Lincoln Reversed Decision to Deny Benefits of Project Manager Suffering from Chronic Paroxysmal Hemicranial Cluster Headaches
Attorney Rachel Alters filed an appeal after Lincoln denied long-term disability benefits to a Project Manger suffering from chronic paroxysmal hemicrania/hemicranial cluster headaches, cervicalgia, and osteoarthritis of the temporomandibular joint bilaterally, which prevented her from being able to perform with reasonable continuity each of the main duties of her regular occupation. It was evident from review of the denial letters and claim file that Lincoln had failed to understand the significance of the claimant’s medical condition and its impact on her ability to perform the main duties of her occupation.
Two appeals were filed on the claimant’s behalf, the first by the claimant and the second by Dell Disability Lawyers. After conducting a second internal review Lincoln determined it decision to deny LTD benefits was wrong, paid all of her past benefit since December of 2012 and put the her back on claim.
Paroxysmal Hemicrania/Hemicranial Cluster Headaches
According to the National Institute of Neurological Disorders and Stroke, paroxmal hemicrania is “a rare form of headache that usually begins in adulthood. Patients experience severe throbbing, claw-like or boring pain usually on one side of the face; in, around or behind the eye; and occasionally reaching to the back of the neck. This pain may be accompanied by red and tearing eyes, a drooping or swollen eyelid on the affected side of the face, and nasal congestion. Patients may also feel dull pain, soreness or tenderness between attacks. Attacks of paroxysmal hemicrania typically occur from 5 to 40 times per day and last 2 to 30 minutes. This disorder has two forms: chronic, in which patients experience attacks on a daily basis for a year or more, and episodic, in which the headaches may remit for months or years. Certain movements of the head or neck or external pressure to the neck may trigger these headaches in some patients. The disorder is more common in women than in men.”
The Mayo Clinic defines cluster headaches as follows: “Cluster headaches occur in cyclical patterns or clusters, which gives the condition its name. Cluster headache is one of the most painful types of headache. Cluster headache commonly awakens you in the middle of the night with intense pain in or around one eye on one side of your head. Bouts of frequent attacks, known as cluster periods, may last from weeks to months, usually followed by remission periods when the headache attacks stop completely. During remission, no headaches occur for months and sometimes even years. Fortunately, cluster headache is rare and not life-threatening. Treatments can help make cluster headache attacks shorter and less severe. In addition, medications can help reduce the number of cluster headaches.”
The claimant began suffering from the above-described severe headaches during the third trimester of her pregnancy. After she gave birth to her son, the headache pain significantly worsened and became completely debilitating. The medical records that were provided to Lincoln documented attempts to diagnose and treat her condition. She had been evaluated by numerous physicians and specialists: neurologists, otolaryngologists, an oral and maxillofacial surgeon, orthopedic surgeon, chiropractor, acupuncturist, ophthalmologist, pain specialist, as well as her primary care physician. She has undergone multiple MRIs of her brain, as well as her TMJ and cervical spine. She has endured EMGs, nerve conduction studies, ECGs, and has been tried on numerous medications and even botox injections. Though she had been able to obtain some relief, the severe, debilitating headaches defined as paroxysmal hemicrania or hemicranial cluster headache continued.
Lincoln Conducted a Substandard Review of the Claim
In review of the first appeal, Lincoln sent her file to an internal medicine physician for a paper review of the medical records. The physician did not meet, examine, or speak with the claimant, nor did she attempt to speak with any of her multiple treating physicians for further insight into her medical condition.
Lincoln’s physician rendered the following opinion:
“The claimant is unable to perform safety sensitive duties such as no working at heights, no operating heavy machinery and no driving commercial vehicles. The evidence within the file does not support findings of warranted restrictions and/or limitations that would preclude the claimant’s ability to perform in her own sedentary occupation from 6/15/2012 forward… The records support that the claimant is able to fulfill activities of daily living (ADLs) and care for her infant and her family. The records do not support total inability to work. The claimant would be capable of performing in her own sedentary occupation.”
Based on the above opinion, Lincoln made the decision to uphold the denial her claim for long term disability benefits. However, Lincoln neglected to address why it failed to give weight to the contrary opinions of her treating physicians that she was not capable of working, nor did they address why its doctor did not give any weight to the opinions and findings of the treating physicians or what evidence her proposed restrictions and limitations were based on. As such, it was apparent that Lincoln accepted the opinion that suited their goal of denying the claim for LTD benefits, against the weight of the actual medical evidence from the treating providers which lends to a contrary finding that the claimant is disabled under the Long Term Disability Policy. Attorney Alters submitted a second appeal addressing each issue presented in Lincoln’s denial letter and submitted supporting opinions from several of the claimant’s treating physicians all attesting to her inability to work. After conducting another review, Lincoln overturned its original decision to deny her benefits, paid her past benefits owed to her and put her on claim.
Dell Disability Lawyers will continue to manage her claim to help ensure she remains on claim until she is well enough to return to work.
Resources to Help You Win Disability Benefits
Disability Benefit Denial Options
Submit a Strong Lincoln Financial Appeal Package
We work with you, your doctors, and other experts to submit a very strong Lincoln Financial appeal.
Sue Lincoln Financial
We have filed thousands of disability denial lawsuits in federal Courts nationwide against Lincoln Financial.
Protect Your Benefits
Get Your Lincoln Financial Disability Application Approved
We help claimants throughout the entire application process.
Prevent a Lincoln Financial Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.
Negotiate a Lincoln Financial Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Lincoln Financial Reviews
(652)
Policy Holder Rating
5
0%
4
0%
3
1%
2
55%
1
43%
Timely Payments
2.0out of 5
Handling Claim
1.9out of 5
Customer Service
2.0out of 5
Dependable
1.8out of 5
Value
2.0out of 5
Showing 8 of 652 Reviews
Lincoln Financial
Never received benefits my entire leave - or help with them
I used my short term disability insurance for maternity leave and started the process beforehand knowing when I would be out (scheduled induction.) It took a little over a... read more >
Lincoln Financial
Well Documented correspondence
I read other situations and it’s all very similar to my case. I have received STD from May 2023 and when my FMLA run out LF would not respond or answer my calls. My last... read more >
Lincoln Financial
Lincoln Financial made my life a living hell
Lincoln Financial made my life a living hell. I went on medical leave from my job just to work for them basically. My mental health is worse than it was and I still do not... read more >
Reply
Lincoln Financial
Lincoln Financials wants to claw back my money
Lincoln financial wants to claw back money from ssi and we had two employers so I got disability from both employers one used Lincoln one used Cal EDD for short term so we... read more >
Reply
Lincoln Financial
This is the second time I've been shorted in my check
I have been out of work since 3/25/21. I had to jump thru hoops to get an extension from 4/28/21 to 6/13/21. I have had MRI, x rays which showed anuerysmal tumor on my fib... read more >
Lincoln Financial
Lincoln Financial denied my STD claim because one doctor didn't send them my medical information.
In late January 2021 I was referred to a Doctor I meet her for 15 minutes she ordered some X-rays and blood work. In mid Feb I called to change my next appointment due to ... read more >
Reply
Lincoln Financial
Lincoln cancelled my benefits because my doctor's notes were handwritten
I have been on a short term disability since June of 2020. I was paid additional benefits through Lincoln Financial after SDI paid me. In august of 2020, Lincoln Financial... read more >
Reply
Lincoln Financial
Lincoln denied my disability claim even though Dr said I couldn't work
My Doctor took me out of work starting October 12, 2020 due to GI illness. I am unable to work. Lincoln denied my disability claim.
Reply
Answered Questions by Our Lawyers
(51)
Showing 8 of 51 Answered Questions
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 >
Helpful Videos
(904)
Showing 12 of 904 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips
Has Lincoln Contacted You About Your Liberty Disability Claim?
Earlier this year Lincoln Financial and Liberty Mutual Insurance Group entered into an agreement in which Lincoln purchased Liberty Life Assurance Company of Boston, the group disability and life insurance group benefits portion of Liberty Mutual Insurance Group. For insured with disability or life insurance benefits provided by their employer, Liberty Life Assurance Company of Boston is most commonly known as... Read More >
Is Lincoln Relying on MDGuidelines to Review Disability Appeals?
I have recently reviewed first level appeal denial letters from Lincoln in which Lincoln appears to be relying on information through the website/software MDGuidelines as opposed to an internal medical review or a medical review performed by an outside peer reviewing physician. In both instances the initial denial of benefits was predicated upon the review of a doctor identified in the denial letter, to includ... Read More >
Lincoln Financial to Buy Liberty Life - Does This Affect My Disability Claim?
On January 19, 2018, Lincoln Financial Group announced that they are buying Liberty Life / Liberty Mutual’s Group Benefits business for $3.3 billion. Lincoln claims that the combined company would be the number one seller of Disability sales with a 14 percent market share.As disability insurance attorneys that have handled hundreds of claims with both Liberty and Lincoln we think that this merger is a go... Read More >
What Can A Claimant Expect With A Lincoln Financial Group Disability Claim?
Lincoln Financial group is one of the larger disability insurance companies. In this video disability insurance attorneys Gregory Dell and Stephen Jessup provide a lawyer's perspective on handling a Lincoln Financial disability insurance claim.We discuss common trends that we see when helping claimants to recover disability benefits from Lincoln Financial. W... Read More >
Do You Know The Job Requirements To Be A Lincoln Financial Disability Claim Specialist?
As a disability lawyer that has handled thousands of disability insurance claims I often wonder about the qualifications and experience of the disability company employee that is making the decision to approve or deny my client's claim. During our routine activities of watching The Lincoln Financial Group, I came across an internet job posting for an "Associate LTD Benefit Specialist" at Lincoln Financial in A... Read More >
Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?
When it comes to securing your disability insurance benefits, it's vitally important that your disability insurance lawyer thoroughly understands the symptoms and impact of your disabling condition. Doctors can help you create strong medical records, but they're not accustomed to dealing with the rigorous documentation disability insurance companies require. Lea... Read More >
Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak
If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >
Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company
When you're seeking disability insurance benefits, your medical records and treating physician's statement are two of the most important components of your claim. But because the insurance company has a vested interest in denying your disability insurance claim, it often will rely on tactics like ambushing your doctor with a phone call in an attempt to get them ... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases
Nurse Denied Long-term Disability Benefits by Lincoln After the Definition of Disability Changed
Our client, a registered nurse for Dignity Health, found herself in a difficult situation after being diagnosed with lumbar spondylosis and left knee arthritis. She continued to work, however, struggled while attempting to work through chronic lower back pain and left lower extremity radicular symptoms on a daily basis. Sadly, her condition failed to improve and... Read More >
Lincoln Reverses Decision to Terminate LTD Benefits of Corporate Attorney after Dell Disability Lawyers Appeals the Decision
The claimant is an 64 year old former Corporate Attorney and at a prominent Florida business law firm who was forced to cease working in his highly successful and rewarding profession, job, and career on January 27, 2021, and to seek disability compensation under his policies with Lincoln due to severe symptomatology stemming from or following a viral COVID-19 i... Read More >
Lincoln Denies Disability Insurance Benefits to 66 Years old Software Developer with Long Covid and MS
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.... Read More >
Lincoln LTD Denial Reversed for an Occupational Therapist that was Denied Benefits After 24 Months
Our now client came to us after she received a denial letter following her receipt of long term disability benefits (“LTD”) for a period of 24 months. This is very common as with any denied claim, at the 2-year mark is when many ongoing claims are denied. Why? Typically group long term disability insurance policies have special provisions that kick after 24 months of be... Read More >
FPL Lineman Wins Lincoln Disability Denial Appeal
Lincoln Life Assurance Company of Boston improperly denied our client’s long-term disability benefits. Prior to filing for disability, our client was employed as a Line Specialist-Early for FPL (Nextera Energy, Inc.). According to the Position Summary, the material and substantial duties of his occupation include but are not limited to:Position Summary:... Read More >
Attorney Alexander Palamara of Dell Disability Lawyers gets LTD Benefits Reinstated for former Walmart Manager who is now found disabled from Any Occupation
A former Manager of Quality Assurance at Walmart is again receiving Long Term Disability (LTD) benefits following an appeal filed by Dell Disability Lawyers. Our now client was only recently hired by Walmart in May of 2017. He loved his job and began to shine at his occupation until he unfortunately suffered a serious shoulder injury in late 2017. After this initial shoulder injury, additional injuries ... Read More >
Lincoln Approves Long Term Disability Benefits After Four Year Fight
With financial protections afforded to disability insurance companies under ERISA that insulate them from extra contractual damages there is very little financial disincentive to deny long term disability benefits to an insured. This is especially true of disability applicants who are high wage earners whose resulting monthly disability benefits are extremely high. In our experience, insurance companies will g... Read More >
Lincoln National LTD Denial for Pre-Existing Condition Reversed on Appeal
On December 8th of 2020, a new employee at ServerCentral, now known as Deft, a well-known IT infrastructure provider, found himself in the Emergency Room due to facial numbness and confusion. This ER visit was unfortunately not something new for him as he had just been there two weeks prior in late November due to a headache and dizziness. With this visit ... Read More >
Disability Lawsuit Stories
(765)
Reviews from Our Clients
