What Does a Denial of LTD Benefits Due to “No Objective Findings” Mean?

What Does a Denial of LTD Benefits Due to “No Objective Findings” Mean?

Many insurance companies in considering claims for long-term disability benefits will request “objective” evidence to support claims. Objective evidence is evidence that proves the existence of a disabling medical condition based on diagnostic tests, laboratory test results, or other similar measurements of disability. For example, if you are claiming that you have a back condition that affects your ability to work, an MRI or CT scan showing a herniated disc is objective evidence supporting your claim. Likewise, if you suffer from a condition that can be proven by blood test results, you have objective proof of your diagnosis.

The problem with insurance companies requiring objective evidence is that tests can not measure some medical conditions. There may be no way to prove the existence of these medical conditions with any objective evidence. Instead, the diagnosis of some medical conditions may rely on subjective findings, such as your reports to your doctor of pain, fatigue, chronic headaches, or vertigo. It is these types of medical conditions that can lead to insurance companies denying benefits based on “no objective findings.”

However, plan administrators usually must take subjective evidence, such as self-reported symptoms, into account. If the plan administrators choose not to take this evidence into account, they must inform the claimant in writing and explain why they discounted the evidence.

Furthermore, some medical conditions are not measurable by any objective testing. As a result, it is unreasonable for plan administrators to deny a claim for LTD benefits due to “no objective findings” when considering medical conditions for which there are no objective means of testing. Conditions like headaches, tinnitus, chronic fatigue syndrome, and fibromyalgia are diagnosed mainly on patient reports of symptoms and effects of those symptoms on their lives. For these conditions, plan administrators must take subjective evidence into account in considering claims.

Bonnici Law Group provides client-focused representation throughout the ERISA claims process. We are here to consider the evidence in support of your ERISA long-term disability claim and evaluate your application. Next, we can develop the most effective strategy for fighting any denials of coverage that you may receive. Allow us to handle your legal needs while you focus on your physical and emotional health. Contact the ERISA long-term disability attorneys of Bonnici Law Group at 619-259-5199 or help@bonnicilawgroup.com.

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