Charles Schwab Investment Product Director With Chronic Pain Syndrome Wins Colorado Lincoln Financial LTD Insurance Appeal After Denial
Lincoln Financial approved our client’s long-term disability insurance claim, paid benefits for ten months, and then cut him off. He was an Investment Product Director at The Charles Schwab Corporation in Colorado, forced out of a demanding executive role by chronic pain syndrome and a cluster of spinal, neurological, and cognitive conditions.
We have taken apart terminations like this one for decades, and we know exactly where they break down. Our appeal found every weak point, and Lincoln reinstated his benefits.
The turning point came from an unexpected source: one of Lincoln’s own doctors. If Lincoln or any other disability insurance company has denied or cut off your benefits, speak with one of our long-term disability lawyers. We represent claimants nationwide, and there is no fee unless benefits are paid.
Table Of Contents
- 1. Why this case matters for every Lincoln Financial claimant
- 2. A job built on focus, a body that would not cooperate
- 3. Lincoln cuts him off with two paper reviews and 54 minutes of video
- 4. We built the record Lincoln never bothered to build
- 5. Taking apart Lincoln’s paper reviews
- 6. Lincoln’s own appeal reviewer said he could work only part time
- 7. Lincoln reinstates his benefits
- 8. Speak with one of our lawyers today
Why This Case Matters for Every Lincoln Financial Claimant
We handle long-term disability insurance claims for chronic pain against every major carrier, and this Lincoln Financial appeal captures the problems we see in them most often.
“Part-time capacity” is a finding of disability when your job is full time. If your policy asks whether you can reliably perform your own full-time occupation, an insurer’s finding that you can work only part time is evidence that you cannot. Lincoln’s own appeal reviewer reached exactly that conclusion here. Read every insurer review line by line, because the strongest evidence may come from the insurer’s own doctor.
Answer every new peer review the insurer sends during your appeal. Under federal claims regulations, the insurer must share new evidence developed during an appeal and give you a chance to respond before denying the appeal. Lincoln commissioned two new reviews in the middle of the appeal and set a short deadline to respond. We rebutted both within a week, and Lincoln reinstated benefits four days later. Silence lets the insurer’s version of the record stand unchallenged.
In-person testing with validity checks beats a paper review. A functional capacity evaluation and formal neuropsychological testing measured what Lincoln’s reviewers only guessed at: endurance, concentration, and processing speed. Even Lincoln’s appeal reviewer accepted the functional testing as valid.
Make the insurer evaluate your real job, not a “sedentary” label. Lincoln reduced an investment executive’s role to sitting and typing. Sustained concentration, constant screen work, and fast, high-stakes decisions were material duties of his occupation, and the evidence tied each measured deficit to them.
Less than an hour of surveillance does not prove you can work 40 hours a week. Self-paced errands with rest in between say nothing about an eight-hour workday, or about what happens after the camera stops rolling.
A Job Built on Focus, a Body That Would Not Cooperate
Our client’s formal title was CSIM Product Director, a senior role within Charles Schwab Investment Management. Lincoln’s own occupational analysis, prepared by Sarah S, C.R.C., acknowledged that the work revolved around analyzing financial information on a computer, noting that “All of their tasks require the ability to utilize the computer and maintain frequent access to a computer screen.”
Lincoln still classified the job as sedentary, the lightest exertional category. Sedentary work, as federal regulations define it, involves lifting no more than 10 pounds at a time and sitting for most of the workday. That label captured almost nothing about what his job actually required:
- Developing investment strategies and building investment products
- Financial forecasting and investment performance analysis
- Oversight of portfolio management, product development, and compliance
- Ongoing communication with clients, consultants, and portfolio managers
- High-level buy and sell decisions affecting portfolio performance
Over several years, his health eroded on multiple fronts at once. Chronic pain syndrome (ICD-10 G89.4) is a condition in which chronic pain, meaning pain lasting longer than three months or beyond normal healing, combines with fatigue, poor sleep, and mood changes to disrupt everyday function. For our client, it sat on top of a long list of documented diagnoses:
- Cervical spondylosis with radiculopathy (M47.22), meaning degenerative neck disease pinching the nerve roots, with a prior two-level cervical fusion
- Lumbar radiculopathy (M54.16), with moderate bilateral foraminal stenosis at L5-S1, a narrowing of the passageways where the spinal nerves exit
- Fibromyalgia
- Chronic migraines striking about three times a week, with severe sensitivity to fluorescent and outdoor light
- Right hip osteoarthritis that required a total hip replacement
- Hypersomnia, leaving him sleeping or resting 16 to 18 hours a day despite medication
- Mild neurocognitive disorder
- Adjustment disorder with mixed anxiety and depressed mood (F43.23)
The decline did not go unnoticed at work. As he later told the neuropsychologist who evaluated him, “they knew I just wasn’t doing it.” He stopped working when pain, migraines, exhaustion, and slowed thinking made executive work impossible.
How Lincoln’s policy defined disability
He applied for long-term disability insurance benefits under his employer’s group policy, insured by The Lincoln National Life Insurance Company. The elimination period is the waiting period between the start of a disability and the first benefit payment, commonly 90 to 180 days. Once it ended, Lincoln approved the claim and began paying.
For the first 24 months, the policy used an own-occupation standard. Under an own-occupation definition of disability, a claimant qualifies if they cannot perform the material duties of their own job, even if they could do some other kind of work. After 24 months, the test shifts to whether the claimant can perform any occupation suited to their education, training, and experience.
During the own-occupation period, Lincoln’s policy asked only whether he was unable to perform “with reasonable continuity the Substantial and Material Acts necessary to pursue his Own Occupation in the usual and customary way.”
Two words in that sentence, reasonable continuity, would decide this case. In a disability insurance policy, reasonable continuity means performing job duties reliably, day after day, across a full workday and workweek, not just in short or occasional stretches.
Lincoln Cuts Him Off With Two Paper Reviews and 54 Minutes of Video
About ten months after benefits began, Lincoln terminated the claim. Nothing in the file showed that his conditions had improved. Lincoln built its decision on two paper reviews and a surveillance report instead.
A paper review, also called a file review or peer review, is a medical opinion from a doctor hired by the insurance company who reads the claimant’s records but never examines the claimant in person. If your disability insurance benefits were denied based on a paper review, the doctor whose opinion ended your claim never met you.
A psychiatric review that confused orientation with work capacity
Psychiatrist Briana Mizrahi, M.D., acknowledged adjustment disorder with mixed anxiety and depressed mood and persistent pain disorder. She even agreed that chronic pain was a leading cause of his depression and anxiety. She then pointed to therapy notes describing him as alert, oriented, and euthymic (a normal, stable mood), added the surveillance, and concluded:
“When considering the lack of significant abnormalities documented on psychotherapy notes, and considering activity on surveillance footage, including going to church, eating at a restaurant, and working with heavy equipment, the claimant would not be prevented from working in any capacity.”
Those same therapy notes described him shifting in his seat from pain, needing daytime naps for the first time, and struggling to keep his eyes open in the middle of a conversation. Dr. Mizrahi never reconciled any of it with her conclusion.
A physical medicine review that ignored its own findings
Du Pham, M.D., board certified in physical medicine and rehabilitation, accepted cervical spondylosis with radiculopathy, lumbar radiculopathy, chronic pain syndrome, and right hip osteoarthritis as impairing diagnoses. Yet the restrictions he assigned looked like those of a healthy man:
- Sitting unrestricted, with position changes allowed for comfort
- Standing and walking frequently
- Lifting, carrying, pushing, and pulling up to 30 pounds occasionally
- Bending, stooping, and kneeling frequently
- Keyboarding, typing, mousing, and gripping unrestricted
On fibromyalgia, Dr. Pham wrote simply: “No restrictions indicated for the diagnosis of fibromyalgia, based on the records provided for review.” On migraines, he asserted that no records mentioned an active treatment plan for headaches, so no limits on screen time were supported.
Surveillance of church, lunch, and a lawn aerator
Lincoln also hired CoventBridge Group to follow our client over four days. The investigators produced about 54 minutes of video showing him driving to church, eating at a restaurant, walking a dog, and operating a lawn aerator for roughly 35 minutes. Both reviewers treated that footage as proof he could work full time.
Silence from his doctors, counted against him
Lincoln sent the psychiatric review to his counselor and the physical medicine review to the physician he had identified as certifying his disability. The counselor did not respond, and the physician’s office said it would not comment on disability. Claims specialist Charles M. then closed the file:
“Based on the medical documentation received in relation to the requirements of your occupation, you no longer meet the definition of disability outlined above. Thus benefits are no longer payable and we must close your claim.”
We Built the Record Lincoln Never Bothered to Build
Can you appeal a Lincoln Financial disability insurance termination? Yes, and you must before you can sue. Because his coverage came through his employer, the claim was governed by the Employee Retirement Income Security Act (ERISA), the federal law that regulates most employer-sponsored disability insurance. ERISA’s claims procedure provision, 29 U.S.C. § 1133, requires plans to give every claimant a full and fair review of a denial. That review happens through an administrative appeal: a written challenge filed with the insurer.
Lincoln’s letter allowed 180 days to appeal, and we used that time deliberately. In most ERISA cases, the appeal record is the evidence a federal judge will review if the claim becomes a lawsuit under ERISA’s civil enforcement provision. So we gathered the evidence Lincoln never sought.
A functional capacity evaluation spread across three sessions
A functional capacity evaluation (FCE) is a standardized, hands-on test of how long and how well a person can sit, stand, walk, lift, and use their hands, with built-in checks on whether they gave full effort.
A licensed occupational therapist conducted our client’s FCE, and he could not get through it in one sitting. Every session ended early because of migraine, pain, and fatigue, none lasting longer than about an hour and a half. He also canceled two other appointments, one because he felt too sick and one because he overslept.
His effort was not in question. He produced consistent, valid results on 26 of 27 validity measures, and the evaluator documented:
- Maximum sitting tolerance of 26 minutes before hip pain, back pain, and sleepiness forced a position change
- Maximum standing tolerance of 22 minutes
- Walking limited to 100 feet during testing, with a slow, flat-footed gait
- No floor-to-knuckle or overhead lifting, and only sedentary-range lifting otherwise
- Grip strength in his dominant left hand significantly below the normal range
- Fine motor performance below the 10th percentile
- Significant light sensitivity, with a hand repeatedly raised to shield his eyes
In plain terms, he could not sit through a long meeting, let alone a workday. During dexterity testing he stopped talking entirely because he could not manage a conversation and the task at the same time. The evaluator called that “a major concern for his ability to react and respond to the urgency of the essential functions of his job duties.”
She concluded that he could not perform his own occupation on a full-time basis, and that he did not appear capable of maintaining any occupation full time.
Neuropsychological testing that measured the decline
Neuropsychological testing uses standardized tasks to measure attention, memory, processing speed, and other thinking skills, then compares the results with what is expected for that person. A neuropsychologist tested our client over two sessions. Her observations started before any scoring: he needed standing breaks to stay awake, covered his eyes during memory tasks, and asked for the lights to be dimmed.
The scores confirmed what his employer had noticed. In everyday terms, his brain was working slower and harder than it should for someone with his background, and new information was not sticking:
- Processing Speed Index at the 4th percentile, in the Borderline range, meaning he performed as well as or better than only 4 percent of comparable adults
- 18 test scores fell meaningfully below his own baseline (more than one standard deviation), when only 7 would be expected
- Overall performance about 11 T-score points below his estimated premorbid level, the ability expected of him before he became ill
- Extremely Low long-term verbal recall
- Extremely Low fine motor performance in his dominant hand
She diagnosed mild neurocognitive disorder due to another medical condition. Mild neurocognitive disorder is a measurable decline in thinking skills, such as attention, memory, or processing speed, that forces a person to work harder or compensate to manage everyday tasks.
She also cautioned that the scores alone understate his limitations, because chronic pain, fatigue, hypersomnia, depression, and anxiety compounded every deficit she measured.
A treating physician willing to put it in writing
Lincoln had used his doctors’ silence against him, so we made sure the appeal carried a treating opinion. His primary care internist reviewed years of records and specialist reports, then wrote that “the constellation of neurologic diagnoses, spine disorders, neuropathic conditions, cognitive impairment, and chronic pain results in impairment that is reasonably expected to severely limit his ability to engage in meaningful work and certainly prohibits his ability to work in his profession.”
Taking Apart Lincoln’s Paper Reviews
Attorney Alexander Palamara, a partner in our firm, wrote the appeal and paired the new testing with years of treatment records. Every argument went straight at the reasoning Lincoln had relied on.
A normal mental status exam is not a work capacity test
A mental status exam checks orientation, speech, mood, and thought process during a single office visit. As the appeal explained, it says nothing about whether a person can sustain concentration for eight hours, process complex financial data, or make investment decisions under pressure. Being oriented and cooperative during a 50-minute therapy session does not qualify anyone for executive work.
Chronic conditions do not work in isolation
Dr. Mizrahi evaluated depression and anxiety on their own, even after acknowledging that chronic pain drove them. Dr. Pham accepted fibromyalgia as a supported diagnosis, then dropped it from his impairment analysis without explanation. Yet the hallmarks of fibromyalgia (widespread pain, fatigue, non-restorative sleep, and cognitive fog) filled the very records Dr. Pham summarized.
Splitting one person into separate physical and psychiatric files makes every piece look manageable. We have beaten that approach before, including a Cigna termination involving fibromyalgia and cervical spondylosis, which we also won on appeal.
Lincoln’s headache finding did not match the record
Dr. Pham’s claim that there was no active headache treatment plan collapsed the moment we checked it against the records. Neurology had treated our client’s migraines continuously, including:
- Repeated rounds of Botox injections
- An emergency department migraine cocktail
- A prescription for Aimovig, a preventive migraine medication
- Additional migraine injections
- Repeated Xeomin injections
That is why every factual statement in a denial letter deserves a check against your own records. Screen time limits followed naturally from debilitating migraines, severe light sensitivity, and an occupation built around a computer screen. Lincoln has leaned on an unsupported paper review in a headache claim before, as in our Lincoln appeal for a project manager with cluster headaches, a denial we also reversed.
Surveillance shows activity, not capacity
Can a disability insurance company deny benefits based on surveillance video? It can try, but footage of brief, self-paced activity does not prove anyone can sustain full-time work.
Of the roughly 54 minutes of footage, only 47 minutes and 9 seconds showed any activity at all, spread across four days. The video never measured endurance, concentration, or what happened after he got home. As the appeal put it, he attempted limited activities despite his conditions, and “He then paid the price thereafter.”
Errands done at one’s own pace, with the freedom to stop and rest, are not competitive work. We have seen insurers lean on thin footage before, including a Liberty Mutual surveillance termination for a manager with multiple sclerosis, which we also reversed on appeal.
Nothing had improved
Can a disability insurance company stop paying benefits when your condition has not improved? Neither of Lincoln’s reviewers identified any improvement in our client’s condition. An insurer can terminate benefits without any change in your medical condition, but a reversal on the same medical picture demands a reason. Lincoln never gave one, and the evidence supporting our client’s claim had only grown since approval.
Lincoln’s Own Appeal Reviewer Said He Could Work Only Part Time
Lincoln did not decide the appeal on the record we submitted. It sent the file to Dane Street, a medical review vendor, for two new paper reviews. Appeals consultant Charles J. forwarded them to us and paused the appeal clock while we responded.
That step is required by federal ERISA claims regulations, 29 C.F.R. § 2560.503-1, and it gave us the chance to answer both reviews before Lincoln ruled.
Dr. Nicole Nguyen: a valid FCE and part-time capacity
Nicole Nguyen, D.O., board certified in physical medicine and rehabilitation, identified cervical radiculopathy, lumbar radiculopathy, migraines, fibromyalgia, and chronic pain syndrome as primary impairing diagnoses. She accepted the FCE results as valid, citing their validity metrics.
She also found that our client had “chronic pain syndrome from multiple diagnoses, altogether resulting in significant activity intolerance.” Then she reached her bottom line: “The claimant is capable of part-time work with these restrictions.”
Her restrictions included occasional standing, lifting capped at 10 pounds, and sitting limited to frequent rather than constant, with position changes as needed. Yet she rated keyboarding and gripping unrestricted, despite noting that a normal EMG (a test of nerve and muscle electrical activity) had been followed by one showing active left C8 radiculopathy. In plain terms, a nerve root that controls hand and finger strength had become newly pinched.
Dr. Staci Ross: no examination, no impairment
Staci Ross, Ph.D., a neuropsychologist, acknowledged mild neurocognitive disorder and adjustment disorder and agreed the testing was valid for basic interpretation. She still found no impairment, reasoning that fluctuations of effort could not be completely ruled out and pointing to driving, socializing, and travel. She never examined our client, administered no tests, and admitted the raw data was not available to her.
Part-time work is not reasonable continuity
We answered both reviews within a week. A man limited to part-time work cannot perform a full-time executive job with reasonable continuity, and Attorney Palamara’s rebuttal made that point its centerpiece:
“Thus, even accepting Dr. Nguyen’s opinion at face value, her conclusion does not support Lincoln’s termination decision, it directly undermines it.”
The rebuttal pressed several other points:
- A sedentary lifting classification does not prove anyone can sit and work eight hours a day, five days a week
- Dr. Nguyen conceded that routine office exams likely do not fully capture his activity intolerance, so she had no basis to rank them above valid functional testing
- Unrestricted keyboarding cannot be squared with an objectively worsening cervical radiculopathy
- The inability to rule out poor effort is not evidence of poor effort
- Driving and socializing at one’s own pace say nothing about executive-level concentration
Lincoln Reinstates His Benefits
Four days after our response, Lincoln reversed course. Its letter confirmed that Lincoln had completed its review and “determined that benefits are payable,” with past-due benefits to follow under separate cover.
Lincoln will keep requesting updated information, as insurers do on every open claim. The record we built now stands as the foundation for each of those reviews.
Speak With One of Our Lawyers Today
As our appeal told Lincoln, “Indeed, the evidence supporting disability is stronger today than when Lincoln initially approved his claim.” Evidence like that does not assemble itself. It takes objective testing, treating physician support, and a line-by-line answer to every reviewer the insurer hires.
If Lincoln or another insurer has denied or terminated your long-term disability insurance benefits, the clock is already running. ERISA plans generally give you 180 days to appeal, and that appeal may be your only chance to build the record. Speak with one of our disability insurance lawyers for a free consultation. We represent claimants nationwide, and there is no fee unless benefits are paid.
Since our founding in 1979, we have helped tens of thousands of disability insurance claimants and recovered more than $2 billion in benefits.
