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. This evidence is highly valued in LTD claims because it provides concrete proof of a medical condition.
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).
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.
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.
Objective Versus 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.