How do you handle a claim supported only by “subjective” evidence?
Can you reject the claim outright? No. You must weigh the subjective evidence. That’s a key point highlighted in a recent case.
Miles v. Principal Life Insurance Company [pdf], __ F.3d __ (2nd Cir. June 26, 2013) (Merely pointing out that the evidence is subjective is not, by itself, a proper basis to reject evidence.)
This case also stands for the interesting proposition that a claimant with a history of “hard work” may be more credible…
FACTS: Miles, a real estate lawyer, stopped working in April 2009, claiming disability from ringing in the ears (tinnitus), hearing loss, headaches and vertigo. He made an ERISA disability claim. The law firm benefits coordinator told Principal, the administrator, that Miles may have quit working for “other reasons[.]” Independent Medical Evaluators concluded Miles could work. Principal concluded Miles failed to present objective evidence of significant impairment. After his claim was denied, Miles sued and lost before the district court. He appealed.
Second Circuit HELD: REVERSED and Remanded to Administrator
A reviewing court must determine whether the plan gave “sufficient attention to [the claimant’s] subjective complaints …before determining that they were not supported by objective evidence.” Op. at 16.
Principal “did not give adequate attention to Miles’s subjective complaints as it failed to assign any weight to subjective complaints, or specific reasons for its reasons to discount them.” Op. at 16.
“Pointing out the evidence is subjective is not, by itself, a proper basis to reject evidence.” Op. at 16.
“Miles’s long history of hard work supports his credibility on [the claimed tinnitus and hearing loss].” Op. at 16.
“As Principal cites no reason to discount the evidence (other than its subjective nature), we conclude that Principal arbitrarily rejected Miles’s subjective evidence of disability.” Op at 16.
Requiring objective evidence of tinnitus was unreasonable. The record suggest there is no objective test to prove the presence of tinnitus. Op at 17.
Key Take Away: Document your assessment and weighing of the subjective evidence.