symptoms may not satisfy a policy requirement for objective evidence, but that doesn’t mean all is lost. Just because you cannot prove objectively that you have a disability, may not mean you are not disabled under the terms of your short or long-term disability plan.
If your insurance company requires that you provide them with objective evidence but you cannot objectively verify your disability, you still have options. You will need to submit additional documentation from your physicians along with all of your medical, pharmacy records. You should request that your treating doctor send a formal letter to the insurance company outlining the extent and severity of your disability. The doctor can provide additional insight and reasons for their medical opinion, which the insurance company may find credible.
An insurance company cannot simply ignore your doctor’s findings, even if those findings are based on opinion and not objective evidence. Even so, some insurance companies are so intent on not paying your claim that they will reject your doctor’s opinion and deny your claim.
What now? You can consider appealing. If you have an individual short or long-term disability policy but seek the opinion of a seasoned insurance bad faith lawyer first. But you should only do so with the guidance and support of a trusted and experienced long-term disability lawyer. Your legal team can help you collect the medical, occupational, financial, and vocational evidence necessary to help you overcome the hurdles placed in front of you by your short or long-term disability insurance provider.
Even if no objective evidence is available, the insurance company cannot ignore your pain and the restrictions, the severity, causes along with your doctor’s opinion. With careful and strategic documentation, you can overcome the lack of objective evidence with your subjective evidence of doctor’s notes, medical records, and your own testimony about how your disability prevents you from working.
A Skilled Long-Term Disability Lawyer Can Help
The lawyer you choose can help you collect the evidence necessary to get your insurance company to approve your disability claim. While it might take some time and a lot of effort, in the end, it is well worth it so that you can get the benefits you deserve under your short or long-term disability policy.