How Do Insurers Evaluate Medical Conditions for Disability Benefits?

Disability insurance companies will always say that “diagnosis does not equal disability”. This is a true statement in many cases, as there are people every day that are diagnosed with a medical condition yet they are still able to work. The difficulty develops when a person is claiming disability and the disability company is challenging the claimant’s diagnosis and medical condition.

A medical condition which is recognized by the medical community has a general set of guidelines for diagnosis of the condition. For example, if a claimant is diagnosed with depression, then the disability company will expect the claimant to satisfy the criteria for depression as stated in the DSMV-4. There are several medical conditions which are disputed within the medical community, such as Lyme Disease, Chemical Sensitivity disorder, Fibromyalgia, Chronic Fatigue and Headache disorders. Different medical organizations and institutions have created different medical criteria for the same medical condition. Lyme disease is a perfect example of disputed criteria and treatment for the same condition. Despite the dispute among medical doctors, these are all disabling medical conditions.

The disability insurance companies will often subscribe to the least favorable standards for a medical condition or make a claimant satisfy a medical threshold which is almost impossible to achieve. When presenting a disability claim it is more important to have your complaints, symptoms and restrictions diagnosed and documented, than it would be to have an exact diagnosis. Medicine is not an exact science and doctors sometimes give a patient a diagnosis because they have excluded all other possible causes of patient’s symptoms. Regardless of the diagnosis the claimant’s inability to work as result of there symptoms is what must be proved.