Key Takeaways
- A Wisconsin hospice counselor with long COVID sought long-term disability (LTD) benefits from Hartford but was denied due to insufficient objective evidence of impairment.
- The court upheld Hartford’s denial, ruling it was not arbitrary or capricious to require objective proof, even for conditions defined by subjective symptoms like fatigue and brain fog.
- This case highlights the challenges claimants face when insurers dismiss treating physicians in favor of in-house reviewers demanding diagnostic testing.
Background on the Claim
The plaintiff and claimant, Stephanie Schwingle, worked as a spiritual and grief counselor for Agrace Hospicecare in Wisconsin. After contracting COVID-19 in October 2021, she developed long COVID. Long COVID is a condition marked by ongoing fatigue, cognitive dysfunction (“brain fog”), depression, and physical limitations. Despite trying to return to work, she could not sustain full-time hours.
Hartford initially approved Ms. Schwingle for short-term disability benefits but denied her application for LTD benefits in 2022. Hartford’s decision claimed that her medical file lacked objective evidence proving functional impairment. Though her doctors supported her need for reduced hours, Hartford dismissed these opinions because they were based largely on her self-reported symptoms.
Why Hartford Denied the Claim
Hartford employed multiple medical reviewers and relied heavily on their conclusions in denying the LTD claim. The LTD denial was based on several factors raised by Hartford’s medical reviewers:
- Cognitive Testing Results: Despite Schwingle’s complaints of memory issues and confusion, her cognitive test scores were “normal.”
- Physical Exam Findings: Pulmonary and cardiovascular testing did not reveal impairments that would prevent her from working.
- Treating Physician Opinions Discounted: While her doctors restricted her to part-time work, Hartford found their opinions unsupported because there was no objective testing validating the self-reported symptoms.
- Independent Reviews: Specialists retained by Hartford concluded there was no diagnostic or objective evidence substantiating her reported fatigue and brain fog.
The court ultimately agreed, ruling that Hartford’s decision was not arbitrary because it had reasonably demanded objective evidence of the self-reported symptoms.
The Court’s Reasoning Under ERISA Law
Under ERISA, when a benefits plan gives the insurer discretionary authority to make claim determinations, courts review these denials under the “arbitrary and capricious” standard. This is a highly deferential standard that asks whether the insurer had a reasonable basis for its decision—not whether the claimant was in fact disabled.
Here, the court found that Hartford’s denial was reasonable because:
- The LTD plan required “proof of loss” that was “satisfactory to Hartford,” which the insurer interpreted as requiring objective corroboration.
- Schwingle’s own cognitive tests showed no impairment, undermining her reported symptoms.
- Hartford explained its reasoning and gave Schwingle opportunities to provide additional testing, such as a neuropsychological evaluation, which was never obtained.
- Treating physicians did not identify objective evidence of functional limitations, instead relying on Schwingle’s reports of fatigue and brain fog.
Although the court acknowledged that Schwingle and her doctors may have been credible, it held that Hartford’s demand for objective evidence was within its discretion.
What Does “Objective Evidence” Mean in LTD Claims?
One of the most pressing issues in disability insurance law is how insurers apply the concept of “objective evidence.” Many disabling conditions, such as long COVID, fibromyalgia, chronic fatigue syndrome, migraines, and mental health disorders, are defined by subjective symptoms that are difficult, if not impossible, to measure with traditional diagnostic tools. For example, there is no blood test or imaging report that can measure chronic fatigue. k
Insurers Often Use “Objective Evidence” Requirements to Deny Claims
Insurance companies know that subjective symptoms are harder to prove, which makes them a common target for denials. Insurers often argue:
- Normal diagnostic tests mean the claimant is not disabled.
- Treating physician opinions are unreliable if based on patient self-reports of pain or fatigue.
- Daily activities (like preparing meals or driving short distances) prove the claimant can work full-time.
This tactic shifts the burden onto claimants to produce evidence that may not exist in a straightforward form.
How Claimants Can Overcome the “Objective Evidence” Barrier
While insurers often misuse the objective evidence requirement, there are strategies for strengthening LTD claims in cases involving subjective conditions:
Functional Capacity Evaluations (FCEs)
An FCE is a series of standardized physical tests conducted by a physical therapist or occupational therapist designed to measure a person’s ability to perform work-related tasks. For conditions like long COVID or chronic fatigue syndrome, an FCE can provide measurable data showing reduced stamina, limitations due to pain, or inability to sustain activity over time.
Neuropsychological Testing
For claimants with cognitive complaints, like brain fog or memory issues, comprehensive neuropsychological testing can reveal cognitive impairments not seen on routine evaluations with a doctor. These evaluations measure processing speed, attention, working memory, and executive functioning, which are crucial for knowledge-based professions.
Cardiopulmonary Exercise Testing (CPET)
A CPET is one of the most reliable ways to objectively measure fatigue and post-exertional malaise, which are common in long COVID and chronic fatigue syndrome. This test evaluates heart, lung, and muscle function during physical exertion and can document reduced exercise tolerance or abnormal recovery patterns. Results from CPET testing can be powerful evidence of functional impairment when insurers challenge claims based on fatigue.
Detailed Physician Support
Treating doctors should provide more than check-box forms or brief notes. Strong support includes:
- Thorough explanations connecting medical findings to work restrictions.
- Documentation of symptom patterns (e.g., worsening fatigue after exertion).
- Observations corroborating the self-reported symptoms.
Symptom Tracking and Daily Impact Reports
Claimants can maintain logs documenting fatigue, cognitive lapses, or flare-ups. Family members and coworkers can also provide third-party observations showing how symptoms impair daily life and job performance.
Why This Matters for Long COVID and Similar Claims
The Schwingle case highlights the uphill battle many claimants face: insurers acknowledge the reality of conditions like long COVID but deny claims on the grounds that subjective symptoms are not “proven.” Courts often uphold these denials unless claimants can provide objective documentation of functional limitations.
This does not mean such claims are unwinnable—it means they must be handled with proper strategy, expertise, and careful evidence development.
How Dabdoub Law Firm Helps Claimants Facing Objective Evidence Demands
At Dabdoub Law Firm, we know that insurers like Hartford use the “objective evidence” requirement to deny valid claims. Our team has decades of experience pushing back against these tactics.
- We focus exclusively on disability and life insurance claims—this is all we do.
- We have successfully challenged denials involving subjective conditions, including chronic fatigue syndrome, fibromyalgia, migraines, and long COVID.
- We work with independent experts to secure functional capacity evaluations, neuropsychological testing, CPET testing and strong physician reports to satisfy insurers’ demands.
- We represent clients nationwide and have taken on every major disability insurance company.
- We are a litigation powerhouse with a track record of winning cases in federal court when insurers act unreasonably.
If your disability insurance claim has been denied because your insurer says you lack “objective evidence,” we can help. Our attorneys understand how to build the right kind of record, fight back against unfair denials, and pursue the benefits you are entitled to under the law.
Disclaimer: Dabdoub Law Firm did not handle this case.