Lincoln Financial Reinstates Disability Benefits Following the Submission of an Appeal for an Attorney With Wrist Injuries
Author: Attorney Stephen Jessup
Prior to filing a claim for disability, our client was a successful managing attorney at the law firm she worked for. In late 2010, she suffered a fracture of the carpal bone and a wrist dislocation that required surgery to repair. Lincoln Financial initially approved her claim and paid benefits for approximately one year. During the time she was on disability she was required to undergo surgery on her other wrist as well. In November 2011, she was notified by Lincoln that her claim was being terminated based upon Lincoln’s opinion that she should be able to perform her occupation as an attorney, which Lincoln deemed to be a “light physical capacity” occupation.
Although her job would require being able to work at a light physical demand, the true main duties of her occupation as an Attorney far exceeded the ability to simply work at a light physical level. Prior to contacting Attorneys Dell and Schaefer, she filed her first ERISA appeal in an attempt to clarify how her medical condition limited her ability to perform each of the main duties of her occupation. Upon receipt and review of the appeal, Lincoln notified her in February 2012, that they were upholding their denial of her claim based upon the review of the information contained in the claim file.
Under her policy, Lincoln allows for a second voluntary appeal. However, the time frame for submitting this second appeal was only 60 days, as opposed to the ERISA mandated 180 days for a first appeal. Not wanting to take any additional risks, she contacted Attorneys Dell and Schafer to assist her in the filing of the second appeal. Attorneys Stephen Jessup and Gregory Dell set to work quickly to obtain a copy of the claim file and to coordinate additional testing and treatment that could prove beneficial to our client’s claim. A thorough review of the claim file indicated that Lincoln was not properly classifying her pre-disability occupation, and that the review of her medical records was insufficient, incomplete and evidenced Lincoln’s attempts to cherry pick information favorable to support its position. Attorneys Jessup and Dell prepared and submitted the final ERISA appeal in advance of the shortened 60 day deadline. Based upon the information provided and argument made, Lincoln reinstated our client’s monthly benefits, and paid almost a full year of back benefits owed to our client.
If your ERISA governed disability claim has been denied by Lincoln Financial, or any other insurance carrier, or you have questions regarding your claim, please contact Attorneys Dell and Schaefer for a free consultation.