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What is the Self-Reported Symptoms Limitation in ERISA-Governed LTD Claims?

What is the Self-Reported Symptoms Limitation in ERISA-Governed LTD Claims?

Some long-term disability insurance policies contain provisions that limit coverage if the claimants do not meet certain criteria. One example of such a provision is the self-reported symptoms limitation. Although many individuals receive disability benefits based on medical conditions that might invoke these limitations, the self-reported symptoms limitation is becoming more prevalent in group employer-sponsored LTD plans.

A self-reported symptoms limitation is designed to limit coverage for those medical conditions that are documented largely by the claimants as self-reported symptoms. In other words, there may not be specific diagnostic tests or examinations available that conclusively proves that a medical condition exists, as there is for breast cancer, for example. There also may be no way to verify the existence of certain symptoms, other than by the patient reporting the symptoms. Self-reported symptoms might include headaches, dizziness, nausea, fatigue, numbness, stiffness, and pain.

Medical conditions that an insurance company might deem as wholly or partially reliant on self-reported symptoms include auto-immune disorders such as lupus, Hashimoto’s disease, or Sjoegren’s disease. These conditions also may include fibromyalgia, chronic fatigue syndrome, constant pain due to nerve damage incident to an automobile accident injury, and even migraine headaches.

One example of a self-reported symptoms limitation in a long-term disability insurance policy is a provision that limits coverage for these medical conditions based on self-reported symptoms to 24 months. However, self-reported symptoms limitations can vary widely from one LTD policy to the next, so it is important to be aware of how your medical condition might trigger this limitation at some point during your receipt of long-term disability benefits. Long-term disability insurance policies often contain many provisions that you might not be aware of, including self-reported symptoms limitations. Bonnici Law Group has handled the claims of countless individuals who have encountered difficulties in procuring long-term disability benefits under their employers’ ERISA-governed insurance policies. We will protect your rights and advocate on your behalf throughout every stage of the claims process. Call our office at 619-259-5199 to set up an appointment to speak with us today. 

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