Migraine headaches are a big problem. The Mayo Clinic reports that this condition is the second leading cause of disability worldwide. The Mayo Clinic's neurologists further confirmed that the disabling symptoms are not just the pain, but also sensitivity to light and sound as well as nausea and vomiting. People who experience migraine headaches know how severe and disabling such a headache can be. On the other hand, some people who have migraine headaches are able to continue to function for the most part and work. The headache is not so severe. That presents a problem for employers, insurance companies, and courts. Who is experiencing symptoms so severe as to preclude work?
Migraine headaches are typically not a daily occurrence for the majority of people. They are sporadic, affecting an individual only a few days a month for a few days, but on the other hand, sometimes one headache can last an entire week. When a severe headache comes on, it is common to hear comments such as “I go to a dark room and stay in bed”. Many do very little for days on end and some do not eat until the symptoms subside. Others may take very strong medication which then makes it difficult to think or focus and that may only reduce but not eliminate the symptoms. Individuals with severe migraine headaches are clearly not fit for work.
The problem arises as to whether an employer can accommodate unplanned absences. If the individual is out several days every single month how can an employer rely on that individual to be present at work if that is a required job duty? Working with reasonable continuity is generally important for employers. If an employee has excessive absences such as two or three random days (or more every month), that may lead to termination.
If the employer must terminate the employee, it seems fair that the long-term disability insurance coverage in place should pay the claim. But that is not the case as insurance companies take a very hard line against conditions that cannot be objectively demonstrated with an x-ray or diagnostic test. When a claimant challenges that decision in court, claimants find that courts often side with the insurance company. Many courts find it reasonable for an employer or an insurance company to require some sort of objective proof of a disabling or limiting condition. They won't just take the claimant's word for it notwithstanding that most claimants would much prefer to receive the income they had from working, rather than a much-reduced percentage of their base pay.
So what evidence is needed? First of all, one must ask what does the plan require? If the plan expressly requires a certain type of objective evidence the claimant will have to provide proof of that specified evidence. On the other hand, if there is no such express provision then the plan may yet deny the claim, but if it requires some objective evidence it must specify what evidence should be provided.
The 11th Circuit in Creel v. Wachovia Corp., No. 08-10961, at *18-19 (11th Cir. Jan. 27, 2009) explained, “When the plan has no such requirement (of a certain type of objective evidence) …. an administrator's decision to deny benefits would be unreasonable if it failed to identify what objective evidence the claimant could have or should have produced, even if the administrator submitted the file for peer review. See, Oliver v. Coca-Cola Co., 497 F.3d 1181, 1196-97 (11th Cir. 2007), vacated in part on other grounds, 506 F.3d 1316 (11th Cir. 2007) (finding it arbitrary and capricious to deny benefits for fibromyalgia and chronic pain syndrome when the claim was supported by ample evidence and administrator never requested any particular kind of evidence).
The 11th Circuit Creel court also noted that neither party has identified any objective tests that would automatically establish the existence of neurologically-based migraine headaches. The court cited with approval, Thompson v. Barnhart, 493 F. Supp. 2d 1206, 1215 (S.D. Ala. 2007) (noting that "neither the SSA nor the federal courts require that an impairment, including migraines, be proven through objective clinical findings"); Ortega v. Chater, 933 F. Supp. 1071, 1075 (S.D. Fla. 1996) (finding that, because "present-day laboratory tests cannot prove the existence of migraine headaches," objective clinical evidence of the symptoms of migraines can suffice as proof).
Thus the 11th Circuit condoned as adequate proof certain forms of subjective and objective evidence. This included “… chart notes, standard diagnoses, and lab reports from multiple physicians discussing her condition and identifying it as physically-based, all of which are valid forms of objective proof under the Plan and can serve as the basis for a diagnosis of migraines.” Id at *20. “In addition, she (Ms. Creel) provided her headache diary, which was the sole additional evidence requested by the claims administrator. This diary both corroborated the diagnosis of migraines and chronicled the degree to which they incapacitated her at regular albeit unpredictable, intervals.” Id. at 20-21.
So to answer the title question, yes you can be disabled from a migraine headache but there must be careful attention to the plan document requirements and then submission of subjective and objective proof that demonstrates the existence of the migraine as well as the extent to which it disables. This same analysis is also adequate for fibromyalgia and chronic pain syndrome claims.