Lincoln Financial Reinstates Disability Benefits To School Teacher

Our client, a former Special Education Teacher, was brutally assaulted in a commercial gym by another gym patron that required brain surgery and resulted in a traumatic brain injury that left our client with severe cognitive problems, migraines, seizures, and post-traumatic stress disorder. Shortly after the attack our client filed a claim for disability insurance benefits through his county school district’s disability insurance policy with Lincoln. Given the nature and severity of his condition Lincoln quickly approved his short term disability claim and when it came time to transition to long term disability, approved that claim with no problem.

Similar to the overwhelming majority of employer provided disability policies, his policy through Lincoln provided benefits for the first 24 months in the event he was unable to perform the duties of his prior education, in this case that of a Special Education Teacher. For the first 18 months of long term disability it would seem that there would be no problem in continuing to receive his monthly disability benefit. However, in December of 2016, almost six full months before the definition of disability in his policy changed from the “own occupation” standard to the inability to perform the duties of “any occupation,” Lincoln advised our client that it had determined that he would no longer be disabled as of May 2017 and that his claim was being closed. According to the denial letter sent to our client, Lincoln argued that the available medical information, to include neuropsychological testing, failed to establish medically necessary restrictions and limitations that would prevent our client from working at a “sedentary” or “light” duty level as defined by the Department of Labor.

The Administrative Appeal

After receiving the denial letter our client contact Attorneys Dell & Schaefer and spoke with Attorney Stephen Jessup to represent him in filing his administrative appeal. Attorney Jessup obtained a copy of our client’s claim file from Lincoln and in doing so received a copy of the medical report conducted by Lincoln’s physician consultant. Per the denial letter Lincoln argues that the reviewing doctor’s report indicated a lack of evidence of disabling cognitive problems that would prevent our client from working. However, upon closer examination it became obvious that the physician consultant actually agreed with our client’s treatment providers that our client continued to experience cognitive limitations that resulted in deficits in attention, processing and organization skills, as well as the inability to effectively multi-task. As our client’s occupational skills existed solely in the realm of teaching Attorney Jessup argued that the ongoing cognitive problems documented in the neuropsychological evaluation would prevent him from returning to gainful employment.

Furthermore, Attorney Jessup argued against Lincoln’s position that the medical information on file evidenced the ability to work at a sedentary or light duty demand level. Attorney Jessup noted that our client’s claim has never been due to an inability to physically perform tasks, but rather solely on his inability to meet the cognitive/mental demands of work in his prior occupation and any other gainful occupation. After gathering additional supportive documents from our client’s treating physicians along with statements from friends and family Attorney Jessup submitted our client’s appeal.

Although it would seem clear to a reasonable mind that our client would not be able to work in any gainful capacity, Lincoln did everything it could to find a way to uphold its decision to deny the claim. During the course of the appeal review Lincoln required our client to undergo an Independent Medical Examination with a Neurologist. Unfortunately for Lincoln the IME doctor only verified what our client and his doctors had been saying all along- that our client is unable to work due to the lingering injuries and cognitive problems stemming from the assault that left him permanently injured.

With no other option, Lincoln notified Attorney Jessup that it was overturning the denial of our client’s claim for benefits, reinstating his claim, and issuing all benefits owed to date. Attorney Jessup continues to represent our client to best ensure that Lincoln will not terminate the benefit again.

Please feel free to contact our office to speak to one of our disability attorneys for a free consultation as it relates to any concerns you may have with your disability insurance claim.

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FAQ

Do you help Lincoln Financial claimants nationwide?

We represent Lincoln Financial clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Lincoln Financial disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Lincoln Financial. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Lincoln Financial.

How do you help Lincoln Financial claimants?

Our lawyers help individuals that have either purchased a Lincoln Financial long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Lincoln Financial:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews   *****

Jack B.

I called Dell & Schaefer the day I received the LTD denial letter, and immediately spoke with attorney Cesar Gavidia. From our phone conversation he understood what I was up against. After my denial I was feeling hopeless and was ready to throw in the towel. Cesar explained to me the next step was to file a lawsuit and take the case before a federal judge. We settled the case at mediation with the insurance co. rep and their counsel.

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