What Is Objective Medical Evidence?


I am David Martin with the Martin Law group. We help people with disability policies and ERISA claims. I post a new disability policy term every Thursday. Subscribe and get the Edge in understanding your policy. Today let’s discuss “What is objective medical evidence?” This term means independent evidence that shows a point apart from what you say. It means medical evidence such as diagnostic tests, laboratory findings, and clinical examination findings. It does not include only symptoms or a diagnosis. Generally objective medical evidence is shown if there is a personal examination by a physician with specific findings documenting the diagnosis as well as restrictions and limitations. An x-ray showing a fracture, limits on rotating your head or reaching, and muscles visibly wasting away or decreasing in size are examples.

Pain is a widely accepted basis supporting restrictions and limitations for the inability to work. The problem is that pain can vary widely between individuals. You can be in severe pain but unless that pain is supported by objective medical evidence the claim may be denied. Your word may not be enough. Some policies provide that benefits will be paid based on subjective medical evidence but only for a limited time frame such as one year or two years.

What is critical is to demonstrate the cause of the pain, a medical condition that is known to cause restricting pain, treatment of that condition, and the overall credibility of the claimant. Many insurance company doctors disregard complaints of pain since diagnostic tools such as x-ray or MRI cannot demonstrate the level of the pain. This, as a result, has caused some courts to accept a combination of an objective diagnosis known to cause pain, clinical findings by an examining physician, pain or headache diaries, and observations by others. Good standards for evaluating disability, do take pain into account by looking at objective proof of a condition known to cause restricting or distracting pain. Remember we are here to help if you run into problems. Call us at the first hint of trouble.

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