Lincoln Denies Disability Benefits to 66 Years old Software Developer with Long Covid and Multiple Sclerosis
Our client came to us after he was denied continued Long Term Disability (LTD) benefits by The Lincoln National Life Insurance Company. Previously employed as a Software Developer for Novo Nordisk, the multinational pharmaceutical company, after years of service our client found he could no longer work following a severe case of Covid 19 which left him hospitalized for 30 days.
Following the Covid infection, this Software Developer continued to have symptoms associated with PACS (post-acute covid syndrome). Additionally, his covid infection complicated his past diagnosis of Relapsing-Remitting Multiple Sclerosis. His symptoms included (and include) debilitating fatigue, shortness of breath and cognitive decline which include processing issues, forgetfulness, difficulty with concentration, taking longer to do things and exhaustion. All of this led to him being unable to perform his high intellectually demanding career as a software developer.
Fortunately, his employer provided him with Disability Insurance coverage and that coverage was with The Lincoln National Life Insurance Company.
Following his stopping work in February of 2021, our client quickly made a claim for LTD benefits which was initially approved by Lincoln. Benefits started in early August of that year and benefits were paid consistently and on-time. It all seemed too easy and, unfortuantely, it was. However, when dealing with a disability insurance company, no one should never let their guard down.
Our client learned this when out of nowhere he received a denial letter in July of 2022.
The July 28, 2022 Denial of his Claim
By way of the aforementioned denial letter, Lincoln informed our client that it was denying additional benefits based upon the opinion of a hired Peer Review Consulting Physician who was of the opinion that ongoing restrictions were not supported. Keep in mind that this reviewing doctor, who was board certified in pulmonary diseases and internal medicine, never treated our client, never met our client and never even spoke with our client or the treating providers. However, based upon a review of some of the medical records in the file, this outside doctor believed his opinion to be superior than those of the treating providers, and Lincoln utilized this opinion to justify a denial of continued benefits.
Baffled by this denial and due to the fact that there was just no way that he could do his own occupation due to his medical conditions, our client found our firm and Attorney Alexander Palamara who quickly agreed to take on his claim.
Dell Disability Lawyers Hit the Ground Running
As soon as he was retained to represent this former Novo Nordisk employee, Attorney Palamara immediately ordered the claim file from Lincoln and quickly arranged for additional testing of his client to prove the various complaints that our client was suffering from. Attorney Palamara also reached out to the treating providers to garner additional support for this claim. Every piece of evidence that came all supported the contention that our client was prevented from performing the material and substantial duties of his own occupation.
For instance, Attorney Palamara sent his client to a Functional Capacity Evaluation (FCE) in an effort to show that he was physically functionally unable to perform the material duties of his occupation. The results of this testing showed that our client could not perform work even at a Sedentary Level. Additionally, Attorney Palamara sent his client to a Neuropsychological Evaluation. The results of this testing showed a decline in various ability to recognize, recall and retrieve information and that he had a decline in his overall neurocognitive functioning. The testing psychologist even stated that there was “valid, objective evidence… to support a claim of neurocognitive disability and neurocognitive deficits” and concluded that our client could not “meet the usual demand of his employment at this time.”
Not to be outdone, the treating providers of our client also wrote letters that supported the contention that our client was disabled. His Post-Covid treating provider wrote that due to the fact that our client had “daily symptoms, including fatigue, brain fog, and body aches”, it is recommended “that he remain out of work.” Additionally, his treating neurologist wrote that due to the notable exacerbations of MS following Covid, his patient was incapable of even low stress work.
Filing the Lincoln Financial Appeal and Getting a Quick Decision
With all our ducks in a row, the appeal almost wrote itself. Armed with so much support from the various testing the treating providers, Attorney Palamara gave Lincoln no choice but to reinstate this claim. And Lincoln did just that.
The appeal was filed on March 23, 2023. Although the governing ERISA laws give the insurance companies up to 90 days to provide an answer on the appeal, the reapproval letter was dated April 14, 2023. A decision in 3 weeks almost never happens. However, with the right plan of action, not only can an appeal be successful, but it can get the job done quickly.
Now that our client is back on claim, we understand that the fight is not over. In fact, it will never be over until our client recovers and is able to return to work or until our client ages out of policy coverage. However, our firm will continue to fight to ensure that our client gets all the benefits that he needs.
If you have been denied benefits by Lincoln or any disability insurance company, please do not hesitate to reach out to us for a free consultation. We would love the opportunity to speak with you and hopefully represent you in getting benefits you deserve.
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Answered Questions by Our Lawyers
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Q: LTD return to work? What if I require training or want to continue education, will I continue to receive payment during this period?
A: If you are still unable to perform the material duties of your occupation or any occupation then yes you shoul... Read More >
Q: What if I never received longterm policy and I never agreed or signed agreement fee with disability insurance company?
A: Erica:The repayment of government benefits such as ssdi or state disability benefits is allowed if your po... Read More >
Q: Should I accept the buyout from Lincoln Financial? I have 7 days to decide.
A: Kendra, it was a pleasure speaking with you today. Thank you for reaching out for the free consultation. We ar... Read More >
Q: Change in Occupation
A: The date is usually the date in which your LTD payments began. Read More >
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?
A: Kara, it would depend on the language in the policy. There is even a chance you could transition into long ter... Read More >
Q: Does Lincoln Financial apply offsets to all claimants equitably?
A: Jerry, yes, Lincoln Financial may seek to recover an overpayment of benefits pursuant to the contractual langu... Read More >
Q: Does payback to Lincoln Financial, once approved for SSDI, include the first year?
A: Bruce: Most group policies require payback for any month in which you received a full LTD benefit and then, su... Read More >
Q: Is LF's doctor, who never spoke with me or evaluated me, allowed to clear me for work?
A: Barb, I am sorry to hear of the stress that LFG is putting you through. Thankfully, it sounds like the 3rd par... Read More >
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