How Do Self-Reported Symptom Policies Apply to Reinstating Denied Claims?

The claimant, a former sociology professor at Rollins College, dedicated her career to teaching, advising students, developing courses, grading papers, and contributing to academic research and writing. Unfortunately, her career and daily life were significantly impacted by Chronic Fatigue Syndrome (CFS), fibromyalgia, and a spectrum of associated symptoms, including persistent pain and fatigue.When the claimant applied for long-term disability benefits due to her debilitating conditions, she encountered a significant challenge. Unum Life Insurance Company of America, her insurer, denied her claim based on a provision in her employer’s plan. This provision limited benefits to a 24-month period for disabilities "due to mental illness and disabilities based primarily on self-reported symptoms." Unum determined that the claimant's conditions—CFS and fibromyalgia, characterized by symptoms such as pain and fatigue—fell under this limitation because they were primarily based on self-reported symptoms.In response to the denial, the claimant filed an appeal, determined to overturn Unum's decision. She meticulously compiled additional medical information for review, including office notes from a gastrointestinal specialist and updated records from her treating physicians. She also submitted results from the CPET conducted by an exercise physiologist. This test was specifically designed to objectively measure functional capacity and assess the recovery response to physical stressors. The appeal aimed to demonstrate that her disabilities were not solely based on self-reported symptoms and that she had indeed provided objective evidence of her functional limitations.This is the oral argument in the 1st circuit court of appeals.These public domain recordings are brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA.By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike. If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.