Question

What is clinical review? And what are my chances of getting continual approval during the own occupation period?

Asked on April 19th 2017 by Linsey
I have an own occupation period of 5 years. I have MS, injuries to my spine and a ankle crush accident which required 2 surgeries. Basically I’m a mess. I am completely unable to work my past job, (which by the way I lost this job), not to mention any other job at this point. My claim is constantly in pending status. It is now under clinical review. I’ve been on LTD for about 15 months. What are my chances of getting continual approval during the own occupation period. What documents would I need to submit to keep benefits going. I have a lawyer, but he seems a little “non-aggressive” He seems to never push LFG for approval like I, myself would and have since the claim was opened. I didn’t take on this lawyer until I was on LTD about 8 months, (Almost a year including STD). I’m not sure what I’m asking exactly but I guess I am tired of Lincoln constantly putting me in pending every month and why they keep doing it. Will they ever just leave it in pay status for at least a few months after documentation is received. I want to call them myself and push them for answers but I suppose I can’t because I now have a lawyer and he seems to be a little nonchalant. Am I wasting my time with this lawyer or is it usual to be so cool during a very crucial time in a claim? What is clinical review and what more do I need to do or give them to ensure the clinical review goes in my favor. My lawyer doesn’t seem to be giving me much to go on as far as how to ensure approval. Advice to a claimant is key for the claimant to pursue aggressively and ensure the documents are giving the insurance what they need to approve. I am an aggressive claimant and I need an aggressive lawyer. Whatever it takes to get approved, just tell me and I’ll make sure I get it, period. That’s how I work. All I get from my lawyer is maybe’s and hope so’s. For instance, he will say, “I was hoping the last documentation would have worked but maybe they will agree after your office notes are recieved”. It’s clear my documentation shows I can’t work my own occupation so let’s go, get on them and prove it! I feel like a sitting duck each month.

Answer

Answered on April 20th 2017 by Attorney Stephen Jessup

Linsey, as disability benefits are determined on a month to month basis an insurance company is allowed to review your claim each month. It is not common for an insurance company to approve a claim through an own occupation period regardless of the medical condition. Although the reviews are certainly annoying, there is really little that can be done to prevent an insurance company from conducting them.

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Lincoln Financial Reviews
(93)

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Showing 8 of 93 Reviews
Lincoln Financial

Lincoln Financial made my life a living hell

Reviewed by Salyna D on June 1st 2022   Verified Policyholder
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
Sent on June 2nd 2022 by Attorney Stephen Jessup

Salyna, I am sorry to hear about your experience. I wish I could say it is an anomaly, but it is an all too common occurrence. Depending on if the claim was ever approv... read more >

Lincoln Financial

Lincoln Financials wants to claw back my money

Reviewed by Paul F. on June 30th 2021   Verified Policyholder
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
Sent on June 30th 2021 by Attorney Stephen Jessup

Paul, unfortunately, under employer provided policies there are provisions related to offsets for sources of Other Income. Both the California disability and Social Sec... read more >

Lincoln Financial

This is the second time I've been shorted in my check

Reviewed by Wendy J. on June 16th 2021   Verified Policyholder
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.

Reviewed by Eric J. on April 6th 2021   Verified Policyholder
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
Sent on April 6th 2021 by Attorney Stephen Jessup

Eric, it sounds like there is more to the story than what Lincoln is telling you. Have you received the formal denial letter? If so, we can review the letter with you t... read more >

Lincoln Financial

Lincoln cancelled my benefits because my doctor's notes were handwritten

Reviewed by Maci P. on February 7th 2021   Verified Policyholder
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
Sent on February 7th 2021 by Attorney Rachel Alters

Maci, unfortunately this is common behavior for Lincoln. Please contact our office at 888-729-3355 and ask to speak to an attorney who can assist you with your STD appe... read more >

Lincoln Financial

Lincoln denied my disability claim even though Dr said I couldn't work

Reviewed by Richard F. on December 25th 2020   Verified Policyholder
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
Sent on December 25th 2020 by Attorney Stephen Jessup

Richard, have you filed an administrative appeal of the denial? Please feel free to contact our office to discuss your claim and denial in detail to determine how we ma... read more >

Lincoln Financial

Lincoln doesn't think renal failute and 4 dyalisis treatments per day are enough to be. Disabled

Reviewed by Brenda G. on September 21st 2020   Verified Policyholder
I was approved for SSI disability but my short term has exhausted. I have long term plus disability but not approved I have renal failure and do 4 dyalisis treatments a da... read more >
Reply
Sent on September 21st 2020 by Attorney Gregory Dell

Brenda, was your long term disability denied or is it just pending at this point? Please feel free to contact our office to discuss your claim in greater detail.

Lincoln Financial

They promised me min 10% of my salary and max 60%. I got 6%

Reviewed by Alvaro D. on May 7th 2020   Verified Policyholder
Lincoln financial insurance payed me around $60 a week, wich is about 6% of my salary, for my short term disability. I asked for documents showing how they came out with t... read more >
Reply
Sent on May 7th 2020 by Attorney Gregory Dell

Alvaro, we can gladly look into this issue for you. Please gather the disability policy and contact us for a free consultation. We will request a copy of the policy and... read more >

Answered Questions by Our Lawyers
(47)
Showing 8 of 47 Answered Questions

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?

Answered on October 29th 2022 by Attorney Stephen Jessup
A: Kara, it would depend on the language in the policy. There is even a chance you could transition into long ter... Read More >

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Q: Is LF's doctor, who never spoke with me or evaluated me, allowed to clear me for work?

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Answered on July 9th 2020 by Attorney Alex Palamara
A: Sandra, I am sorry to hear of the issues that Lincoln is giving you. Unfortunately, while Lincoln has to take ... Read More >

Q: Do I have to tell Lincoln Financial that I was denied for SSDI?

Answered on June 8th 2020 by Attorney Cesar Gavidia
A: Thomas, you may have an obligation to inform them that you have been denied for SSDI. Please refer to your pol... Read More >

Q: What do I do if LF denied my claim because depression is "mild, not severe"?

Answered on May 7th 2020 by Attorney Rachel Alters
A: Anna, you will need to consult with your treating doctors and submit additional evidence of your medical condi... Read More >
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