Hitachi Energy Project Manager With Coronary Artery Disease and Cognitive Impairment Wins North Carolina Lincoln Financial Long-Term Disability Insurance Appeal After Benefits Terminated at 24 Months

Lincoln Financial terminated long-term disability benefits for a North Carolina Hitachi Energy project manager after more than three years of payments — cutting him off precisely when the policy definition shifted from own occupation to any occupation. Our client had suffered a heart attack, required coronary stent placement and a pericardial window procedure, sustained a cerebrovascular infarction, and continued to experience crushing fatigue, shortness of breath, and progressive cognitive decline. None of that changed when Lincoln decided to stop paying.

This is a pattern we have seen from Lincoln Financial over and over again. The insurer pays benefits through the own occupation period, then uses the 24-month definition change as an opportunity to terminate — relying on paper reviews from hired physicians who never examine the claimant. We have handled thousands of Lincoln Financial disability insurance claims, and the playbook rarely changes. We appealed, and Lincoln reversed its denial in full — reopening the claim and paying all back benefits.

Below, we break down exactly how Lincoln built its denial, why it failed, and what we did on appeal to force the reversal. If Lincoln Financial or any other disability insurance company has denied or terminated your benefits, speak with one of our disability insurance lawyers for a free consultation. We represent claimants nationwide, and you pay nothing unless we recover your benefits.

Table of contents

• Why this case matters for every Lincoln Financial claimant
• The 24-month definition change and Lincoln’s denial strategy
• Lincoln’s paper reviews — contradictions built into the denial
• How Lincoln dismissed the treating providers
• The vocational analysis that ignored reality
• Building the appeal — filling every gap Lincoln created
• The FCE: below sedentary on every relevant measure
• The cognitive functional assessment: objective proof of decline
• Lincoln reverses in full
• If Lincoln Financial has denied your disability benefits

Why This Case Matters for Every Lincoln Financial Claimant

The 24-month mark is the most dangerous point in any Lincoln Financial disability claim. Most group long-term disability policies shift the definition of disability from “own occupation” to “any occupation” after 24 months of benefit payments. A 24-month definition change means the insurer no longer asks whether you can do your own job — it asks whether you can do any job. Lincoln used this transition to terminate benefits for our client despite paying him for more than a year into the any-occupation period.

Paper reviews that contradict each other can still be used to deny your claim. Lincoln’s own cardiology reviewer found ongoing restrictions and disagreed with the treating cardiologist — yet Lincoln still concluded our client could work full-time. The neurology reviewer dismissed cognitive impairment entirely because no formal cognitive testing existed in the file. Two reviewers, two contradictory approaches, one predetermined outcome: denial.

When an insurer tells you exactly what evidence is missing, that is a roadmap for your appeal. Lincoln’s neurology reviewer denied cognitive restrictions specifically for “lack of measurable evidence such as cognitive analysis/assessment.” We obtained both a Functional Capacity Evaluation and a Cognitive Functional Assessment — and Lincoln reversed within weeks of receiving them.

Your treating provider’s response to insurer contact letters matters enormously. Lincoln sent physician contact letters to our client’s treating nurse practitioner twice. Both times, she responded with brief, conclusory opinions and no supporting documentation. Lincoln cited this both times to justify disregarding her findings. Providers must respond with detailed, evidence-backed opinions — or the insurer will use the weak response against the claimant.

Social Security disability approval does not protect your private long-term disability benefits. Lincoln explicitly acknowledged that the Social Security Administration had approved disability benefits for our client — and stated in the same breath that the SSA decision does not determine entitlement under the group policy. Claimants cannot assume that one approval guarantees the other.

The 24-Month Definition Change and Lincoln’s Denial Strategy

Our client worked as a Project Manager for Hitachi Energy USA, overseeing high-voltage engineering projects with significant profit-and-loss responsibility. He held a Bachelor of Science in Electrical Engineering and had spent more than three decades advancing from Sales Engineer to Project Manager — a career that demanded complex analytical reasoning, sustained concentration, and the ability to manage large-scale international operations.

His disability began when he suffered a silent heart attack while exercising. He required emergency coronary stent placement in his left circumflex artery, followed by a second surgery for pericarditis that necessitated a pericardial window procedure — an operation to drain fluid that had accumulated around his heart. He was subsequently hospitalized again for unexplained weight loss, and a brain MRI revealed a chronic stroke with evidence of prior bleeding in the right frontal region, along with numerous small areas of vascular damage in both hemispheres consistent with longstanding hypertension. Over the following years, his medical picture continued to worsen. His diagnosed conditions included coronary artery disease status post stent placement, cerebral infarction, pericardial effusion, hypertension, hyperlipidemia, obstructive sleep apnea, cognitive impairment, major depressive disorder, generalized anxiety disorder, and post-traumatic stress disorder.

Echocardiograms confirmed progressive cardiac dysfunction. His most recent study showed a left ventricular ejection fraction (LVEF) of 40–45% — a measure of how effectively the heart pumps blood with each beat, where values below 50% indicate weakened cardiac function. The study also revealed lateral wall hypokinesis (reduced movement in a section of the heart wall), grade I diastolic dysfunction (impaired ability of the heart to relax and fill between beats), and mild mitral valve regurgitation. An earlier myocardial perfusion study had shown a reversible anterolateral defect with decreased LVEF and anterolateral hypokinesis — findings consistent with ongoing ischemic damage from his prior heart attack.

Our client was also managing severe psychiatric conditions that compounded his physical limitations. Over more than a year of biweekly psychotherapy with a licensed clinical social worker, he consistently presented with depressed mood, anxiety, PTSD symptoms, poor recent memory, variable attention, and functional impairment rated as moderate to severe. Standardized screening placed his depression at severe levels (PHQ-9 scores of 20–25), his anxiety at severe levels (GAD-7 scores of 19–21), and his PTSD symptoms well above clinical thresholds (PCL-5 scores of 46–69). His therapist repeatedly documented that he was not capable of returning to work.

To manage these overlapping conditions, our client took multiple daily medications including three blood pressure medications (Amlodipine, Carvedilol, and Losartan/Hydrochlorothiazide), daily aspirin, two cholesterol-lowering agents (Ezetimibe and Repatha), thyroid medication (Levothyroxine), and an anti-inflammatory for arthritis (Meloxicam). The medication regimen itself reflected the complexity and severity of his health profile.

Lincoln had already narrowed the claim before terminating it entirely. The group policy contained a 24-month limitation on benefits for disability due to mental illness or substance abuse. Lincoln applied that limitation to cap our client’s psychiatric benefits, which expired after 24 months of payments. After that, the only remaining basis for benefits was his physical and cognitive impairments — and Lincoln targeted those next by using the any-occupation definition change to terminate the claim altogether. This was not a single denial decision. It was a systematic effort to eliminate the claim in stages.

Under the group disability policy issued through Hitachi Energy, the definition of disability during the elimination period and the first 24 months required proof that the claimant could not perform the material and substantial duties of his own occupation. After 24 months, the standard shifts to “any occupation.” Under an “any occupation” standard, a claimant must prove inability to perform, with reasonable continuity, the material and substantial duties of any job for which he is reasonably fitted by training, education, experience, age, and physical and mental capacity. Many claimants ask what happens when disability insurance changes from own occupation to any occupation — and this case illustrates the answer. Under the Employee Retirement Income Security Act of 1974 (ERISA), group disability policies are governed by federal law, and claimants have 180 days to appeal a denial.

Lincoln approved the claim and paid benefits for more than three years — well past the 24-month mark. This meant Lincoln itself had already determined, for more than a year into the any-occupation period, that our client’s impairments were incompatible with sustained employment. Then, without any meaningful change in his medical condition, Lincoln terminated benefits.

Lincoln’s Paper Reviews — Contradictions Built Into the Denial

A paper review — sometimes called a file review — is when an insurance company hires a physician to review a claimant’s medical records without ever examining the claimant in person. The insurer relied on two paper reviews to terminate benefits, and neither withstands scrutiny.

The Cardiology Review: Restrictions That Lincoln Ignored

Lincoln retained a physician board-certified in Cardiovascular Disease and Internal Medicine, Dr. Andre Akhondi, to review the claim file. Dr. Akhondi concluded that our client had ongoing impairment requiring restrictions and limitations, effective through the present and ongoing. He acknowledged the full scope of our client’s cardiac history and documented restrictions including:

• Standing limited to frequently; walking limited to occasionally
• Lifting, carrying, pushing, and pulling limited to occasionally, up to 20 pounds
• Climbing stairs, balancing, stooping, kneeling, crouching, and crawling all limited to occasionally
• Overhead reaching limited to occasionally

Critically, Dr. Akhondi disagreed with the treating cardiologist, who had stated that our client required no cardiac-focused restrictions. Dr. Akhondi explained that given our client’s advancing age, underlying coronary artery disease, history of pericardial effusion, mildly decreased left ventricular ejection fraction, and ongoing complaints of shortness of breath and fatigue, restrictions were necessary to avoid worsening symptoms and mitigate the risk of injury.

Yet the insurer used this same review — the one that confirmed ongoing restrictions — to conclude that our client could work full-time in sedentary management positions. Lincoln cherry-picked the physical capacity findings while ignoring the chronic fatigue, cognitive decline, and the review’s own acknowledgment that our client’s conditions predisposed him to future complications.

The Neurology Review: Dismissing Cognitive Impairment for Lack of Testing

Lincoln also retained Dr. Jonathan Marehbian, a board-certified neurologist, to evaluate the claim from a neurological perspective. Dr. Marehbian acknowledged our client’s history of cerebrovascular accident and his complaints of cognitive issues — concentration difficulties, memory impairment, and problems staying on task. Multiple treating providers had consistently documented these deficits over an extended period.

But Dr. Marehbian concluded that no neurological restrictions were warranted. His reasoning: the file contained no formal cognitive testing or assessment from more than a year before the denial onward. He acknowledged the complaints existed but dismissed them because they were not accompanied by “measurable evidence.”

This reasoning is a tactic we see constantly in disability insurance denials. The reviewer sets a standard — formal cognitive testing — that does not exist in the file, then uses its absence to deny the claim. Meanwhile, the insurer never ordered cognitive testing itself, despite having the option to require an independent medical examination or neuropsychological evaluation at any time.

How Lincoln Dismissed the Treating Providers

Our client’s treating nurse practitioner had documented significant restrictions in her Attending Physician’s Statements. She limited him to lifting and carrying only 10 pounds, restricted sitting, standing, walking, bending, squatting, climbing, crawling, and overhead reaching to approximately two hours per workday, and found moderate impairment in attention, concentration, memory, decision-making, and the ability to interact with others. She concluded he was unable to return to employment.

Lincoln sent physician contact letters to the nurse practitioner after both the cardiology and neurology reviews, giving her five business days to respond with any comments or changes. Both times, she responded with brief statements — noting that the patient’s cognitive issues, psychiatric symptoms, and physical limitations should be considered — but provided no detailed explanation or supporting documentation.

The insurer used this against her both times, noting in the denial letter that “no explanation for the medical opinion or supporting medical documentation were provided” by the treating provider. This is a deliberate strategy. The company creates a narrow window for the treating provider to respond, and when the response is anything less than a fully documented rebuttal, it cites the inadequacy of the response as grounds to disregard the provider’s opinion entirely.

The Vocational Analysis That Ignored Reality

A Transferable Skills Analysis (TSA) is a vocational review that identifies occupations a claimant could theoretically perform based on their skills, education, and the restrictions assigned by the insurer’s reviewers. Lincoln’s vocational specialist identified four occupations our client could allegedly perform:

• Project Director
• Branch Manager
• Promotion Manager
• Manager of Customer Technical Services

Every one of these positions requires sustained concentration, complex decision-making, stress tolerance, and the ability to work full-time with reasonable continuity. The vocational analysis was built entirely on the flawed foundation of Dr. Akhondi’s physical restrictions — which placed no limits on sitting — while ignoring the chronic fatigue, cognitive impairment, and emotional dysregulation that made sedentary management work impossible. It also disregarded the neurology reviewer’s finding that cognitive issues existed but could not be measured — a gap, not a disproof.

Building the Appeal — Filling Every Gap Lincoln Created

Attorney Jason Macri of our office assembled a comprehensive Lincoln Financial disability appeal that attacked every weakness in the denial and filled every evidentiary gap Lincoln had identified. The appeal strategy had three pillars:

• Obtain the objective testing Lincoln’s reviewers said was missing. We arranged for a comprehensive Functional Capacity Evaluation (FCE) and a Cognitive Functional Assessment (CFA) — the exact types of evidence Dr. Marehbian had cited as absent.
• Expose the internal contradictions in the insurer’s own reviews. Dr. Akhondi confirmed ongoing restrictions yet Lincoln concluded full-time work capacity. Dr. Marehbian acknowledged cognitive complaints but dismissed them for lack of testing that the company never ordered. The appeal laid out these contradictions in detail.
• Demonstrate that the insurer’s surveillance found nothing inconsistent with disability. Lincoln had conducted social media surveillance on two separate occasions, years apart. Both investigations found no activity inconsistent with disability — further undermining the claim that our client could sustain competitive employment.

The FCE: Below Sedentary on Every Relevant Measure

A Functional Capacity Evaluation is a standardized, multi-hour clinical assessment that objectively measures a person’s ability to perform work-related physical activities. Our client underwent a comprehensive FCE lasting approximately six and a half hours, conducted by a licensed occupational therapist. The results confirmed what his treating providers had been documenting for years: he could not sustain even sedentary employment.

Physical Capacity Findings

The Department of Labor defines sedentary work as involving primarily sitting, with occasional walking and standing, and lifting no more than 10 pounds. Our client’s measured tolerances fell below even this minimal threshold in critical areas:

• Sitting tolerance: 30 minutes continuously, four hours total — well below the six or more hours required for full-time sedentary work
• Standing tolerance: up to two hours total
• Walking tolerance: up to one hour total
• Typing speed: 13–15 words per minute, notably below average

Throughout the evaluation, the evaluator documented objective signs of fatigue — frequent sighing, huffing, deep exhalation, shortness of breath during moderate exertion, slowed movement, and decreased cadence during physical tasks. These observations confirmed that his limitations were not self-reported complaints but objectively measurable deficits.

Cognitive and Behavioral Observations

The FCE evaluator also observed significant cognitive and emotional deficits during testing. Our client demonstrated poor concentration, mental fatigue, low frustration tolerance, and irritability that required periodic redirection and breaks. These were not willful behaviors — they were consistent with the cognitive and emotional dysregulation that follows cerebrovascular and cardiac events.

The FCE concluded that our client was unable to return to work at any level, including sedentary employment, due to the combined impact of his conditions on his endurance, cognition, and emotional regulation. Validity indicators — including consistent grip strength measurements and heart rate increases exceeding 10 beats per minute during exertion — confirmed genuine effort throughout.

The Cognitive Functional Assessment: Objective Proof of Decline

The Cognitive Functional Assessment directly addressed the gap Dr. Marehbian had identified — the absence of formal cognitive testing. Our client underwent a comprehensive evaluation conducted by a licensed clinical psychologist, which included standardized assessments of intellectual ability, executive functioning, and effort validity.

The Critical Finding: Intellectual Ability vs. Executive Function

Testing revealed a striking disparity. On the Reynolds Intellectual Assessment Scales (RIAS-2), which measures general cognitive ability, our client scored in the above-average range — consistent with what you would expect from someone with a degree in Electrical Engineering and three decades of managing complex international projects. But on the Wisconsin Card Sorting Test (WCST-64), which specifically measures executive functioning — the ability to adapt to changing demands, solve problems, and shift strategies — his scores fell between the 1st and 7th percentiles. That means he performed worse than 93–99% of the population on the cognitive skills that were once central to his professional success.

This pattern is a hallmark of acquired neurocognitive decline. The underlying intellectual capacity remains, but the executive functions — planning, organizing, decision-making, and sustaining mental effort — have deteriorated. The evaluating psychologist concluded that our client did not possess the cognitive capacity to return to work in any occupation, particularly one requiring the sustained concentration and complex reasoning his career had demanded.

Behavioral Presentation During Testing

During the evaluation, the psychologist observed markedly irritable and easily frustrated behavior, tangential thought processes, labile affect that shifted unpredictably between anger and inappropriate laughter, and rapid, pressured speech. These observations were consistent with the treating providers’ notes documenting progressive cognitive and emotional deterioration over the preceding years.

Lincoln Reverses in Full

After receiving the appeal, Lincoln reversed its denial. The company reopened the claim and paid all back benefits dating to the termination date. The approval letter confirmed that upon review of the additional information provided, the medical evidence supported our client’s claim for benefits.

This outcome did not happen by accident. The insurer denied benefits because the claim file lacked the objective testing its own reviewers demanded. We obtained that testing, presented it alongside a detailed attack on the contradictions in the paper reviews, and forced the reversal. As attorney Jason Macri argued in the appeal, Lincoln’s own history of paying benefits for more than a year into the any-occupation period was itself evidence that our client’s impairments were incompatible with sustained employment — and nothing in the medical record had changed. That is the difference between hoping an insurer will do the right thing and building a record that leaves it no room to refuse.

If Lincoln Financial Has Denied Your Disability Benefits

If you are facing a denial or termination of long-term disability benefits from Lincoln Financial — particularly at the 24-month definition change — the appeal deadline is critical. Under ERISA, you have 180 days from the date of the denial letter to file your appeal, and whatever evidence you submit during that window is likely the only evidence a court will ever see if the case proceeds to a Lincoln Financial disability lawsuit.

Our office has represented tens of thousands of disability insurance claimants since 1979 and has recovered more than $2 billion in benefits. We understand how Lincoln builds its denials, and we know how to dismantle them. We have won appeals for claimants in similar situations, including:

• A nurse whose Lincoln benefits were denied after the 24-month definition change
• A corporate attorney whose benefit termination was reversed on appeal
• An occupational therapist denied at 24 months whose claim we won back

If you need help with a Lincoln Financial disability claim — or a claim with any disability insurance company — speak with one of our long-term disability lawyers today. The consultation is free, and you pay nothing unless we recover your benefits.