Long-Term Disability Claims: The ‘Objective Evidence’ Myth
LTD insurers often deny claims by arguing that the claimant hasn’t provided objective evidence of a disease or injury. This isn’t just a tactic to deter lawsuits—they frequently defend claims in court on the same basis.
Yet, when asked under oath to define the “objective evidence” required to approve a claim, insurer representatives often can’t provide a clear answer. They usually concede that a claimant can meet the definition of disability based on subjective symptoms. The demand for “objective evidence” is largely a myth perpetuated by insurers.
Even when a claimant proves an objective illness or injury (e.g., herniated disc, fracture, brain lesions), insurers may argue there’s no objective evidence of functional impairment. In other words, the symptoms are dismissed as too subjective—this is often the insurer’s fallback argument.
Many illnesses, including mental health conditions, cannot be definitively proven by tests or scans. LTD insurers frequently deny these claims on the grounds they are based solely on subjective reports. There is also bias against conditions like environmental illnesses, Lyme disease, fibromyalgia, IBS, and other gastrointestinal disorders. Still, claimants with these conditions are entitled to LTD benefits if they’re unable to work.
Fortunately, courts in Canada and the U.S. have rejected the idea that objective evidence is always required. But insurers won’t make it easy. They often retain consultants, specialists, or occupational therapists to review claims or conduct medical exams. If these experts support the insurer—as they often do—the claimant must respond with their own expert evidence. This is where an experienced LTD plaintiff lawyer is crucial: they can help secure expert reports and push the case forward in litigation.
Clients often ask who pays for the medical evidence needed to win an LTD claim. Typically, the insurer ends up covering the cost—especially when they realize the claimant is serious about going to court. In some cases, the mere threat of litigation and expert involvement prompts insurers to approve or settle claims.
LTD litigation is highly specialized. Seek advice from a lawyer with a proven track record in LTD claims—or someone who has worked for insurers and knows their tactics.