Disability insurance is meant to provide financial protection to individuals who are unable to work due to a qualifying disability. To ensure fair assessments, insurers typically require claimants to provide “objective” medical evidence supporting their disability claims. While the requirement for objective evidence serves a valid purpose, some disability insurance companies have been known to exploit it to deny otherwise meritorious claims. In this article, we will explore the significance of objective medical evidence in disability claims and how to avoid the unjust denial of disability benefits based an alleged lack of objective evidence.
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Defining “Objective” Medical Evidence
Objective medical evidence refers to factual, measurable data derived from medical tests, examinations, and imaging studies that support or disprove a claimant’s reported symptoms and limitations. Unlike subjective evidence, which is based on a person’s perception of their condition, objective evidence offers concrete and verifiable information to aid in the assessment of disability claims. It has been defined by one court as “‘open to observation by oneself and by others,’ as opposed to a symptom such as pain which can be observed only by the patient and is, therefore, considered ‘subjective.’” Moberg v. Phillips Elecs. N. Am. Corp. Grp. Welfare Ben. Plan, No. CIV 12-5081, 2013 WL 6048909, at *4 (W.D. Ark. Nov. 15, 2013), aff’d, 576 F. App’x 633 (8th Cir. 2014) (quoting STEDMAN’S MEDICAL DICTIONARY, 28th Ed.).
Types of Objective Medical Evidence
Clinical Findings: Clinical findings encompass a wide range of medical observations made by healthcare professionals during physical examinations. These findings may include abnormal vital signs, motor and sensory deficits, range of motion limitations, joint swelling, muscle weakness, and other observable and measurable signs of impairment.
Imaging Studies: Imaging studies, such as X-rays, CT scans, MRIs, and ultrasounds, provide detailed visualizations of internal body structures. These objective images can reveal abnormalities, injuries, or the progression of certain medical conditions, supporting the claimant’s diagnosis and treatment.
Laboratory Studies: Laboratory studies involve the analysis of blood, urine, or tissue samples to detect specific medical conditions, assess organ function, and monitor disease progression. Blood tests, for instance, can reveal the presence of certain markers or pathogens associated with chronic illnesses or disabilities.
Electrodiagnostic Studies: Electrodiagnostic studies, including electromyography (EMG) and nerve conduction studies (NCS), evaluate the electrical activity of muscles and nerves. These tests can help diagnose neurological or neuromuscular disorders, such as carpal tunnel syndrome or peripheral neuropathy.
Neuropsychological Testing: Neuropsychological testing evaluates cognitive function, memory, attention, and other aspects of brain function. Neuropsychological testing can help assess the cognitive impairment associated with traumatic brain injuries or neurodegenerative disorders like Alzheimer’s disease.
Functional Capacity Evaluations: Functional capacity evaluations assess a claimant’s physical abilities and limitations related to work-related tasks. These evaluations are conducted by physical or occupational therapists and provide an objective assessment of the claimant’s functional abilities.
Headache Diaries: Believe it or not, a headache diary or symptom diary can qualify as “objective” evidence of disability, particularly in the case of migraine headaches, for which there are no conventional objective tests.
How Insurers Abuse Objective Evidence to Deny Claims
Objective medical evidence serves as crucial documentation in disability claims, allowing insurers to verify the legitimacy and severity of the claimed disability. This requirement helps prevent fraudulent claims and ensures that genuine disabilities receive the necessary support. However, disability insurers have been known to place undue emphasis on objective evidence, to the exclusion of other evidence, leading to the denial of valid claims. Below are some ways in which this abuse of discretion occurs:
Overreliance on Objective Evidence to the Exclusion of Other Evidence: Insurers may unreasonably prioritize objective medical evidence over subjective symptoms, particularly in cases of chronic pain, mental health conditions, or other invisible disabilities. This emphasis on objective evidence may lead to the denial of claims where concrete testable data is limited or unavailable, even though the claimant’s symptoms significantly impact their ability to work.
Selective Consideration of the Evidence: Selective consideration of the evidence is a hallmark of arbitrary and capricious decision making, and that is no less true when it comes to objective medical evidence. Disability insurers will often emphasize “normal” imaging studies or clinical findings while ignoring or minimizing other abnormal findings. This tactic, which is known in formal logic as the “fallacy of the red herring,” was criticized by the court in Tobin v. Hartford Life & Accident Ins. Co., 233 F. Supp. 3d 578, 587 (W.D. Mich. 2017), which observed: “The fallacy occurs when the proponent introduces a new issue, usually one the proponent is prepared to address, in an attempt to distract or avoid the subject or topic of discussion.”
Demanding Objective Evidence Where None Can Exist: Another hallmark of arbitrary and capricious decision-making is demanding objective evidence of disability where none can exist. For example, an insurer might deny a disability claim due to migraine headaches because the claimant’s brain MRIs were normal, even though MRIs are known to be normal in migraine headache patients. Courts have held that conditioning an award on the existence of evidence that cannot exist is arbitrary and capricious.
Strengthening Your Claim With Objective Medical Evidence
Seeking regular medical care is crucial for generating a robust trail of objective evidence. Make it a point to regularly visit healthcare providers and adhere to their treatment plans to establish continuity of care.
Keeping detailed medical records is equally important; maintaining organized and comprehensive records, including diagnostic reports, test results, treatment plans, and progress notes as they serve as essential documentation for disability claims.
To ensure accurate documentation of your medical condition, be transparent with healthcare providers. Openly communicate all symptoms and limitations, avoiding downplaying or exaggerating symptoms to maintain the credibility of your claim. Periodically review your medical records to make sure they are comprehensive and accurate.
If a healthcare provider recommends diagnostic tests or imaging studies, follow their advice, as these tests can offer objective evidence of your condition’s severity, aiding the disability claim process.
Cooperate with insurance companies by being responsive and providing any requested medical records and additional evidence promptly. Timely submission of objective medical evidence can expedite the claim review process.
Lastly, consider consulting an attorney if your disability claim has been denied due to a lack of objective medical evidence, or if you are concerned about that possibility. The attorneys at DeBofsky Law are experienced at navigating disability claim denials based on an alleged lack of medical evidence and can help you to build your case to avoid or reverse an unjust denial.
