What is a Self Report Or Other Limited Condition Clause?
“The self-report or the other limited condition clause applies to any physical disability claim where you can’t objectify with tests or treatment or a CT scan, an MRI, a brain image, I’ve got pain. I’ve got a headache. How do I prove objectively that I’ve got a headache? You’ve got to accept my self-report.”
“And most long-term disability policies have a very short self-report or other limited condition clause. It can be as short as 18 months or 12 months. Have chronic fatigue? Have fibromyalgia? Got TMJ? Got back pain, neck pain without objectification by an MRI or CT? That’s how the self-report comes in.”
“So if you have a self-report or other limited condition clause in your policy or certificate, you need to make sure you can objectify your pain. Back pain, neck pain– you need an MRI, a CT, or an EMG. Or you need an office visit where your doctor can objectify through the testing that they manually do. Have a headache? You can objectify that. It’s the frequency, intensity, and severity of the treatment. Otherwise, be very careful. They can be as short as 12 months.”