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The challenges posed by self-reported symptoms in disability claims

On Behalf of | Nov 30, 2021 | Long Term Disability Claim Denial

Do you know what your employer-provided long-term disability insurance policy says about self-reported symptoms? Some policies carve out exceptions for symptoms that only the patient can detect. In other words, if objective medical tests such as MRIs or CAT scans cannot detect the disease, the insurance company will not pay the benefits. For a person who suffers from a serious and debilitating disability, such a decision can be devastating and may seem extremely unfair.

Examples of symptoms

Medical tests can detect a wide range of impairments and diseases, from minor muscle strains to cancerous growths. No test, however, can measure symptoms like pain, discomfort, fatigue and nausea. These can only be self-reported by the patient him- or herself.

Diseases that are difficult to detect

Certain medical conditions elude detection by objective testing. Examples include:

  • Fibromyalgia
  • Chronic fatigue syndrome
  • Nerve damage

Such conditions may make it difficult and even impossible to work. Sadly, many who suffer from such diseases have only met with rejection when seeking the LTD benefits they need.

A common cause for legal disputes

If you have been denied LTD benefits, a lawsuit may determine if the insurance provider’s limit on self-reported symptoms is applicable under your employer provided long term disability insurance policy, which is falls into the Employment Retirement Income Security Act (ERISA).

In one recent case, a woman who suffers from fibromyalgia and chronic fatigue syndrome sued Unum Insurance Company on the grounds that it had wrongly denied her claim due to a limit on self-reported symptoms. While the 1st U.S. Circuit Court of Appeals ruled in favor of Unum, the plaintiff is considering requesting a rehearing or taking the case to the U.S. Supreme Court.

Other courts have ruled in favor of plaintiffs in these types of cases. If your LTD claim has been denied, you don’t have to accept that decision as the final word.  You may have legal options that could result in a restoration of your benefits.