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What is a diagnosis of exclusions?

On Behalf of | Apr 26, 2024 | Erisa

If you’re looking to make an ERISA disability claim, one of the first steps in the process is simply getting the diagnosis that you are disabled. With many different disability cases, this medical evidence is the crux or the cornerstone for the entire claim. It helps to show exactly why the condition is a disability and how that will affect a person’s life moving forward.

But some people will get what is known as a “diagnosis of exclusions.” This can make the process a bit more complex, even if you believe that your medical team has correctly identified the issue. Why is this controversial?

Is it just an educated guess?

There are those who refer to a diagnosis of exclusions as more of an educated guess being made by medical professionals. Per the National Library of Medicine, this is a “diagnosis that rests solely on clinical grounds, with no means of objective proof.”

For example, perhaps the doctors are not sure what is causing chronic pain. They do tests and rule out a number of common conditions, such as nerve damage or fibromyalgia. Once they have ruled out enough conditions, they decide what they believe is happening. By excluding all of these other possible conditions, the medical team determines what they think is wrong with the patient.

But this can make seeking disability benefits more complex. Say that the insurance company argues that you aren’t really disabled and an accurate diagnosis hasn’t yet been made. The medical evidence may not be deemed sufficient for approval.

Because this can get so complicated, it’s critical to understand exactly what legal steps to take. It can be helpful to contact an attorney such as ERISA Law Center.