What is Objective Medical Evidence and When is it Needed?

Insurance companies often deny benefits based on “lack of objective medical evidence.” That really means that the evidence available is not convincing enough for them.

Insurance companies also use terms like – “We don’t have enough evidence of your disability.” What they really mean is that the evidence available is not convincing.

When is the evidence not convincing? – The evidence is usually not convincing when you have a “soft” disability such as fibromyalgia or chronic pain. In these types of cases insurance companies are loath to pay benefits because they cannot differentiate between people who are exaggerating or stretching the truth and people in real pain who absolutely cannot work. Also, just because a person has some pain does not mean they cannot work. It may mean that they have to tough it out and work with pain. If you can go to work with pain, then you are not considered to be disabled by the insurance company.

In fact, when insurance companies deny disability benefit claims, disability claimants are often forced to go back to their job or find a new job for financial reasons. They then have more health problems and a few months later, realize they can no longer work. Well…. by going back to work, they have just proven to the insurance company that they “can” work. Then they may quit or get fired because it is too difficult to continue, but the insurance company’s spin is that the claimant can work. They did work. The decision to stop working was a personal life choice – not because of a disability. After all they were working – there was no change in their medical condition – and then they stopped. Hence the insurance company’s position is that it was a personal decision to stop working.

Be aware of how your claim and actions will look to a third party.

Remember, labels do not prove disability. A label of fibromyalgia or chronic pain or even a heart attack are not proof of disability. They are evidence but not determinative of ability to work. Why? Because some people with these conditions can still work. The condition can be mild, moderate, or severe. Some people with fibromyalgia still manage to work.

If the insurance company thinks you should be able to tough it out and still work, then you are not disabled in their eyes and they will say there is no objective medical evidence of your disability.