Lincoln Reverses Disability Benefit Denial For Patient Care Coordinator

Our client, a former Coordinator of Rehabilitation Services suffering from a multitude of chronic pain conditions, was denied long term disability benefits by Lincoln during her transition from short term to long term disability. Despite having determined our client to be disabled during the short-term disability period, in denying long term disability benefits Lincoln essentially argued that the same medical information used to approve benefits was now being used to deny benefits- an all-too-common scenario.

Our client’s denial of benefits was predicated on the file reviews of three medical doctors, none of whom ever examined our client or spoke to her treatment providers, who determined that despite our client’s multiple medical conditions would have the ability to work at a sedentary demand level. This opinion would not have necessarily been detrimental to her claim had it not been for the fact that Lincoln had misclassified our client’s pre-disability occupation as a Medical Social Worker, which is classified as a sedentary demand occupation by the Department of Labor. 

The Lincoln Disability Appeal

In appealing Lincoln’s denial Attorney Jessup knew that establishing the correct classification of our client’s occupation would be crucial. Utilizing the job description from our client’s employer, occupational information from various government resources and a vocational assessment Attorney Jessup was able to make a strong case for our client’s pre-disability occupation being a light demand level occupation. In doing so Attorney Jessup was able to argue that the opinions of Lincoln’s medical reviewers supported disability as they had opined our client was only capable of sedentary work.

Although that may have been enough to get the denial overturned, Attorney Jessup was considering our client’s claim into the future. Like most disability policies, our client’s policy with Lincoln provided 24 months of disability benefits if one is unable to perform the duties of their own occupation, after that the definition of disability would change to mean the inability to perform the duties of any occupation one would be qualified for based on training, education and experience. Attorney Jessup knew that Lincoln could very well approve our client during the own occupation stage and then deny her at the any occupation stage by identifying sedentary occupations she would be capable of performing.

To give our client the best chance of staying on claim into the any occupation period and to set the groundwork for the claim going forward Attorney Jessup sent our client for a Functional Capacity Examination (FCE) to determine functional restrictions and limitations. The FCE determined, based on the culmination of the testing, that our client would not be capable of any work activity. Attorney Jessup then sent questionnaires to each of our client’s doctors, specific to the conditions they treated our client for, to obtain additional information and opinion in support of disability.

Lincoln notified Attorney Jessup prior to the expiration of their 45-day review period that it was approving our client claim.

Make sure you are protecting your disability benefits.

Our client’s case highlights the importance of accurate job classification, and the challenges claimants may face when their occupation is misclassified. Job descriptions and the DOT may not accurately reflect the physical demands of a particular job, which can lead to a denial of benefits for claimants who are unable to perform the duties of their actual occupation leaving you having to fight for benefits that should have never been denied.

The laws that govern employer provided policies are very favorable to the insurance industry and your last chance to provide information establish entitlement to benefits will be during the appeal process. If your claim has been denied please feel free to reach out to our office to speak with Attorney Jessup or another one of our disability attorneys.