Clarifying Objective Evidence

Saturday, June 7th, 2008

A common basis for denying disability claims is a purported lack of objective medical evidence. The trouble is that claims adjudicators simply disregard how policies, plans or regulations define objective evidence.

I represent a 43 year old insurance claims representative who was initially denied her Social Security Disability (“SSD”) benefits on the grounds that she failed to produce medical evidence to substantiate her claim. However, nothing could have been further from the truth.

The claimant had a serious back injury, and treated with, among other physicians, a spine specialist, who finally determined that absent surgery he could not help her any further. The disability examined who denied the claim asserted that while the diagnostic testing supported the claimant’s SSD application, the spine specialist’s opinion was based on the claimant’s subjective medical complaints.

As an initial matter, the diagnostic evidence should have sufficed. MRI reports revealed a herniated disc at the L5-S1 level causing a mass effect on the S1 nerve root, and a herniated disc at the C5-6 level flattening the spinal cord, and an EMG/NCV was consistent with L5 radiculopathy. Perhaps more importantly, there were significant objective clinical findings that were overlooked. Specifically, the spine specialist’s report identified the objective clinical examination findings of decreased range of motion, paraspinous tenderness and muscle spasm, and sensory loss at the L4-5 level. I cited case law that held that the aforementioned findings constituted “objective medical findings”.

Treating doctors are in the best position to evaluate a claimant’s functional limitations because of their first hand longitudinal treatment history. Nonetheless, claims adjudicators frequently reject the opinions of the treating doctors because they purportedly base their opinions on their patients’ subjective complaints. Therefore, it is necessary to point out of all of the objective clinical findings and not only the test data when arguing that a treating doctor’s opinion should be credited.

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