ERISA disability benefit plans commonly require objective medical evidence of disability. This can be a difficult hurdle for claimants who believe they are disabled by conditions that cannot be evaluated by objective evidence. In one recent case, for example, the employee argued that she was disabled because of severe debilitating migraines, but that it was impossible to substantiate the severity of the migraines with objective evidence. The employee benefit plan at issue required objective medical evidence, and the plan’s physicians concluded that “there is not objective information available on laboratory testing or by history that these headaches are an organic process, but rather by history would be most consistent with depression, stress, and anxiety.” The court said,
While it could be argued that Defendant’s decision was unfair, because it is almost impossible to have objective medical evidence that substantiates the severity of her migraines and her subjective complaints, the terms of the Plan require that Plaintiff submit evidence in support of her claim for disability benefits in a form satisfactory to Defendant and that Defendant could require objective medical evidence. . . . As such, while Defendant’s decision may have been unfair, it was not wrong under the terms of the Plan.”
According to the court, “it is not this Court’s function to determine if the terms of a plan are fair.”
The court quoted from another factually similar case in which the court held as follows:
Plaintiff asserts she should be exempted from the requirement of producing “objective medical evidence” of disability [fibromyalgia], because her condition is not readily susceptible to objective identification or documentation. The court recognizes that a fibromyalgia sufferer will not always be able to present objective evidence to support all of her symptoms, and that resulting difficulties may sometimes arise in the pursuit of disability benefits. Nonetheless, plaintiff has presented no authority that would allow the court to disregard a plan term requiring objective medical evidence whenever a claimant suffers from a condition which does not readily lend itself to objective identification. The court’s task is to determine whether it was “wrong” for [the administrator] to determine that plaintiff is not disabled under the plan. It is not for the court to determine whether the plan is fair to plaintiff as written, or to rewrite a plan term if it creates an obstacle for plaintiff in marshaling evidence to support her claim.
Ecklund v. Continental Casualty Co., 415 F. Supp.2d 1353, 1372 (N.D. Ala. 2005).
