Lincoln Denies LTD Claim Even Though Claimant’s Condition Was Deteriorating
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 infection and subsequent diagnoses of (i) COVID pneumonia and related chest pain, chest tightness and breathing difficulties/shortness of breath, (ii) bladder and enlarged prostate (and urinary control and incontinence) issues, and (iii) acute “brain fog” (post-acute sequelae of COVID-19 or “PASC”), chronic fatigue, disequilibrium and severely impaired attention, memory, cognition and ability to focus, concentrate, process, learn and function at any meaningful or functional level, as well as headaches, visual distortion, balance disorder, anxiety and depression. Lincoln abruptly, unreasonably and without medical or other support or justification terminated his LTD claim, without any documentation or evidence of improvement. In fact his condition was in some ways deteriorating, and clearly not improving.
Lincoln’s decision to terminate our client’s claim for LTD benefits was not only unfounded and wrong but an abuse of discretion under the LTD policy. There was no proper grounds or defensible basis upon which to terminate LTD benefits as the medical evidence – including the diagnoses, assessments and findings of his attending physicians, based on examinations, tests, scans, review of medical records and extensive neurocognitive testing and statements of treating physicians – substantiated an ongoing severity of impairments that would not allow for any reasonable or reliable return to the demands, functions, or requirements of his highly demanding, high-stakes, high-intensity and complex job and occupation.
Extensive Neurocognitive Testing Supports Ongoing Disability
It is beyond reason and comprehension how Lincoln could terminate the claimant’s LTD benefits considering the content, nature and extent of medical evidence substantiating his ongoing disability. His severe cognitive impairments alone, as confirmed by his multiple treating physicians and recognized by UHealth’s neurocognitive testing and the UHealth Report, clearly prevent him from reasonably or reliably performing his high-level, sensitive, and complex occupational duties. It is evident that Lincoln did not afford adequate (or any) weight or consideration to the severe cognitive deficits and the detrimental effects that they would impose on his employer, colleagues, and clients should he return to work in his role as a Corporate Attorney. While Lincoln asserted as a basis for its denial suboptimal effort during neuropsychological testing, the neuropsychological report itself confirmed that “the claimant’s behavior during the evaluation was indicative of appropriate effort. Relying in part on biased opinions of its own medical consultants (so-called “Peer Reviews” arranged and paid-for by Lincoln, as referenced in its adverse claim determination letter), who never examined, observed or contacted him, Lincoln erroneously concluded he was no longer disabled in accordance with the terms of the LTD policy.
Lincoln based its denial primarily on the opinions of Dr. Peggy Geimer, a peer review physician, who opined “the records failed to reasonably support any medical diagnoses that are the cause of impairment or the need for restrictions or limitations after 2/19/21, further (incorrectly) noting there was never a referral to post-acute COVID clinic or physical therapy for evaluation and treatment.” Lincoln was well aware that the claimant had been referred by his doctors to a post-acute COVID clinic for evaluation and treatment at the time they denied his claim, yet they chose to ignore this and failed to request the records. Specifically, in a medical record and letter dated January 20, 2022, by Dr. Grosz, MD/Neurology, Dr. Grosz referred him to a cognitive neurologist at a tertiary care center for further evaluation with an eye towards cognitive rehabilitation. Lincoln was clearly aware of this referral, yet never requested the records (which were extremely supportive of his inability to work), terminated his benefits without first reviewing this pertinent information and then accused him of failing to follow up with the proper specialist. Lincoln’s actions, and inactions were an abuse of discretion under his LTD policy.
In arriving at its adverse claim determination, Lincoln – in a clear and damaging abuse of discretion – ignored the relevant medical evidence and relied solely on the biased opinions of its own contracted medical consultants who, unlike the claimant’s treating physicians, never examined or tested (or requested to examine of test) of his physical, mental, or cognitive functional capacities. Based solely on a “paper review”, Lincoln’s consultants irresponsibly looked for and highlighted selected information and wrongfully concluded that he no longer had restrictions or limitations that would prevent him from functioning and working in his job and occupation as a Corporate Attorney as of June 25, 2021. The so-called “peer review” opinions lacked any factual basis, were conclusory and were clearly unfounded in light of the claimant’s telling and significant medical history and examination findings.
After reviewing the appeal submitted by Attorney Rachel Alters, Lincoln overturned the erroneous determination, paid all the back benefits owed to the claimant and he is currently received monthly disability payments. Attorney Alters is currently managing his claim to help ensure Lincoln continues to pay these benefits until he is able to return to work.
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