What You Need to Know About Appealing an LTD Denial Based on “Objective Evidence”

If your long-term disability (LTD) claim has been denied because of a lack of “objective evidence,” you’re not alone. Insurance companies often use this reason to deny claims, especially for conditions like chronic pain, fibromyalgia, or mental health conditions, where symptoms may not show up on diagnostic tests.

While the term “objective evidence” can feel like an insurmountable barrier, overcoming this hurdle with the right strategy is possible. Here’s what our nationwide claims attorneys at Disability Insurance Law Group want you to know about appealing an LTD denial based on “objective evidence.”

What Is “Objective Evidence”?

In LTD claims, “objective evidence” refers to medical documentation that can be measured, observed, or verified through diagnostic tests or clinical evaluations.

Examples include:

• MRI or CT scans.
• X-rays.
• Blood tests.
• Functional Capacity Evaluations (FCEs).
• Psychological testing.

Insurance companies often argue that subjective complaints, such as pain, fatigue, or depression, are insufficient without corresponding objective evidence.

Why Insurance Companies Demand Objective Evidence

Insurance companies are in the business of minimizing payouts, and requiring “objective evidence” is a common tactic to deny valid claims. This standard can be especially problematic for conditions that rely heavily on patient-reported symptoms or have no definitive diagnostic test.

Steps to Appeal a Denial Based on Objective Evidence

Start by carefully reviewing the insurer’s denial letter. The letter should explain why your claim was denied and what evidence is insufficient. This information is crucial for crafting a practical appeal.

Next:

Understand Your Policy Requirements

Examine your LTD policy to determine whether it explicitly requires objective evidence for your condition. Some policies include specific language about evidence requirements, while others do not. The denial may be unwarranted if the policy does not mandate objective evidence.

Work with Your Treating Physicians

Your doctors play a critical role in your appeal.

Ask them to:

• Provide detailed records of your diagnosis, treatment, and ongoing symptoms.
• Write a statement explaining why objective tests may not fully capture your condition.
• Document specific limitations that prevent you from working.

Gather Additional Supporting Evidence

Even if your condition lacks definitive diagnostic tests, other types of evidence can strengthen your case, including:

• Functional Capacity Evaluations (FCEs) to assess your physical limitations.
• Neuropsychological testing for cognitive impairments.
• Daily activity logs document how your condition affects your ability to perform basic tasks.
• Testimonies from family, friends, or coworkers about how your disability impacts your life.

Challenge the Insurance Company’s Evidence

Insurers often rely on biased medical reviewers or flawed evidence to justify denials. Request a copy of your claim file, including any reports from the insurance company’s doctors, and identify inaccuracies or gaps in their assessments.

Submit a Comprehensive Appeal

Prepare a detailed appeal letter that addresses the insurer’s reasons for denial.

Include:

• A point-by-point rebuttal of the denial.
• Updated medical records and supporting evidence.
• Expert opinions from treating physicians or independent specialists.

Navigating an LTD denial can be overwhelming, especially when dealing with complex evidence requirements. Our disability insurance claims attorneys can help you build a strong case and ensure your appeal meets all procedural requirements.

How Disability Insurance Law Group Can Help

Appealing an LTD denial based on “objective evidence” requires a strategic approach and a deep understanding of disability insurance policies. At Disability Insurance Law Group, our experienced claims attorneys help clients challenge unfair denials nationwide and secure the benefits they deserve.

We know how to counter insurance companies’ tactics and present compelling evidence for conditions that may lack traditional diagnostic tests. If your LTD claim has been denied, don’t wait. Contact us today by calling 954-989-9000 or online for a free consultation, and let us help you fight for the benefits you need.