Visible symptoms do not accompany some medical conditions. Rather, the symptoms of that condition will be subjective, unique to the individual suffering from it, and impossible to gauge using objective medical evidence. Even though these symptoms are not objectively quantified or easily observed, they can significantly affect an individual's ability to perform everyday activities and may even prevent them from working.
When invisible conditions stop you from performing your job duties, as long as you have the appropriate insurance coverage, you may recover long-term or short-term disability benefits. These benefits can be life-altering. They can cover medical costs, provide financial relief, and provide the stability you need to move forward. However, when applying for these benefits, proving the subjective symptoms can be challenging. This blog provides you with tips on proving your claim so you can obtain the maximum possible benefits for your subjective condition.
Defining Subjective Symptoms
Also called self-reported symptoms, subjective symptoms are conditions that an individual reports but cannot be confirmed by diagnostic tests such as nerve conduction studies, blood tests, or CT scans. The symptoms generally depend on a person's experience of discomfort and pain and vary significantly from one individual to another.
Subjective symptoms do not just involve nebulous conditions such as chronic fatigue syndrome and fibromyalgia. More conventional diagnoses, such as migraines, lupus, and many autoimmune disorders, also entail subjective symptoms.
Regarding long-term and short-term disability benefits, proving subjective conditions can be difficult because they rely heavily on the individual’s self-reported experiences rather than objective tests, such as blood tests and X-rays.
On the other hand, objective symptoms refer to measurable, observable signs that healthcare professionals can independently verify. Examples include findings from lab tests, imaging studies, and physical examinations that offer tangible evidence that a person is suffering from a health condition.
Common subjective conditions are as follows:
- Decreased stamina and fatigue
- Discomfort and chronic pain
- Stomach pain and nausea
- Anxiety and depression
- Visual disturbances
- Tinnitus and other hearing disturbances
- Memory loss and poor concentration
- Dizziness
- Headaches and migraines
- PTSD symptoms such as profuse sweating and hypervigilance
Behind these symptoms, there are usually valid and, at times, fatal conditions. However, because they are subjective, these underlying health conditions are sometimes unknown, making them harder to demonstrate.
However, in long- and short-term disability benefits claims, it is crucial that you provide expert opinion and thorough documentation to corroborate how the symptoms affect your capability to work and everyday life. This might include detailed evaluations from medical providers and comprehensive diaries. Medical providers can attest to the severity and validity of your subjective condition.
Why Disability Insurers Focus on Self-Reporting Symptoms
Insurers typically have one duty: to establish whether you satisfy the requirements to obtain disability insurance benefits. Since self-reported symptoms are generally unquantifiable, insurers tend to consider them less important than objective conditions when making the determination.
Insurers focus on subjective conditions for various reasons. Firstly, their workers have undergone training to be suspicious of and look out for fake disability insurance claims. Whereas fake disability claims are rare, they occur. A person can easily claim subjective symptoms without the supporting evidence necessary for objective conditions.
Secondly, insurers also strive to avoid paying out disability claims. Thus, they will look for reasons to refuse your insurance claim or decrease its value. Many long-term disability plans contain a cap for subjective conditions. Should your claim be affected by this provision, you may only qualify for 2 years of disability benefits, significantly lowering your claim's value.
Medical Evidence Will Help Prove Your Disability Claim
If you have a disability that significantly involves self-diagnosed or subjective symptoms, having evidence such as medical records will be essential to demonstrating your disability benefits claim. However, substantiating your claim's validity is not as straightforward as providing your medical records and history to the insurance company. The following tips can help you have strong medical evidence to prove your claim.
Accompany Your Claim with Comprehensive Notes and Medical Records
Some medical records are simply a report of past treatment plans, illnesses, and injuries, and exclude the kind of details insurance providers need to evaluate your disability. You will need to ensure your medical report focuses on how your subjective symptoms affect your abilities and everyday life.
- Inform your physician that you intend to pursue disability benefits
- Inform the doctor about any difficulties or episodes that happened between visits and ask them to include a note in your medical record.
- Ask your physician to record the objective findings and impairments they notice at your examinations and appointments.
Consistently Obtain Medical Care
When you are not working, reducing your out-of-pocket medical expenses can be tempting, particularly if you can control symptom flares. But your doctor can record both your objective and self-reported symptoms. Their notes will become crucial evidence in your disability benefits claim because they will have identified the severity and frequency of the symptoms.
Say, for example, you have chronic asthma or chronic obstructive pulmonary disease (COPD) and have a flare of symptoms. You can record subjective problems such as difficulty breathing and fatigue in your disability journal. Then, your physician can prove them with chest x-rays, pulmonary function tests, and your oxygen saturation levels. Importantly, your physician may also successfully help you relieve your symptoms using a detailed treatment plan.
Submit a Physician’s Letter Describing Your Disability
Many disability insurers do not validate a physician's letter, particularly if it is precise and written after you have filed a benefits claim. However, a thoroughly written letter may benefit your insurance claim. Ask the physician to write a letter and include the following:
- A brief account of your health and treatment history
- Objective findings supporting your diagnoses, stressing clinical evidence and test results
- Your current psychological or physical conditions
- An estimated prognosis or recovery timeline
- A description of how your condition affects your capability to work
Your Record and the Steps You Take Can Help Prove Your Case
As the victim, your own documentation and records can also substantially corroborate your claim. That said, the following steps can help you build solid evidence:
Document Your Symptoms
Among the most crucial aspects of demonstrating subjective symptoms is consistently noting them as they occur. Keep a comprehensive diary of all your fatigue, pain levels, and other symptoms you are experiencing. Note when they happen, their seriousness, how they fluctuate throughout the day, and how they impact your capability to do job-related duties and daily tasks. This information will help paint an explicit picture of your medical condition over time.
Gather Medical Evidence
Medical evidence will help establish the severity and existence of subjective symptoms. Obtain comprehensive records from your medical provider, including treatment plans, diagnoses, and objective test results supporting your claim. You can also ask your physician to write a statement for you outlining your restrictions and how the condition impacts your capability to work.
Provide a Personal Affidavit
If possible, you can give your insurer an affidavit regarding how your subjective symptoms affect your day-to-day work and life. This personal statement adds weight to the medical records.
Maintain Consistency
Ensure the details you include in your claim align with the statements you give to your medical providers and your medical records. Inconsistencies can cast doubts regarding the legitimacy of your case, making it even harder to recover benefits.
Address Functional Limitations
Concentrate on showing how your subjective symptoms limit your capability to do job-related duties. List examples of ways in which your symptoms hinder your capacity to stand, concentrate, sit, or keep a consistent work schedule. The information will help prove the degree of your symptoms and how they are affecting your employability.
Even though self-reported symptoms themselves cannot be directly measured, you can prove and strengthen your insurance claim by linking them to objective evidence, such as:
- Therapeutic interventions. Include reports of treatments like physiotherapy. Medications you took and their impact can also be indirect evidence. Generally, if any treatment utilized for your subjective symptoms is recorded as your routine, it corroborates the existence and seriousness of the condition. The treatment’s intensity can also be a proxy for symptom intensity and, thus, disability.
- Diagnostic tests. Provide results from all tests that may indirectly corroborate your medical condition. For example, whereas pain is a subjective symptom, an MRI may prove the root cause consistent with the pain reports.
- Observations by third parties. Statements from friends, coworkers, or family who have seen the effect your symptoms have had on you can support your report.
By thoroughly documenting your treatments and symptoms, working together with your healthcare providers, and incorporating all the evidence available in a strategic way, you can develop a strong claim contingent on subjective symptoms. This multifaceted approach can help prove the severity and validity of your condition, making it difficult for the insurer to decline your claim.
Avoid These Mistakes When Pursuing Disability Benefits Based on Subjective Symptoms
If you are applying for disability benefits because of subjective symptoms, it is essential to be careful when navigating the process to avoid committing mistakes that could compromise your claim. Key mistakes you should avoid include the following:
Failure to Follow Recommended Treatment Plans
Inconsistently following or disregarding your healthcare provider's prescribed treatment plan can seriously weaken your case. The insurer may assert that you are not following treatment, which means your condition is not as disabling as you claim. Always follow treatment and attend recommended appointments.
Providing Insufficient Medical Information
Among the most serious mistakes is the lack of consistent and detailed medical records. Your medical records should include comprehensive accounts of your self-reported symptoms, diagnosis, and treatment plan. Consistent records and regular medical appointments show the seriousness and continuity of your condition, which is essential in demonstrating disability.
Overlooking the Significance of Non-Medical Evidence
Medical evidence is essential, but non-medical statements also play a vital role. Accounts from friends, coworkers, and family who can explain how your condition impacts your everyday work performance and life can boost your case. This form of evidence can explain your disability in detail.
Not Using Expert Testimonials
Failing to include the expert opinions of medical providers who can confirm the impact and severity of your condition is a prevalent mistake. Expert testimonies give your claims credibility, particularly in intricate cases where self-reported symptoms predominate.
Keeping Symptom Records Poorly
A comprehensive symptom journal is a vital tool in the process of recovering disability benefits due to subjective symptoms. If you do not routinely update your journal or fail to include detailed entries about the condition's intensity, frequency, and effects, it can be challenging to prove how chronic your symptoms are. Be consistent and thorough in your symptom record-keeping.
Submitting Incorrect Information or Incomplete Forms
Filing a disability claim entails extensive paperwork. You must fill out every form completely and correctly. Mistakes in completing forms of presenting incomplete details can drag the claims process or result in a denial.
Failure to Consult Legal Counsel
A disability claim, especially one based on self-reported symptoms, can have several legal complications. Failing to seek help from an experienced disability lawyer can damage your chances of obtaining the benefits you deserve. A skilled attorney can help solve the complexities of disability insurance laws, ensure you have complete paperwork, and effectively fight for your interests against your insurer.
Avoiding these mistakes can boost your disability case, increase your chances of approval, and help you obtain the maximum possible benefits. Remember, paying attention to every detail and preparing thoroughly are your greatest tools when seeking disability benefits for subjective symptoms.
Find an Experienced Disability Insurance Attorney Near Me
If you have a medical condition preventing you from performing your job duties, even though the symptoms are subjective, you can still be eligible for long- or short-term disability benefits. And since insurers highly scrutinize these conditions, you want to work with an experienced disability insurance lawyer to decrease the chances of a denial.
At Leland Law, we are famous for our skilled legal strategies and client-focused results. If the insurer denied your application or reduced your benefits because of subjective symptoms, we can help you establish the best type of objective medical evidence for your claim and how best to present your case before the insurer. If you are anywhere in California and would like to discuss your case, please contact us at 866-449-6476.
