After Appeal, Lincoln Overturns Denial of LTD benefits for Trucking Supervisor

Our client, Mr. D, formerly worked as a Trucking Supervisor for a large steel distribution center. For many years Mr. D suffered from chronic debilitating effects of multiple physical conditions and ailments, including severe degenerative osteoarthritis and cervical spine multilevel degenerative disc disease, which left him with debilitating physical impairments. Mr. D was unwilling to give up his career and worked as long as he possibly could. As a result of his serious medical conditions and associated restrictions and limitations, Mr. D was forced to stop working in June 2016 and apply for disability benefits under his company’s Short and then Long Term Disability (LTD) Policies, both of which were administered and funded by Lincoln.

Lincoln found Mr. Dougherty to be totally disabled and approved his STD claim through the 13 week maximum benefit period which ended in September 2016. With the expiration of the STD benefits Mr. D’s claim was submitted for continued payment under Lincoln’s LTD Policy, with the same definition of disability. After paying his LTD benefit for 21 months Lincoln terminated benefits because claiming Mr. D could now perform his prior “heavy” occupation. Mr. Dougherty filed a timely appeal that was unsuccessful. Following a successful second level appeal, benefits were extended only for the balance of the own occupation period to September 2018 as Lincoln determined that Mr. D could perform other gainful occupations. After receiving the denial, Mr. D contacted Dell & Schaefer and discussed his case with Attorney Jay Symonds, who identified several significant issues in Lincoln’s denial letter and in the evidence it relied on and agreed to prepare and submit Mr. D’s ERISA appeal with the assistance of his appeal team.

The Appeal

The appeal addressed all of Lincoln’s short-comings and reasons for denial. First, the appeal detailed the results of a February 2020 FCE attended by Mr. D specifically for his appeal. The FCE objectively quantified his maximum physical functional capacity. With regard to sitting, standing and walking the FCE confirmed, among other restrictions, Mr. D had the ability to sit for 40 minute intervals, stand for 30 minute intervals and walk for 10 minutes intervals. Based on the findings in the FCE Mr. D would be  unable to perform work in the sedentary physical demand level due to his inability to sit for 2 hours at any one time, stand and/or walk up to 2 hours, work an 8 hour workday, nor repetitively use his lower and upper extremities. The FCE findings were then reviewed and adopted by Mr. D’s primary care physician. 

The Appeal Challenges Lincoln’s Medical Consultant

Next the appeal addressed the purported opinions of Lincoln’s medical consultant. More specifically, the consultant’s opinion relied, in part, on his belief that Mr. D could perform modified occupations, which was clearly outside the scope of his role as a medical records reviewer. Whether an occupation is available to be performed on a modified basis and whether an employer is willing to modify a particular occupation to accommodate employees is for a Vocational Consultant to determine, not a medical consultant. What’s more, the consultant was not board certified in a specialty relevant to Mr. D’s complex medical conditions (e.g., an Orthopedist) but rather as a physical medicine and rehabilitation physician, did not physically examine Mr. D prior to rendering his opinions and his conclusions were contradicted by the objective finding throughout Mr. D’s medical records.

And finally, the appeal addressed Lincoln’s failure to meaningfully review and consider Mr. D’s Social Security Disability Award, which Courts have repeatedly found instructive when determining whether a carrier conducted an unreasonable investigation. More specifically, the appeal argued that Lincoln’s conduct raised serious questions about whether its denial was the product of a principled and deliberative reasoning process or Lincoln’s financial conflict of interest due to its role as both the funding source and decision maker.

A Swift Decision by Lincoln

Just 6 weeks after filing his appeal, and after reviewing hundreds of pages of exhibits and medical records, Lincoln overturned its decision to terminate benefits, paid full LTD back benefits and reinstated Mr. D’s LTD benefits. Attorney Symonds continues to represent our client to best ensure that Lincoln will not terminate his benefits again. Feel free to call our disability attorneys for a free consultation regarding any matter relevant to your disability claim.

Questions About Hiring Us

Do you help Lincoln Financial claimants nationwide?

We represent Lincoln Financial clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Lincoln Financial disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Lincoln Financial. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Lincoln Financial.

How do you help Lincoln Financial claimants?

Our lawyers help individuals that have either purchased a Lincoln Financial long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Lincoln Financial:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Anthony M.

My experience with Mr. Dell and all of the staff working at the practice has been an excellent experience. Planning to make a claim for disability with a private insurance company can be very intimidating for the average person. Mr. Dell is professional and sharp, just what I was looking for in an attorney to represent my case. He walked me through every step and helped me make the best application for benefits. There were absolutely no surprises while applying for my benefits as we were both well prepared for any questions that could arise during the process. Mr. Dell was able to work with me and my physicians to make sure the application was thorough and complete. No mistakes were made along the way and my benefits were approved without any problems whatsoever. I will truly be grateful for Mr. Dell for the rest of my life.

***** 5 stars based on 202 reviews

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