DATE POSTED 11. 04. 2016, By

What a Long-Term Disability Insurer or Plan Means by Stating Your Claim Has “No Objective Evidence”

Those pursuing claims for long-term disability insurance in Chicago without a lawyer often find themselves puzzled by an insurer’s insistence on “objective medical evidence” in a denial letter.  More puzzling, the insurer does not explain exactly what that objective medical evidence is, or what you can submit to satisfy the insurer and approve your claim.  This can be especially challenging when you have had a condition for a long time that degenerates and causes increasing pain over time.  Claimants, and less experienced attorneys, often trip up.  But well-advised claimants usually overcome this hurdle.

In Elson v. UnitedHealth Group Inc., No.: 2:14-cv-01554,, 2016 U.S. Dist. LEXIS 37789 (D. Nev. Mar. 22, 2016), Elson worked as a telemonitor nurse for UnitedHealth Group, which required her to monitor patients remotely via telemonitoring devices.  She had long-standing back pain following being run over by a truck ten years earlier.  Her doctors diagnosed her with severe arthritis, spinal foraminal narrowing, bilateral radiculopathy, and spondylosis.  Absent taking narcotic pain medication, Elson would not be able to withstand the pain, but the side effects of opioids impaired her ability to think critically and make the sorts of decisions her job required.  Sedgwick denied the claim, citing a lack of “objective medical evidence,” despite MRI results supporting Elson’s claim, and no explanation by Sedgwick as to what objective evidence would be and what evidence Elson needed to provide to satisfy Sedgwick.  Sedgwick never explained why the conditions from which Elson suffered did not affect her ability to work.  Sedgwick’s criticized that Elson had these conditions for a long time, and the evidence did not explain why she could previously work, but now could not.

Elson sued to recover her benefits under ERISA § 502(a), and the court ruled in her favor.  Sedgwick dismissed medical opinions from Elson’s treating physicians without any explanation and it demanded objective medical evidence without explaining why the records and MRI results were insufficient, or identifying what sorts of objective evidence Sedgwick required.  None of the medical consultants Sedgwick relied upon gave opinions that related to the terms of the plan, because none of them addressed whether Plaintiff could work as a telemonitor nurse with “reasonable continuity,” in light of the pain and use of narcotic medication.

If your claim for short-term or long-term disability has been denied due to lack of “objective medical evidence,” consult with an ERISA long-term disability lawyer.

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