The Objective Evidence Myth: LTD

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By: Chuck J. Ford

The Big LTD Myth

LTD Insurers often deny claims on the basis that the Claimant (Plaintiff) has not proven any objective evidence of a disease or injury. This is not just a tactic to dissuade claimants from starting a lawsuit. The LTD insurers often defend claims in court on this same premise.

It is always interesting when you ask a representative of an insurance company, under oath, to define what objective evidence they require in order to approve a claim. Most of the time, they cannot answer the question, and they concede that a claimant can meet the definition of disabled based on subjective symptoms. The requirement for “objective evidence” is the biggest myth propagated by insurance companies.

Injury v. Function

Even when a claimant is able to prove an objective illness or injury (e.g., herniated disc, fracture, lesions on the brain), insurers often state that while there is objective evidence of an injury/disease, there is no objective evidence demonstrating a loss of function. In other words, the reported symptoms of an objective injury/illness are too subjective. This is the LTD Insurer’s Plan B.

There are many illnesses and diseases which cannot be definitively proven by a test, or a scan. LTD Insurers usually deny mental illness claims on the basis that the diagnosis and symptoms are entirely subjective in nature. There is also a bias against environmental illnesses, Lyme disease, fibromyalgia, Irritable bowel syndrome, and other gastrointestinal disorders. To be clear, people with these diseases/illnesses are entitled to receive LTD benefits if they are unable to function in the workplace.

LTD Lawyers Can Help Prove Your Case

Thankfully, there are several cases in Canada and the US where judges and juries have whole-heartedly rejected this concept. But the LTD Insurer will not make things easy. Many Insurers will retain a medical consultant, a medical specialist, or an occupational therapist to conduct a paper review of an application. If the matter is in litigation, they may ask you to attend a medical examination. If the medical consultant or OT supports the LTD insurer – which is almost certain – then it is up to the claimant to get their own experts and treatment providers to challenge the insurer. That is where an experienced LTD plaintiff lawyer can help. How? By providing resources to hire obtain expert evidence and to apply pressure to the Insurer by forcing litigation forward.

One question we get from clients is who will pay for the medical evidence that is usually needed to win an LTD claim. The answer is usually the LTD Insurer, once they realize that you are prepared to challenge their denial in court. Sometimes, just the threat of retaining experts is enough to force the LTD insurer to approve benefits or settle the case. LTD litigation is a highly specialized area of law. Make sure that you seek legal advice from someone who has a track record of advancing claims against Insurance companies, or from someone who used to work for them.

Contact Valent Legal for more information about how we can assist in your LTD claim.


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