Inconsistent Diagnosis

Often in my law practice I see clients where the doctors are having a hard time diagnosing the claimant’s illness. Because of this the insurance company often balks at paying disability benefits. The insurance company concern is that if there is no diagnosis, then there is no treatment that can help, and the claim can be open ended. As well the insurance companies’ concern is that without a diagnosis, they cannot tell whether the claim is legitimate or fraudulent.

Yet, doctors are very often unable to come up with a firm diagnsis of a person’s illness. In a situation with chronic pain or simply a feeling of being unwell, doctors often cannot find a physical cause. Yet the illness persists and can be devastating to the person who cannot work.

Luckily, the courts have taken a step back and have often found that lack of a diagnosis is not a reason to deny disability benefits. In fact, courts are cognizant of the fact that if you send a person to 3 different doctors, you will often get 3 different diagnosis.

Inconsistencies with the diagnoses of the various medical professionals is not relevant. All that matters is the effect of the illness and not the label used by the doctors. This was the position taken by Madam Justice Pritchard in L.S. v. Saskatchewan [1998] S.J. No. 854:

In determining that the plaintiff was unable to work at any Reasonable Occupation as at September 17, 1992, the court finds it unnecessary to label or categorically determine the disease or diseases from which Ms. L.S. suffers.
Eminently qualified experts disagree on the appropriate naming of her condition and as it is not necessary, it would be inappropriate for the court to make the determination as to whether Ms. L.S. suffers from organic depression, reactive depression, fibromyalgia, chronic pain, an adjustment or somatization disorder or any combination of the foregoing. Whatever the name of the disease, it is clear that Ms. L.S. has been severely affected by it and unable to work at any Reasonable Occupation.

So, if your doctor has been unable to put a diagnosis on your medical issues but you are and remain disabled, then call our office. We can still help you with your claim for disability insurance benefits.