Most employer-sponsored long-term disability plans contain numerous provisions that are not beneficial to the employees who are eligible to receive the benefits. For instance, the definition of disability for eligibility for benefits may change over time, or the policy may exclude or limit coverage for mental or nervous conditions.

Additionally, long-term disability insurance policies often place limitations on coverage in specific circumstances. One standard limitation in these policies involves self-reported symptoms. For instance, some policies provide that disability benefits will cease after 24 months if the illness or injury for which individuals are receiving benefits is based primarily on self-reported symptoms.

Essentially, self-reported symptoms are those symptoms that patients report to their doctors, but that doctors cannot verify through tests, procedures, or examinations. Self-reported symptoms may include headaches, tiredness, soreness or stiffness, dizziness, loss of energy, and pain, among others.

Some examples of medical conditions that insurance companies might consider to rely on self-reported symptoms include:

·         Mental illness

·         Alcohol or drug abuse

·         Migraine headaches

·         Chronic fatigue syndrome

·         Fibromyalgia

Other medical conditions that insurance companies may challenge as subject to a self-reported symptoms limitation are lupus and other autoimmune disorders, arthritis, tinnitus, and Lyme disease. As a result, the insurance company may not accept the diagnosis of a medical condition without a test to support the diagnosis. Instead, the physician’s diagnosis relies primarily on the symptoms that the patient reports. Although the insurance company may not dispute the diagnosis or deny that the individuals have the medical condition, the self-reported symptoms limitation may cut off benefits after a certain period. This is the case even if the medical condition has not improved or even worsened over time.

Long-term disability claims are complex matters that require intensive knowledge of ERISA laws and regulations. As a result, you will need experienced legal representation and advice to pursue an ERISA-governed disability claim. Bonnici Law Group is a law firm focusing on ERISA long-term disability benefits and bicycle injury cases in San Diego, CA. When you need effective legal representation, contact Bonnici Law Group at 858-261-5454 or email us at help@bonnicilawgroup.com.