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Ninth Circuit Case Law on Objective Evidence of Disabilities

The Ninth Circuit has repeatedly reprimanded plan administrators and insurance companies for failing to tell claimants what they need to present in order to perfect their claims. The Ninth Circuit is quite skeptical of plan administrators and insurance companies that routinely deny or terminate claims for diseases such as chronic fatigue syndrome, fibromyalgia, and pain and fatigue related conditions because the claimant fails to present "objective evidence" of his or her disability.

In a case involving a claimant ultimately diagnosed with chronic fatigue syndrome and fibromyalgia, the court expressed its understanding of the frustration disability plan administrators have with such claims because the absence of objective proof of the existence or nonexistence of the disease creates a risk of false claims. However, the court also reasoned: "But the claimants are not the only ones with an incentive to cheat. The plan with a conflict of interests also has a financial incentive to cheat. Failing to pay out money owed based on a false statement of reasons for denying is cheating, every bit as much making a false claim. The plan has no exception to coverage for chronic fatigue syndrome, so [the insurance company] has taken on the risk of a false claim for this difficult to diagnose [the] condition." The court ruled that the insurance company's demand for objective evidence to prove the existence of chronic fatigue syndrome - evidence that cannot exist - was, therefore, arbitrary and capricious. While it may seem obvious that demanding evidence that can't possibly exist because medical science can't provide it is unreasonable and unfair, insurance companies and plans commonly deny benefits claims due to disabilities caused by chronic fatigue syndrome or fibromyalgia because the claimant's proof of the disease is "subjective."

Serving Disability Claimants in the Ninth Circuit

Our ERISA attorney serves the Ninth Circuit by representing disability and life insurance claimants in the following states and cities: Alaska: Anchorage, Badger, College, Fairbanks, Juneau, Ketchikan and Sitka; Arizona: Phoenix, Tucson, Mesa, Chandler, Glendale, Scottsdale, Gilbert, Tempe, Peoria and Surprise; California: Los Angeles, San Diego, San Jose, San Francisco, Fresno, Sacramento, Long Beach, Oakland, Bakersfield, Anaheim, Visalia/Tulare, Merced and Stockton; Guam: Agana, Tamuning, Yigo, Agat and Merizo; Hawaii; Idaho: Boise City, Nampa, Meridian, Idaho Falls, Pocatello, Caldwell, Coeur d-Alene and Twin Falls; Montana: Billings, Bozeman, Butte-Silver Bow, Great Falls, Helena, Kalispell and Missoula; Nevada: Las Vegas, Henderson, Reno, Paradise, North Las Vegas, Sunrise, Manor, Spring Valley, Enterprise and Sparks; Northern Mariana Islands: Saipan and JP Tinian Town; Oregon: Portland, Eugene, Salem, Gresham, Hillsboro, Beaverton, Bend, Medford and Springfield; and Washington: Seattle, Spokane, Tacoma, Vancouver, Bellevue, Everett, Kent, Yakima, Renton and Spokane Valley.

More information about how your state’s laws affect your ERISA claim within the Ninth Circuit can be obtained through your state Department of Insurance.