Many disabling medical conditions can be verified by objective testing measures, such as an MRI x-ray, or EMG. However, there are also a number of conditions that cannot be objectively measured. These are known generally as subjective conditions, and they can be just as disabling or even more so than objective conditions. Subjective conditions present a number of unique issues in disability benefits claims, so it is important to understand the nuances of subjective conditions and disability claim challenges if you are or become unable to work due to a subjective condition.
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An Overview of Subjective vs. Objective Conditions
The defining characteristic of objective medical conditions is their ability to be proven by some diagnostic testing measure or examination. Some examples include degenerative disc disease, arthritis, radiculopathy, and neurocognitive impairment, among others. On the other hand, the main characteristic of a subjective condition is that either its existence or resulting limitations cannot be objectively measured or quantified. Some common subjective conditions include:
- Fibromyalgia
- Long-COVID
- Chronic fatigue syndrome
- Migraine headaches
- Lyme disease
- Vertigo
- Chronic regional pain syndrome
- Irritable bowel syndrome
- Most mental illnesses, such as major depressive disorder, generalized anxiety disorder, post-traumatic stress disorder, and bipolar disorder
For the majority of subjective conditions, the main symptom is pain, but they can also cause fatigue, shortness of breath, headaches, and/or psychiatric limitations.
How Disability Insurers and Courts Address Subjective Disabilities
Disability insurers tend to view subjective conditions with skepticism. Indeed, one of the most common reasons insurers deny disability claims is for an alleged lack of objective evidence that confirms the severity of the claimant’s condition and resulting symptoms. Some private disability insurance policies even place a broad and arbitrary 24-month limitation on payment for subjectively-based disability claims, and virtually all disability policies include a 24-month limitation for mental illnesses.
Representative Cases that Involve Complex or Subjective Conditions
Despite those challenges, it is still possible to receive disability benefits for a subjective condition. There are a number of precedential cases within the Seventh Circuit Court of Appeals (which includes the federal district courts of Illinois, Indiana, and Wisconsin) that establish the importance of self-reported symptoms in disability claims. Recently, in Canter v. AT&T Umbrella Benefit Plan No. 3, 33 F.4th 949 (7th Cir. 2022), the Court made it clear that if courts within the Seventh Circuit approach a disability insurer’s need for objective medical evidence flexibly, particularly for medical conditions that do not manifest through physiological symptoms. Per the Court, “[t]he fact that pain or dizziness, or some other symptom, evades clinical detection or explanation is not by itself a reason to discount or disregard it.” Canter built upon the principles expressed in several previous Seventh Circuit rulings, such as:
- Kennedy v. Lilly Extended Disability Plan, 856 F.3d 1136 (7th Cir. 2017)
- Weitzenkamp v. Unum Life Ins. Co. of Am., 661 F.3d 323 (7th Cir. 2011)
- Holmstrom v. Metro. Life Ins. Co., 615 F.3d 758 (7th Cir. 2010)
- Leger v. Tribune Co. Long Term Disability Benefit Plan, 557 F.3d 823 (7th Cir. 2009)
- Diaz v. Prudential Ins. Co., 499 F.3d 640 (7th Cir. 2007)
- Hawkins v. First Union Corp., 326 F.3d 914 (7th Cir. 2003)
In those cases, the Seventh Circuit detailed that most disabling diseases or injuries are in fact disabling due to the pain, fatigue, or weakness that they cause; and those symptoms are inherently difficult to verify with strictly objective evidence. The overarching theme of those cases (and factually similar cases in other federal circuits) is this: disability insurers must appreciate the real and complex nature of subjective medical conditions.
Evaluating Disability Claims Requires Weighing Subjective Insights
In light of the above, disability insurers must strike a fair balance that integrates clinical expertise with subjective evidence, such as patient testimony. In practice, whether a subjective condition is disabling ultimately comes down to whether the claimant’s self-reported symptoms are credible. Credibility can be measured in several ways, one of which is whether the claimant has an established relationship with their doctor(s). This is important, because if a claimant has been treating with a specific doctor over some time, then that doctor is in the best position to observe the claimant’s demeanor and assess whether the reported symptoms are credible.
Another way to weigh credibility is to take a look at the claimant’s treatment history. If the claimant has repeatedly sought treatment and/or undergone several significant procedures in an attempt to alleviate their symptoms, then it is likely that they are credibly reporting their symptoms. On the other hand, if there is evidence the claimant may not be credible, is a malingerer, or is embellishing their symptoms, then an insurer’s denial of the claim may be supported.
Related Article: Choosing the Right Lawyer for Benefit Denial Cases: A Comprehensive Guide?Secure Your Rights with Experienced Disability Attorneys
If you suffer from a disabling subjective condition that prevents you from performing your job, you are likely to encounter a number of obstacles from your disability insurer. Therefore, it’s advised that you hire disability attorneys who have experience getting subjectively-based disability claims approved. DeBofsky Law does just that – we understand that reporting your symptoms to a disability insurer can sometimes feel like conversing with a brick wall, and we are here to help.
