Computer Programmer is back on claim receiving LTD Benefits after Attorney proves to Lincoln it acted wrongly
This case is unique and a valuable lesson for all of those receiving LTD Benefits. Prior to Dell Disability Lawyers getting involved with this claim, our now client worked as a Computer Programmer for ACI Worldwide. She was hired by her employer in April of 1986 and worked there all the way through December of 2005. Unfortunately for her, she suffered from viral vestibular neuritis which led to vestibular nerve damage. The accompanying symptoms of her conditions prevented her from continuing at any employment. Luckily for her, her employer provided a Long Term Disability (LTD) Insurance Policy should she be unable to work. After filing a claim for benefits, her claim was approved and benefits commenced in March of 2006. These benefits continued until May 30, 2017, when unexpectedly, the former Computer Programmer received a letter from Lincoln advising her that her benefits were being terminated. Utterly confused on why this was happening, the former computer programmer contacted our firm and spoke with Attorney Alexander Palamara.
After hearing her story, Attorney Palamara knew that Lincoln’s actions in this claim did not smell right. It made no sense for her to be denied after 11 years as her condition did not improve and Lincoln had not requested updated medical records in some time. Pouncing on this claim and agreeing to work with the former computer programmer, Attorney Palamara first ordered a copy of all the records that Lincoln possessed on this case. In a typical case, after a person is on claim for 2 years, an average claim file should be around 2,000 pages. If a person is on claim for 10+ years, the claim file should be a few thousand pages at the very least. When Attorney Palamara received the claim file he initially thought Lincoln failed to provide the entire document or misunderstood his request. The claim file provided was merely 359 pages. Once the attorney reviewed the file he came to the understanding that this was in fact the entire claim file. He also came to the realization that for the last 11 years, Lincoln had done next to nothing on this case. This lead to the question: If Lincoln did next to nothing on this case, why was it now denying the case with no true justification to do so?
A review of the Claim File
A review of the claim file showed the story of how Lincoln first acted wrongly. After initially approving her claim in 2006, on April 3, 2008, Lincoln made a decision to refer this claim to its “Mature Claims” category. This apparently meant that Lincoln understood that this claimant would be disabled for some time and that requesting updated records and forms from her was unnecessary as no change was expected. Lincoln essentially went into a hibernation mode on this claim and only ended up requesting the claimant to complete “Supplementary Statements” every even numbered years. No updated medical records were requested and thus no updated medical records were provided by the claimant. The claimant believed Lincoln to be satisfied as she always timely and fully complied with their requests.
Unfortunately, the rug was pulled out from underneath the claimant and her claim was denied by way of May 30, 2017, denial letter. In support of its decision to deny benefits, Lincoln solely relied upon the results of an Independent Medical Examination of April 6, 2017, which was performed by Dr. Pamela SantaMaria. Of course Dr. SantaMaria made findings that Lincoln used to deny continued benefits. The doctor stated that “There is nothing in the medical records presented for my review nor in my exam of Mrs. Falk to support a functional limitation at this time.” Well of course this was true as Lincoln’s file had no medical records from 2008 forward and Dr. SantaMaria was only provided records from 2006-2008. Her examination was in April 2017! Even Dr. SantaMaria felt something was odd here as she noted that she “would however like to reserve the right to change that determination if new information is brought forth to support a functional impairment and the need for restrictions and limitations.” In all our years of reviewing IME’s and independent file reviews, we have never seen a doctor state that he/she would like to reserve the right to change their determination. And of course Dr. SantaMaria stated she found nothing in her exam. But in this claim, no doctor would expect to find anything during an exam of this client as when it comes to dizziness, the physical exam is most often normal. Furthermore, any tests done are relatively insensitive to finding causes or even displaying dizziness as being present and it is common for patients to have severe problems and have these tests be entirely normal. In this sense, Vestibular issues are unique and Lincoln’s Claim Examiner was unaware of such.
Appeal by Attorney Palamara
An administrative appeal was timely and properly filed by Attorney Palamara. Beyond providing updated medical records and pointing to the objective evidence, Attorney Palamara also pointed to all the old reviews that Lincoln had conducted that supported this claim and the support from the treating providers. We also pointed out that Social Security still finds her to be disabled. Beyond this, Attorney Palamara was also very critical of how Lincoln handled this claim. It essentially lured this claimant to sleep and pulled the cord on the claim when she least expected it. It essentially ordered no updated records and then said she was not disabled as there was no proof. Well proof would have been provided if it was merely requested. In this case, Lincoln failed to request or order updated medical records. Lincoln failed to review the Social Security Disability Claim File. It even failed to distinguish the past reports it commissioned that were supportive of Ms. Falk’s claim. Everything pointed to the fact that Lincoln acted arbitrarily and capriciously here.
Thankfully, a few weeks after our appeal was filed, Lincoln informed us that her claim was being reinstated. Though our client is thankful, it was really tough for her to be without benefits for those few months. However, this case is pivotal if you are on claim and receiving disability benefits. Claimants must also remember that they have a duty to prove their claim. It is their duty to prove to the insurance company that they are disabled. Furthermore, claimants cannot expect the insurance company to prove it to themselves that the person they are paying is disabled. It is not even logical to expect them to prove to themselves that they should be paying someone. It is always important to continually prove your claim. If you don’t, expect your claim to be denied. Though we will gladly get you back on claim, you may go a few months without benefits.
If you have had a similar situation and Lincoln (or any disability insurance company) has denied your claim or if you are worried about being denied, please do not hesitate to contact Attorney Alexander Palamara at Dell Disability Lawyers for a free consultation.
Resources to Help You Win Disability Benefits
Get Your Lincoln Financial Disability Application Approved
Prevent a Lincoln Financial Disability Benefit Denial
Negotiate a Lincoln Financial Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Policy Holder Rating
Q: If I return to work only part time and decide I can't continue, will Lincoln Financial base my income on when I worked part time or full time?
Q: Can Lincoln Financial deny a total disability claim approved by a federal judge? Can I get a lump sum payout instead of fighting with them for the next 9 years?
Attorney Alexander Palamara of Dell Disability Lawyers gets LTD Benefits Reinstated for former Walmart Manager who is now found disabled from Any Occupation
Lincoln National Life Insurance Company overturned previous denial of long term disability benefits for Wyoming Professor
Kirk & Blum/CECO Environmental Employee Files Lawsuit Against Lincoln Financial Group For Wrongful Termination Of Long-Term Disability Benefits
Reviews from Our Clients
Very satisfied with the work of this team. Took well care of my case and took all the necessary time to be responsive and attentive when I had questions. Guided me through recovery and returning to normalcy. All thanks to Jason & Tabitha, thank you!
I’m extremely satisfied with the experience I have had with this firm from day one. The lawyer who has handled my case, Alex, is very efficient and attentive to all my questions and concerns. They are always aware of how my case has gone and they care about my health. I feel optimistic with them because they are very attentive during the process of my claim. I would not hesitate to recommend families and friends if in any situation they need their services. Kathleen as well has been very well and assisted me with this case. I highly appreciate everything they have done for me.
It’s unfortunate when disability insurance companies come after older disabled policyholders just to help their bottom line. It can be a living nightmare the damage they can do to a family. Dell Disability Lawyers are polite, understanding and knowledgeable. They call you back and answer any question you have no matter how unimportant it can be. The amount of stress they took off of myself and family was incalculable. I recommend them highly to take care of any disability case whether it be filing for benefits or reversing a claim decision. They are outstanding.
I could not have been happier or more appreciative of the hard work they performed on my behalf. I was well briefed on my case and it was closed in a timely manner with a financially successful resolution.
Mr. Symonds and Sonia as well as everyone else we have worked with throughout this process have been very helpful, professional and caring to our situation. We are very thankful to have this great team on our side.
Without them my LTD company was dropping my plan with me still suffering from my accident, even with doctor’s statements I’m still disabled. The LTD company didn’t want to advance my policy to the next stage of years of pay. Dell Disability Lawyers saved my policy, and helped to enforce the LTD company’s own policy (for its policy holder, me) that I would be covered still under the LTD policy I had paid for at my previous job, when my accident occurred. These lawyers know what they are doing and can help you too. LTD companies will try to drop you when you still need coverage just because they don’t want to pay on your policy anymore. Don’t let them break contract with ya because they are trying to get out of it. Hit em with legal action to ensure the continuation of your policy you paid for. Dell Disability worked very well for me and continue to do so.
I was denied long term disability benefits from The Hartford after being on it for years. I found Dell Disability Lawyers after doing research online. In a matter of days they responded and explained to me everything that would be done. Dell Disability Lawyers were able to settle my suit against The Hartford very quickly and responded to me quickly. I would definitely recommend this team of lawyers for anyone that is fighting for their disability insurance.
I have had nothing but a great experience with Dell Disability Law Firm. Mr. Alex Palamara and his team went above and beyond my expectations. They will respond to emails and phone calls in a timely manner. Thank you once again for taking my case.
This law firm is the best so far. MetLife denied me two times, they appealed two times for me and they won of course. So if you are on disability and want a chance at winning your case use this firm Dell disability lawyers, kind courteous understanding and they get the job done. You won’t be disappointed.