No Objective Evidence of Disability Required for Fibromyalgia

Posted on Nov 17, 2013

Beth Cosey applied for long-term disabilty benefits through her employer's long-term disability plan. The plan was insured by Prudential Insurance Company of America, one of the largest disability insurance companies in the country.

According to an opinion from the United States Fourth Circuit Court of Appeals, Cosey was employed as a senior clinical marketing manager for BioMerieux, Inc.. As with most long term disability plans, contract stated that Cosey would be eligible for benefits if she is unable to perform the substantial and material duties of her regular occupation due to sickness or injury.

Cosey filed a claim for benefits. Her claim was based on a number of conditions, including fibromylagia.

Prudential denied the claim, saying:

"Cosey's test results did not support a finding of impairment; there was no medical explanation for Cosey's self-reported symptoms; and [her] conditoin did not preclude her from engaging in full-time work."

Prudential had also done video surveillance which showed Cosey "standing, walking, bending and entering and exiting a vehicle."

The lower court had decided in favor of Prudential, deciding, in part, that Cosey had not presented "objective evidence of disability" and that this plan required the claimant to present objective evidence (even though there was no such requirement in the plan.)

The Court of Appeals rejected that view and sent the case back to the District Court for a new determination, saying:

"No such requirement [for objective evidence] appears in either the STD (short term disability) or LTD (long term disability) plans before us...We hold that the District Court erred in concluding that Prudential could deny Cosey's LTD and STD claims on the basis that her proffo lacked such objective evidence."

If you are dealing with a long-term disability claim, you should get our free book on Virginia disability claims right now.

Additionally, you can call our office at (703)584-7277 to talk with our team about your claim and/or denial of benefits.