My Insurer Says There's No Objective Evidence of Disability. What Now?
If you have a disability, you may need to file an Employee Retirement Income Security Act (ERISA) claim and receive long-term disability benefits. However, many ERISA insurers are reluctant to pay their claimants – and will often say that there’s “no objective evidence” of your disability, especially if its symptoms are not visible on the surface.
It’s unreasonable for insurers to require objective medical evidence for inherently subjective conditions, and this fact has been supported by key court cases. If you’ve received pushback on your disability claim due to a lack of objective evidence, our experienced ERISA lawyers can help you fight for the benefits you deserve.
Invisible Disabilities: Why Some Conditions Are Subjective
Although many disabilities are obvious to the outside world, others are almost invisible, leaving the affected individual to deal with constant misunderstanding from others. Over time, this “invisibility” can amplify the symptoms of your disability, and make it less likely that you’ll receive proper medical treatment and equal opportunities.
Some common invisible conditions include:
- Chronic fatigue syndrome (CFS)
- Brain injuries
- Multiple sclerosis (MS)
- Chronic pain syndrome
- Post-traumatic stress disorder (PTSD)
- Chronic migraines
While there are some medical ways to measure the impact of these disorders, these methods are largely subjective, especially for conditions marked by chronic pain. Thankfully, the courts have increasingly recognized that unlike other disabling medical conditions, there is no purely objective test for complex conditions like CFS or fibromyalgia.
What the Courts Say About Objective Medical Evidence
Insurance companies frequently cite Watts v. Bellsouth Telecomms., Inc, an Eleventh Circuit ERISA disability case, as proof that all claimants must have objective evidence for a disability. In that case, the Court stated that “…where a plan puts the burden on the claimant to prove that she is disabled, it is implicit in the requirement of proof that the evidence be objective.”
But insurance companies are incorrect in applying Watts and similar cases to situations where the disability is subjective. For instance, in Salomaa v. Honda Long Term Disability Plan, the 9th Circuit Court of Appeals concluded that, “Many medical conditions depend for their diagnosis on patient reports of pain or other symptoms, and some cannot be objectively established.” In other words, insurers cannot condition their coverage based on objective proof. The 11th Circuit’s rulings in Oliver v. Coca Cola Co. and Creel v. Wachovia also further this finding, and provide more thoughtful analyses on the issue.
UnlikeWatts and the line of cases following it,Oliver and Creel – handed down after Watts – specifically showed that it does not make sense to require objective medical evidence of a condition when the condition doesn’t lend itself to such evidence. In both cases, the court found it unreasonable (and, thus unlawful) to require claimants to provide this kind of proof, in absence of plan language that clearly spells out that requirement.
How a Skilled ERISA Attorney Can Help
At Dabdoub Law Firm, we’ve been representing individuals with long-term disability claims for more than 20 years, and we’re entirely committed to helping disabled individuals receive their rightful benefits. In many past cases, we’ve successfully questioned the insurer’s right to request objective evidence for subjective conditions.
Our track record clearly shows that we’re able to handle the toughest disability insurance lawsuits. By offering award-winning counsel and powerful legal experience, we’ve been able to secure millions of dollars for our clients – and we can help you seek the same results.
If you have a disability insurance claim, call (800) 969-0488 to speak with one of our experienced disability lawyers. We work on contingency fees, and our consultations are always free!