Employees in Chicago with long term disability coverage under their employer’s disability plan most commonly get frustrated by the insurer’s or administrator’s demand for support of objective evidence. The frustration is especially great in claims for migraines, fibromyalgia, chronic fatigue syndrome, and other illnesses characterized by the lack of an objective test result confirming its presence. This is equally frustrating to the doctors who treat patients with those conditions when they get demands from the insurers and administrators for objective proof. For as well trained as lawyers are in logic, sometimes they fall a little short. A recent case is a great example.
In Canter v. AT&T Umbrella Benefit Plan No. 3, No. 18 C 7375, 2021 WL 663178 (N.D. Ill. Feb. 19, 2021), Canter suffered from migraines and dizziness. The AT&T benefit plan, administered by Sedgwick Claims Management Services, contained a clause stating a claim for disability must be supported by objective medical evidence, and defines “objective medical evidence” as “objective medical information sufficient to show that the Participant is Disabled.” The plan also diagnoses based on self-reported symptoms will not be considered sufficient. The court upheld Sedgwick’s denial for such lack of objective medical evidence because numerous tests, like MRIs and CT scans, came back normal.
Lawyers often overlook principles of evidence, especially in long term disability cases. Evidence of something need not just be direct proof of its existence; it can also be proof of exclusion of other possibilities. Federal Rule of Evidence 401 expressly lays out that relevant evidence is anything that tends to make a fact more or less likely. Logically, objective evidence used to make any other cause of headaches (like a brain tumor) less likely is also evidence of the symptoms caused by migraines. Doctors always run tests of exclusion, and the legal industry often misses that those “normal” test results are in fact objective evidence of diagnoses like migraines and fibromyalgia because the tests have excluded the other possibilities. Obviously, plans do not want to be liable for benefits where a claimant complains of pain and a doctor quickly diagnoses a condition based on the self-reports, and running no diagnostic measures. But running tests to exclude possibilities and arrive at a diagnosis of exclusion does not rely on self-reported symptoms, and is backed up by objective evidence. By making all other possibilities less likely (or excluding them all together), the doctors did rely on objective evidence.
If you have a disabling illness or injury and long term disability insurer or administrator denied your claim for lack of objective evidence, call a skilled long term disability lawyer today.