Migraine

The Hidden Calamity Waiting for You in Your Disability Insurance Policy – The Subjective Medical Condition Clause That Limits the Payment of Disability Insurance Benefits for Migraines

According to the Migraine Research Foundation, over 36 million Americans suffer from migraines. The simplest things can set off a debilitating, painful migraine. It could be perfume, loud noise, or even fluorescent lights. Regardless of the cause, the throbbing pain, nausea, and sensitivity to light or noise of a migraine can make it impossible to work.

The First Line of Defense Is a Lack of an Objective Basis for the Diagnosis

Many disability insurance companies challenge migraine claims on the basis that there is no objective basis for the migraine diagnosis.

It is crucial that you treat with a neurologist who has certification in headache medicine and that you meet the International Headache Society “5, 4, 3, 2, 1” criteria to diagnose migraines. The criteria are:

• 5 or more attacks,
• 4 hours to 3 days in duration,
• At least 2 that have unilateral location, pulsating quality, moderate to severe pain, and aggravation by or avoidance of routine physical activity, and
• At least 1 additional symptom such as nausea, vomiting, sensitivity to light, or sensitivity to sound.

Additionally, your medical records should document:

• Your migraine history, explaining how often the attacks occur, triggers, and symptoms,
• The results of a CT scan,
• The results of an MRI,
• The results of an EEG, and
• The use of and response to triptans, beta blockers, and anti-epileptic drugs.

Once you convince the disability insurance carrier that you have migraines and that the diagnosis is objectively based, be on the lookout for the subjective medical condition clause in your disability insurance policy.

The Subjective Medical Condition Clause That Limits the Payment of Disability Insurance Benefits for Migraines

It is not uncommon for there to be a subjective medical condition clause in a disability policy that can be calamitous for a policyholder. A subjective medical condition clause will limit the payment of benefits to just two years if the disabling medical condition is subjectively based – like migraines.

The disability policy will outline the conditions considered to be subjectively pain-based, such as fibromyalgia or chronic fatigue, and headaches or migraines are often part of that list of limited conditions.

Worse yet, doctors and disability insurance companies have historically considered migraines to be a psychological condition and not a true anatomically or organically based medical condition.

If the carrier doesn’t invoke the limited-pay provisions of the subjective medical condition clause, they will apply the mental nervous condition limitation as the next line of defense.

What Every Migraine Sufferer Must Do Before They Stop Work and Apply for Their Disability Insurance Benefits

Before you stop working, get out a copy of your disability policy and read it cover to cover.

• Is there a subjective medical condition clause that limits the payment of benefits to two years?
• Is the mental nervous condition limitation so broad that it includes migraines?
• If so, what do your medical records say that supports your claim?

Knowing these answers will help you decide if it is time to stop working and apply for benefits now – or whether it is time to consult with a nationwide migraine ERISA disability attorney like Nancy Cavey.

Call 727-894-3188 for a complimentary consultation.