Objective vs. Subjective Evidence In Long-Term Disability Claims

Understanding the nuanced world of long-term disability (LTD) claims means understanding the differences between objective and subjective evidence. Objective evidence is physical, measurable proof of a condition, while subjective evidence typically comprises reported symptoms and experiences. The interplay of these two forms of evidence can significantly influence the outcome of a disability claim.

Objective Evidence in Long-Term Disability Claims

Objective medical evidence includes the measurable, observable, and physical data points derived from medical tests, examinations, and diagnostic procedures. Examples include X-rays, MRIs, blood tests, CT scans, physical exams, and other medical reports.

To better understand what may count as objective evidence in an LTD claim, here’s a closer look at common types:

• Clinical Findings: These are observations made by healthcare professionals during physical exams—think abnormal reflexes, swollen joints, limited range of motion, or muscle weakness. Such findings are based on what doctors can directly observe and measure.
• Imaging Studies: Techniques like X-rays, MRIs, CT scans, and ultrasounds provide internal images of the body. These scans can reveal fractures, herniated discs, torn ligaments, or other structural problems that support a diagnosis.
• Laboratory Studies: Blood tests, urine tests, and tissue samples can uncover infections, autoimmune disorders, or metabolic issues. Lab results provide objective markers that help confirm medical conditions.
• Electrodiagnostic Studies: Tests such as electromyography (EMG) and nerve conduction studies (NCS) assess how muscles and nerves function. These are often used to diagnose neurological conditions like carpal tunnel syndrome or neuropathies.
• Neuropsychological Testing: When cognitive impairment is in question—such as after a brain injury or with neurodegenerative diseases—standardized testing can objectively measure memory, attention, and other cognitive functions.
• Functional Capacity Evaluations: Conducted by physical or occupational therapists, these assessments measure a person’s ability to perform work-related tasks, providing a practical and objective look at physical limitations.
• Headache or Symptom Diaries: In some cases, particularly with conditions like migraines where traditional tests may not show clear results, detailed symptom diaries kept over time can also serve as objective documentation.

By gathering this variety of concrete evidence, claimants can build a much stronger case for the physical reality of their condition. This evidence is highly valued in LTD claims because it provides concrete proof of a medical condition.

Functional Capacity Evaluations: An Objective Tool

A Functional Capacity Evaluation (FCE) is a structured assessment used to objectively measure a person’s physical abilities and limitations as they relate to workplace tasks. Performed by trained professionals like physical or occupational therapists, an FCE evaluates how well a person can perform activities such as lifting, carrying, standing, or sitting over a period of time.

Through standardized tests and observations, the evaluation provides quantifiable data on endurance, strength, flexibility, and range of motion. By collecting this detailed information, the FCE offers insurers and claims administrators a reliable and unbiased snapshot of what a claimant can—and cannot—physically do in a work setting. This makes it a valuable piece of objective evidence in supporting or refuting a disability claim.

Neuropsychological Testing as Objective Evidence

Neuropsychological testing provides measurable data about a person’s cognitive abilities, such as memory, attention span, problem-solving skills, and overall brain function. These assessments involve standardized tasks designed to evaluate how well someone processes information and responds to various mental challenges.

Because the results are based on quantifiable scores, neuropsychological testing offers clear, objective evidence of cognitive impairment. For instance, individuals with traumatic brain injuries or conditions like Alzheimer’s disease often show distinct patterns of cognitive deficits on these tests. These findings can play a critical role in confirming the presence and extent of cognitive impairment for an LTD claim.

Electrodiagnostic Studies and Their Role in Diagnosing Disabilities

Electrodiagnostic studies are specialized tests that assess how well your muscles and nerves are functioning. The two primary types—electromyography (EMG) and nerve conduction studies (NCS)—measure the electrical signals in your body’s nervous system. These studies provide valuable objective evidence when diagnosing conditions that affect the nerves or muscles.

For example, if you experience symptoms like numbness, tingling, or unexplained muscle weakness, your physician may recommend an EMG or NCS. By analyzing the electrical activity, doctors can pinpoint disorders such as peripheral neuropathy, carpal tunnel syndrome, or other neurologic conditions that might underlie your disability. This kind of evidence adds weight to LTD claims because the results are objective, measurable, and rooted in established medical science.

Objective evidence is based on medical signs and laboratory findings. For example, in a claim for arthritis of the spine, MRI or X-ray reports can demonstrate the issue. This data is typically conclusive because the physical presence of a medical condition or injury is visible (either externally or internally via imaging) and can be verified. A long-term disability insurer may require objective evidence in specific claims, such as a claim for a spinal disorder (neck or back).

The Importance of Ongoing Medical Care

Consistent medical treatment plays a pivotal role in assembling strong objective evidence for your disability claim. Regular visits to healthcare professionals ensure your symptoms, progress, and any changes in your condition are thoroughly documented through clinical notes and periodic diagnostic tests.

This ongoing record not only helps track the development of your impairment but also demonstrates to insurers that you are actively addressing your health concerns, following recommended treatments, and ensuring continuity of care.

Failing to seek regular medical attention, on the other hand, can create gaps in your medical history, making it harder to establish the severity and persistence of your condition. For LTD claims, continuous medical documentation serves as the backbone of objective evidence, strengthening your case and making it more difficult for insurers to dispute the legitimacy of your disability.

Objective information is critical in cases where a physical ailment is directly linked to the claimant’s disability. However, it’s essential to note that objective evidence alone does not guarantee claim approval. The insurer must be convinced that the diagnosed condition causes functional limitations that prevent the claimant from performing his/her occupation.

Can Symptom Diaries Be Considered Objective Evidence?

You may wonder whether tools like headache diaries or symptom logs count as objective medical evidence in long-term disability claims. In the context of certain conditions—such as migraines, which often elude standard medical tests—symptom diaries can actually play a supportive role.

While these diaries are primarily based on your self-reported experiences, the regular documentation of symptoms, frequency, and severity as tracked over time is sometimes accepted by insurers and medical professionals to bolster your claim. For example, maintaining a headache diary can help establish a documented pattern that lends credibility to your reports, particularly when objective diagnostic tests simply don’t exist for your specific condition.

Ultimately, while not as conclusive as lab results or imaging studies, symptom diaries may still be considered as part of the objective evidence landscape when other forms of documentation are unavailable—especially for conditions that rely heavily on patient-reported symptoms.

Subjective Evidence in Long-Term Disability Claims

Subjective evidence refers to the symptoms, complaints, or conditions reported by the claimant. These complaints are not readily observable or measurable through medical tests or physical exams. This includes reported pain levels, fatigue, cognitive issues, dizziness, migraines, and more.

These symptoms are often associated with chronic pain syndromes, chronic fatigue syndrome, Lyme disease, fibromyalgia, a migraine headache disorder, or certain mental health conditions. There are no specific diagnostic tests that can prove the existence or severity of the condition. Any similar ailments that primarily rely on the claimant’s testimony for documentation are also included. As a result, the claimants primarily depend on their reported experiences to communicate the severity and impact of these conditions.

Subjective information is often viewed with a degree of skepticism by insurance providers. This is due to its potential for overstatement or fabrication. However, courts have repeatedly held that disability cannot be denied solely due to a lack of objective medical records. It’s crucial for claimants with subjective symptoms to document their experiences and for their healthcare providers to support these claims.

Insurers Sometimes Demand the Impossible

A common pitfall is when insurance companies demand objective evidence for conditions where none can reasonably exist. For example, some claimants suffering from migraine headaches may have normal brain MRIs—a result entirely consistent with the medical literature, as MRIs are typically normal in migraine patients. Yet, insurers may still cite the absence of abnormal MRI findings as grounds for denial.

Courts have found that conditioning an award on objective evidence that cannot exist is arbitrary and capricious. Claimants should be aware that their own detailed reports, daily symptom diaries, and supportive statements from treating physicians play a vital role in demonstrating the legitimacy and disabling impact of subjective symptoms.

Differences Between Objective and Subjective Evidence

The balance between objective and subjective evidence in an LTD claim largely depends on the nature of the disability. Objective test results play a significant role in conditions that can be physically diagnosed. However, subjective complaints become crucial for conditions relying heavily on the claimant’s reported experiences.

Despite this distinction, it’s important to note that both types of evidence are vital in substantiating an LTD claim. A robust claim generally includes a blend of objective tests and subjective reports that corroborate each other. This helps provide a comprehensive view of the claimant’s disability.

Objective evidence can conclusively demonstrate the physical presence of a condition. However, subjective evidence can help illuminate the lived experience of that condition and how it impacts the claimant’s ability to work. Both types of evidence can help a claimant receive disability benefits.

A successful claim requires a comprehensive approach leveraging objective and subjective evidence. Evidence should be tailored to the specific circumstances of the claimant’s condition and symptoms. It is imperative for claimants and their healthcare providers to diligently document all relevant information. This evidence is necessary to present a compelling and holistic disability narrative to the insurance providers.

Steps for Maintaining Thorough and Organized Medical Records

Keeping your medical records well-organized and complete can make a significant difference in supporting your long-term disability claim. Here are several key steps claimants should follow:

• Request and Keep Copies of All Documentation: Make it a habit to obtain copies of doctor’s notes, diagnostic test results, treatment summaries, referrals, and updated care plans after each appointment. Create a dedicated file—either electronic or paper—for quick access to these documents.
• Maintain an Updated Symptom Journal: Consistently record your symptoms, treatment responses, and any changes in your functional abilities. This running log helps bridge gaps between appointments and provides valuable details not always captured in medical records.
• Communicate Clearly With Your Healthcare Providers: Be specific and honest when describing symptoms, limitations, and the impact on daily activities. Clarify details and answer questions fully so your records accurately reflect your lived experience—not just clinical findings.
• Review Your Records Regularly: Periodically check your medical files for any omissions or inaccuracies. If you find discrepancies, promptly address them with your healthcare team to ensure your records remain both thorough and correct.
• Store Records Securely and Organize Chronologically: Place documents in order by date, grouping similar items together (e.g., lab work, imaging, office visit notes) for easier reference when compiling evidence for your claim.

By taking these steps, you strengthen the documentation needed to present a credible, comprehensive case to insurers and support your eligibility for long-term disability benefits.

What Is Selective Consideration of Evidence, and Why Does It Matter?

Selective consideration of evidence occurs when an insurance company highlights only the parts of your medical records that support a denial, while brushing aside or downplaying other significant findings that could support your claim. For instance, they might point to “normal” imaging or physical exam results but overlook abnormal test results, your detailed symptom history, or supportive physician notes that underline your limitations.

This approach can heavily impact the outcome of a disability claim. By focusing exclusively on select pieces of evidence, insurers may create an incomplete or misleading picture of your condition. Courts have criticized this tactic—sometimes referred to as a “red herring”—because it distracts from the full scope of your disability. When reviewing a claim, both favorable and unfavorable evidence should be given fair weight to ensure a just decision.

If your insurer appears to be cherry-picking evidence, it’s important to respond with comprehensive documentation and, when possible, highlight any overlooked clinical findings or opinions from your healthcare team. Demonstrating the full impact of your condition helps present a balanced, accurate narrative—one that is crucial for a fair evaluation of your disability claim.

Get Help with Your Long-Term Disability Claim

If your long-term disability claim has been denied, don’t face the appeals process alone. At Ortiz Law Firm, we specialize in helping claimants navigate the complexities of denied disability claims. Attorney Nick Ortiz and his experienced team are dedicated to building robust appeals, leveraging comprehensive evidence to overturn denials and secure the benefits you deserve.

If your denial was based on a supposed lack of objective medical evidence, it’s especially important to seek knowledgeable legal guidance. Disability insurance companies often rely on this reason to reject claims, but an attorney well-versed in these tactics can help you gather the right documentation, work with your treating physicians, and construct a persuasive case that addresses the insurer’s concerns head-on.

Don’t risk going it alone when your financial security is on the line.

Contact us today for a free case evaluation, and let us help you take the next step toward reversing your denial. Call us at (888) 321-8131 to get started.