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In the last several years, insurers have adjusted and re-adjusted specific targeted impairments that have changed with new medical technology and medical treatment. Ten years ago, patients with FMS were treated with morphine pumps, today physicians recommend treadmills and exercise. Targeted impairments have changed to reflect which ones still lack objective evidence and are the easiest to deny.

Migraines now top the list of targeted impairments due to the uncertainty of the severity, which is different for each individual person. One person’s Advil headache can be another’s excruciating migraine that lasts an entire day. Insurers look for visits to neurologists and MRIs to rule out physical organic brain disease as the causation of migraines. Clinical diagnoses of primary care physicians along with prescriptions for migraine medicine is no longer credible as the cause for permanent disability.

In addition, migraines are unpredictable regardless of what the trigger is. Overhead lights, noise and chemicals can stimulate migraines, but not everyone has the same reaction to stimuli in the environment. Insurers will always take advantage of the uncertainty of the etiology, lack of physical evidence, and unpredictability of migraines is so subjective that the impairment can be disputed for disability purposes.

POTS is becoming a very difficult impairment to support for disability mostly because primary care physicians are still unfamiliar with the impairment and do not order tilt table tests, or document other objective, observable symptoms. The defined disability of “POTS” can also vary from one patient to the next either with very slight symptoms or those severe enough to warrant total disability.

Any disability that is not adequately documented is an impairment “target” with insurers. Although “clinical diagnoses” can be supported with POTS, care must be given that specific medical restrictions and limitations are cited and why. Physicians are getting more and more lax with documentation at a time when insurers have redefined their own credible impairment definitions.

Cognitive Disorders remain as a targeted source of denials for most insurers. I refer to this category as the “rule out” impairment since most neurologists will attempt to rule out the obvious such as Parkinson’s disease, Alzheimer’s, Dementia etc. Once the testing “rules out” obvious causes of cognitive issues, there is nothing left except perhaps a mere mention of memory deficit on a neuropsychological test. Insurers often mistakenly look for organic brain causes to cognitive dysfunction, which almost never show up on MRIs or CAT scans.

HIV/AIDS remains as one of the most targeted impairments in the industry. Due to advances in the development of newer drug “cocktails”, HIV patients have no viral load and T-Cell counts over 500. This is a disease where objective lab reports alone do not reflect the totality of whole body impairment. For example, while lab reports continue to show negative results for AIDS, symptoms and side-effects of medication such as chronic diarrhea, neuropathy, imbalance and cognitive deficits remain severe enough to preclude work.

Insurance companies disregard individual symptoms reported in doctor’s offices in favor of objective lab reports showing no signs of HIV demanding that HIV patients can return to work. This is certainly not true of everyone, and yet insurers will attempt to use the newer medications against a case for permanent disability.

Insurers always include impairment “quick hits” as deniable targets. Claims in the above categories must be managed appropriately in order to avoid the “headaches” of insufficient medical support.