Many who suffer from a disability are often surprised that simply having a diagnoses from a doctor does not guarantee approval of their LTD claim. Claimants must also provide objective proof that their condition limits their ability to perform the duties of their job to improve their claim for benefits.
For long term disability insurance claims, objective proof that a condition limits a worker’s ability to perform job duties (or prevent them from working entirely) is typically highly emphasized by insurers and can make or break an LTD claim. Policies typically require verifiable evidence of both the condition and its functional impacts.
Objective evidence may include measurable, verifiable data from tests or exams such as imaging (XRays, MRI, CT scans), blood tests, EKG, nerve conduction studies and/or clinical findings such as reduced range of motion or swollen joints.
Subjective claims such as a claimants self-reported symptoms of pain, fatigue, cognitive issues, or depression should be documented in the patients’ medical, but are not independently measurable. Courts have held that claimants cannot be denied solely for lacking objective evidence if the condition (migraines, chronic pain, and mental health) doesn’t lend itself to such tests, but it follows that the subjective reports must be consistent and supported by a treating physician.
Key Types of Assessment to Support an LTD Claim
- Diagnostic Tests may include imaging or lab results confirming diagnosis
- Functional Assessments such as functional capacity evaluation (FCE) measures physical abilities against job demands
- Cardiopulmonary Exercise Testing (CPET) for conditions such as chronic fatigue to show post exertion malaise
- Neurophysiological Testing to check for cognitive an mental health impairments
- Psychiatric Testing to measure mental health symptoms and their severity
- Physician Opinion explaining restrictions and how they prevent specific job tasks
- Vocational Evidence outlining a jobs physical and cognitive demands paired with medical evidence showing a claimant’s inability to meet them
Own Occupation VS Any Occupation
It is important to observe the difference between own-occupation and any-occupation requirements detailed in the LTD policy. Own-occupation refers to an inability to perform the material duties of the claimant’s specific job (surgeon with hand tremors cannot operate even if can teach) with claims typically applying to the first 24 months only.
After 24 months, any-occupation rules may apply and a claimant must prove an inability to perform any gainful job they are reasonably suited for based on education, experience and training, making the proof threshold higher.
Contact an Experienced LTD Claim Denial Lawyer for Help
When you have questions regarding long term disability or you have had your LTD claim denied, contact the experienced employment law attorneys of Alan C. Olson & Associates. Just because your claim is denied for lack of objective evidence does not mean your claim is not valid, but you may need to provide more details about your condition and measurable proof of how the condition prevents you from working. Call us today at 262-785-9606 or contact us through this website for assistance.
