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Lincoln Overturns Denial of LTD Benefits After Two Appeals

Attorney Stephen JessupAuthor: Attorney Stephen Jessup

After fighting for her disability benefits for over a year, Lincoln finally awarded benefits to our client following two levels of administrative appeal filed by Attorney Stephen Jessup. When our client first contacted our office she had been recently denied by Lincoln on the basis that the available medical information did not support a level of impairment that would prevent her from performing the material and substantial duties of her occupation as a Customer Service Representative. What stood out to Attorney Jessup most after reviewing Lincoln’s denial letter was the fact that the only medical condition referenced as disabling was our client’s diagnosis of Ulcerative Colitis, with no real evaluation of the effects of her diagnosis of Multiple Sclerosis.

The Mandatory First Level of Appeal

In preparing our client’s first Appeal, Attorney Jessup focused on the contents of Lincoln’s internal medical review report with specific attention to Lincoln’s doctor’s assertion that the available medical records lacked objective evidence of restrictions and limitations as it related to our client’s ability to physically perform her occupational duties. To best assess her physical abilities Attorney Jessup arranged for a Functional Capacity Examination, the results of which indicated that she would not be able to meet the “light” duty physical demand level required of her occupation as set forth by the Department of Labor’s standard contained in Dictionary of Occupational Titles.

As our client’s diagnosis of Multiple Sclerosis was being questioned by Lincoln, an updated MRI of the brain was performed during the course of preparing the appeal that indicated numerous areas of abnormal white matter highly suggestive of multiple sclerosis. This updated MRI along with additional records and opinions from her neurologist were collected to correlate our client’s diagnosis with the results of the Functional Capacity Examination to establish functional impairment as it related to her ability to work in her former occupation.

Armed with this new objective evidence to substantiate our client’s diagnosis and functional restrictions and limitations Attorney Jessup filed the administrative appeal. Lincoln prolonged the review and exercised its right to a 45 day extension to complete its evaluation of the information submitted. Unfortunately, despite new supportive evidence of disability Lincoln denied the first appeal upholding the decision to terminate benefits, and in doing so echoed much of the same argument contained in the first denial letter. Lincoln continued to assert a lack of information to support an inability to perform her “light” duty demand level occupation, despite objective evidence to the contrary.

The Second Mandatory Appeal

Lincoln is unique amongst disability insurance carriers in that Lincoln’s policies require two levels of administrative appeal prior to the filing of a civil lawsuit in Federal court. Following the denial of the appeal Attorney Jessup began preparations for the filing of the second appeal. Updated claim file information was requested from Lincoln, to include the reports of the medical reviewers who determined our client was unrestricted from work duties. In submitting the second appeal Attorney Jessup received focused responses by our client’s doctors to the medical reports created by Lincoln’s doctors; and reiterated arguments pertaining to our client’s physical restrictions and limitations in light of the objective evidence provided. Attorney Jessup and our client remained optimistic despite all the setbacks that the new independent review performed by Lincoln would result in our client’s benefits being reinstated.

Lincoln did not exercise a 45 day extension during the review of the appeal and within thirty days of the filing of the appeal Lincoln notified our office that it was reinstating our client’s claim for benefits. Needless to say following the year long fight with Lincoln to secure her benefits our client finally felt vindicated.