Insurance companies often request “objective evidence” to support claims that an applicant is disabled and unable to work. The insurance adjusters reviewing these claims will want concrete evidence that the claimant suffers from a specific impairment that disables them. Evidence is objective when it is verifiable through a test or an analytical tool. Blood tests, MRIs, and X-rays all are examples of tests that can bolster or prove a diagnosis of a specific illness or medical condition.

Nonetheless, some impairments are based primarily on subjective evidence of symptoms, as reported by the claimant. Examples of subjective evidence of impairment might include headaches, pain, fatigue, weakness, vertigo, and tinnitus.

Plan administrators in ERISA-governed plans may not simply discount subjective evidence in favor of objective evidence. Instead, they must take subjective evidence into account in making decisions on claims. If the plan administrators do not credit or take subjective evidence into account, then they must inform the claimant in writing and provide their reasoning for discounting the subjective evidence. ERISA requires this explanation so that claimants can understand the reasons for their denial of benefits and adequately prepare an appeal.

Furthermore, some medical conditions that render people disabled are not diagnosable through objective testing, such as bloodwork. Fibromyalgia, for instance, is a physical condition that doctors often diagnose only after ruling out various other conditions. If the disabling condition on which a claimant bases his or her claim for benefits can only be proven through subjective evidence, then the insurance company cannot merely disregard that subjective evidence. The bottom line is that the insurance company cannot expect a claimant to provide objective evidence of a medical condition that is purely subjective.

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.