The tendency of insureds to claim multiple diagnoses and co-morbidity for disability purposes is often a self-inflicted risk to denial. While it is possible for insureds to have more than one diagnoses, there is a point of “reasonableness” that will be applied by insurers.
Occasionally, an insured will provide me with a list of “claimed diagnoses” with more than 25+ impairments listed from FMS, CFS, MS, POTS, Chronic Pain, Lyme disease, arthralgia, CTS, and so on. The problem with listing so many impairments is that reactions from insurers will be, “If this insured really had all of these impairments they should be either in intensive care or dead.” This is a point where, due to amount of impairments, medical severity is neither credible, nor discernible.
Apparent in multiple reporting is that insureds listing multiple co-morbidities will absolutely insist they have 25 diagnoses, and often become “insulted” if questioned. Insurers then “classify” the unglued insureds as mental and nervous, or assume somatoform (in your head or imagined) symptom reports. The perspective of the insurance company is, “this insured must be nuts, and is making things up.”
Medically, it is important for all claimants and insureds to prioritize primary and secondary diagnoses that actually contribute, or cause lack of physical or mental capacity to perform work. Many times, insureds make the common mistake of confusing “diagnoses” and “symptoms”, which are two different medical reporting areas.
For example, diagnoses must be those physical impairments that generally have an ICD-10 Code such as FMS (M79.7) and Multiple Sclerosis (G35). Symptoms, such as fatigue, and pain are NOT diagnoses, although some symptoms can be impairing by themselves and do have ICD-10 codes. However, my point is, that it does not add to the credibility of your claim to list 25+ impairments, but hinders the credibility of it.
It does concern me that some insureds will defend their “lists” of multiple diagnoses even when it is not reasonable to report all of them. Lyme disease insureds will absolutely insist they have Lyme after 10 years of antibiotic and hyperbaric treatments even when physicians are telling them they do not have Lyme. And, please don’t misunderstand me, I’m NOT saying some insureds are exaggerating their medical conditions, but I can assure you, insurance companies will.
Therefore, insureds with co-morbidities should prioritize those diagnoses that contribute to their inability to work. Regardless of number, co-morbidities that always should be reported are: Cancer and Cardiac Issues. Reporting excessive diagnoses in order to show claims as credible does not work. Discretion and reasonableness are the key based on each individual’s medical history.
