New Hampshire Court holds that Unum properly terminated LTD benefits based on self-reported pain limitation clause in policy even though Plaintiff provided objective proof of disability through a positive trigger point test.
24 Month Limitation for Self-Reported Symptoms
Many disability polices contain a clause limiting benefits to 24 months when the disability claimed is based on the self-report of symptoms and is not supported by “objective” evidence. Fibromyalgia claims are becoming more common in the disability insurance arena. These claims are very difficult to prove since the diagnoses are based on the patient’s self-reported symptoms of pain. Many physicians argue that the trigger point test is an objective measure of whether or not a patient is suffering from fibromyalgia. However, one court in New Hampshire disagreed with this assessment holding that a trigger point test relies upon the patient’s self-report and therefore cannot be considered an “objective finding.”
In the case of Decorpo v. Unum Life Insurance Company of America, The United States District Court of New Hampshire denied Decorpo’s motion for summary judgment holding that terminating her benefits after 24 months was proper. In Decorpo, Unum did not take the position that the plaintiff was not disabled. Rather, its position was that the disability was primarily based on self-reported symptoms which under the policy are limited to 24months. The court agreed with Unum, finding the diagnosis of fibromyalgia is based primarily on self-report of pain. The court found that a trigger point test was not objective evidence as required under the policy since the nature of that test is based on the patient’s self-report. Furthermore, Unum was entitled to insist on objective evidence that the fibromyalgia rendered Decorpo unable to work.
Courts have held that it is unreasonable to require objective proof of fibromyalgia. The First Circuit in Cook v. Liberty Life Assurance Co. of Boston held that Unum acted unreasonably when it required the plaintiff provide objective proof of her diagnosis of fibromyalgia and chronic fatigue. However, the court stated that “while the diagnosis of chronic fatigue syndrome and fibromyalgia may not lend itself to objective clinical findings, the physical limitations imposed by the symptoms of such illness do lend themselves to objective analysis.”
Unfortunately, without objective proof of her disability, Decorpo was not entitled to benefits beyond the 24 month limitation.