An Accountant for LA County was forced to stop working in 2009 after suffering the crippling effects of Rheumatoid Arthritis, Fibromyalgia, and numerous other debilitating conditions such as Chronic Fatigue Syndrome, Bodily Pain, Osteoarthritis, Neck Pain, Cervical Disc Disease, Carpal Tunnel Syndrome, Low Back Pain, and Lumbar Disc Disease. Due to the multiple chronic and disabling conditions affecting the claimant, Lincoln commenced payment of long term disability benefits in 2009. However, continued benefits were denied 7 years later when Lincoln came to an abrupt conclusion that the Accountant should no longer qualify for benefits.
In support of its denial, Lincoln cited the results of an Independent Medical Examination performed in 2011 and two medical records reviews that were done in 2009. Due to the wrong decision to deny her claim, the claimant decided to file an appeal on her own. Unfortunately, Lincoln was not persuaded and upheld its decision to deny the claim. The former accountant was now left unable to work and without any income. Dismayed by the decision by Lincoln to deny her claim and uncertain about her future with no income, she made the right decision to find assistance with her claim and found Attorney Alexander Palamara of the Dell & Schaefer law firm.
Appeals by Attorney Palamara
After reviewing the denial letters by Lincoln and speaking with the former accountant, it was clear to Attorney Palamara that Lincoln’s denial was improper and that his now client was still unable to work due to serious and debilitating conditions. The claim file from Lincoln was ordered along with our clients past and current medical records to develop a full understanding of her illness, claim, policy, and Lincoln’s handling of her claim. After compiling and reviewing all the necessary information, it was clearer than ever that benefits had to be reapproved. A detailed review of the claim file revealed Lincoln had ignored supportive findings in the IME report and the records reviews, including findings that the claimant was unable to handle any type of work, even sedentary work, and findings that the claimant suffered from weakness, numbness, swelling, and loss of range of motion.
An appeal was drafted and timely filed. The appeal focused on the supportive findings by Lincoln’s own physicians that had been ignored. It also focused on the objective medical evidence in support of her claim and highlighted the opinions of our client’s treating physician, who had indicated he strongly disagreed with the opinions of Lincoln’s reviewing physician and even felt the reviewing physician had distorted their conversation and his ultimate opinion. We also highlighted the numerous flaws and failure of Lincoln to perform a full and proper review of the claim.
As a result of our initial appeal, Lincoln only partially overturned its denial. Lincoln agreed to pay four additional months of benefits. While the partial approval was a small victory, it was not enough given our client’s ongoing inability to work due to multiple chronic and debilitating conditions.
To justify the latest denial, Lincoln relied upon another records review by a hired physician. This physician spoke with our client’s treatment provider and was advised our client suffers from poor grip, trouble walking, and that as a result of her persistent synovitis, she is unable to work at any occupation, including sedentary work. Despite being made aware of her condition directly from the treating physician, the reviewing physician chose to ignore this opinion and Lincoln again terminated benefits.
A second appeal was drafted and timely filed. This appeal highlighted Lincoln’s lack of support for its denial and its arbitrary decision to continue to ignore the opinion of our client’s treating physician. The appeal also argued the denial was improper because Lincoln failed to perform an updated IME. As a result of the second appeal, Lincoln arranged for another IME of our client, which took place roughly one month after the appeal was filed.
Roughly two months after the second appeal was filed and one month after the IME, our client’s claim was finally reapproved indefinitely by way of a letter of November 2017. Thankfully, Lincoln made the proper decision to conduct an IME which confirmed the opinions of her treating physician. Of course our client is ecstatic to be back on claim and is now able to again focus on her health. She knows that the fight will continue, but she also knows that Dell & Schaefer will do whatever it takes to keep her on claim until she is ready and able to return to work.
If you have had a similar situation and Lincoln (or any disability insurance company) has denied your claim, please do not hesitate to contact Attorney Alexander Palamara at Dell & Schaefer for a free consultation.