Lincoln Financial’s denial of long-term disability benefits is reversed following appeal submitted by attorneys Dell & Schaefer

Attorneys Dell & Schaefer were retained by a former chiropractor who was receiving long-term disability benefits from one of her two disability policies. Despite one company paying her long-term disability benefits, Lincoln Financial refused to pay disability benefits, claiming she could perform the substantial and material duties of her occupation as a chiropractor. Following her initial consultation with attorneys, Gregory Dell and Robert Kerr, she retained the firm to pursue the disability benefits owed to her under the Lincoln Financial policy.

Our client was unable to continue working as a chiropractor as a result of back pain and arthritis in her shoulders and hands. Before moving to south Florida, she owned a successful practice in Colorado, and treated with a physical medicine and rehabilitation doctor in Denver. Because of her illnesses, she was forced to stop working and sell her practice. She subsequently moved to south Florida in the hope that the milder climate would ease the pain that makes her unable to work.

Despite her treating physician’s clear support of her disability, Lincoln Financial denied our client benefits based on their independent medical exam (IME) and surveillance of her riding a bike. Dell & Schaefer worked with our client and her physicians to develop the medical support necessary to properly document and support her claim. After several months of treatment by the appropriate physicians, Attorney Robert Kerr submitted an appeal to Lincoln Financial outlining the documentation and clear support for our client’s right to long-term benefits.  Within a reasonable timeframe of receiving the appeal, Lincoln Financial approved our client’s long-term disability benefits and paid all past due benefits.

Attorneys Dell & Schaefer will continue to handle our client’s claim moving forward to ensure that she continues to receive her long-term disability benefits on a monthly basis.

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There are 32 comments

  • I have started a claim with Lincoln back in August due to an issue of blood clits and chiari malformation in my brain. My migraines have become unbearable to work full time. I have been working from home now but that to is soon to come to an end as the company advised they can no longer proceed. Lincoln denied my claim due to not getting all the paper work from the drs. This aster 4 months of them pro longing it. What is the best way to proceed?

    ChristinaJan 6, 2016  #32

  • Concern,

    We handle disability claims against Lincoln nationwide. Please feel free to contact our office to discuss the denial and your claim as it heads into appeal.

    Stephen JessupNov 24, 2015  #31

  • I received my letter on Nov 10th, I sent a letter to them requesting all documentations used on my claim and received this all yesterday. Do you have an attorney whom works LTD for ERISA that is located in Arkansas. As of Nov 25, I will have been off a year now, I had hoped this would go away and I would be able to work but I am not able.

    Also a big concern is that some of my MR / documents could have been sent to someone else as mixed in with my MR from Lincoln was a letter addressed to a provider for another claim. They have violated HIPPA, so makes me worry they have not secured my MR and or lost some of it.

    CONCERN IN BATESVILLE ARNov 24, 2015  #30

  • Concern,

    You will have to go through the administrative appeal process. Lincoln will send you a letter explaining the basis of their denial. Please contact our office when you receive the letter so we can best advise you as to what we can do to assist you.

    Stephen JessupNov 8, 2015  #29

  • I received a call from my contact person assigned my claim work LFG, he informed me that the external provider whom reviewed my MR concluded that I could work at my full time job, which I haven’t worked in about a year now, due to the constant pain and side effects of my medications I have to take to be able to bare the pain, I wish they hurt like I do. So I guess I have been officially denied my long term benefits. What can be done what other information is needed.

    Concern in Batesville ARNov 7, 2015  #28

  • Concern,

    Please feel free to contact our office to discuss your claim and what rights you have at this point.

    Stephen JessupSep 30, 2015  #27

  • They have not paid out any benefits under the LTD policy to date; they are reviewing medical records. My STD was with a different vendor and I was approved for full benefits and have exhausted these and then filed long term disability, around 50 plus days ago.

    Concern in Batesville ARSep 29, 2015  #26

  • Concern,

    A medical review is often conducted by employees of the insurance company and in some cases completed by an outside hired doctor. Has Lincoln paid out any benefits under the LTD policy to date or are they still conducting a review from the transition from short to long term disability?

    Stephen JessupSep 28, 2015  #25

  • After reading these postings I am concern as I have filed a claim with the LFG for long term disability, I have worked 37 plus years and have delt with fibromyalgia for years now and have been experiencing extreme morning stiffness and pain that never stops. I can’t sleep but little cat naps, thus I am fatigue all the time and yes with dealing with this illness for years I am depressed I have very few good days anymore. My claims first delay was getting the medical records from the four different doctors that I was seeing, then they had an initial review and determined a medical review was needed so this is the last I have heard so waiting a response. So if I call LFG (the representative on my claim) and asked them if the provider or providers reviewing my claim are employed by them do they have to answer? I will keep this page bookmarked in case I need to follow up once I have heard from them.
    Just some extra information I have not worked since late November 2014, I did go back for three days under the ADA with my emoloyer allowing shorter work days, new chair, foot rest, and erconomical keyboard holder but I hurt so much I was not effiencient and if I took my meds then I was so sleepy I couldn’t function and was not productive. I would love to be able to work I always enjoyed working and dealing with internal and external customers but I just am not able to handle the extreme pain anymore not sure what has changed but the first of November I fell on our porch and just went down hill from there, first thought I had a flare up but it hasn’t gone away my pain level is around a 7 most of the time but some 9-10 periods it’s never seems to ease yiu just have to make yourself to what needs done and just hurt and take yiur medications.

    Concern in Batesville ARSep 27, 2015  #24

  • Jim,

    It is always a wise decision to consult with an attorney as your administrative appeal will form the basis of any argument you may have to make a trial. Please feel free to contact our office to discuss how we may be able to assist you in appealing the denial of benefits.

    Stephen JessupAug 4, 2015  #23

  • I have been dealing with Lincoln Financial long term disability since September of 2014. I had my knee replaced in June of 2014 and Lincoln payed the short term for three months. At the end of the three months, even after intense physical therapy, the pain in my knees was still such that I could not stand or sit for more than about 15 minutes, walking was also very difficult and I walked with a severe limp. In June they decided my situation was not pre-existing and gave me one month of disability.

    In April my surgeon the problem was in my hip radiating to my knee and said I needed a hip replacement to fix the problem. On July 13th my hip was replaced and the Dr said the hip was very corrosive (the ball or the hip was rough rather than smooth) causing pain whenever the hip moved.

    On July 31st Lincoln notified me my claim was denied as they felt I could have worked in a passive type job.

    I am planning on filing an appeal. Should I do that on my own or get a lawyer involved now?

    JimAug 3, 2015  #22

  • Linda,

    Lincoln typically requires a mandatory second level appeal, which they only give you 60 days to file. Please contact our office to discuss your claim to determine how we can assist. You can reasonably expect that even if the appeal for own occupation benefits is successful Lincoln will still look to deny your claim at the two year “any occupation” mark.

    Stephen JessupJun 3, 2015  #21

  • I have been fighting with LFG since April 2015. They have been paying me for my disability since Sept 2013, and nothing has changed. They all of a sudden in April they denied my claim and stopped paying me. I filed and appeal with them and they stated I can do my job. Which my company fired me back in April of 2014 so I have no job to return to, and also my drs will not release me to work. What can I do to make them pay me? I have neurocardiogenic syncope with this I sometimes of occurrences happening anywhere from 1 to 3 a day.

    LindaJun 2, 2015  #20

  • HG,

    You were, “receiving long term disability because the same” do you mean you were receiving short term disability? If so, the provisions pertaining to Pre-Existing Conditions found in short and long term disability policies are drastically different. Please feel free to contact our office to discuss your claim to see if there is something we can do to assist you.

    Stephen JessupFeb 11, 2015  #19

  • I’m living in Charleston, SC and I have received a letter from Lincoln Financial Group in which they denied my Long Term disability saying the reason was: Pre-existing condition exclusion. I was receiving long term disability because the same, now they come up with this policy for denied my long term disability, it make no sense.

    HGFeb 10, 2015  #18

  • GLM,

    Unfortunately, if your condition falls within the defined mental health limitation of your disability insurance policy you may not be eligible for any additional benefits beyond the 24 month period. Your only continued option for disability benefits would be through the Social Security Administration.

    Stephen JessupDec 13, 2014  #17

  • I am being denied continued long term disability benefits because they cut off services for people with a “mental health nervous condition”. I have a more chronic mental illness that will last the rest of my life, and I feel like I should still receive long term benefits. What should I do?

    GLMDec 12, 2014  #16

  • April,

    Are there any appeals left, or were all appeals already filed? Please feel free to contact our office to discuss the claim. Lincoln usually requires a second level appeal, but only provides 60 days to complete same. In the event they have denied all appeals her only option at this point would be to seek legal recourse under ERISA.

    Stephen JessupMar 10, 2014  #15

  • My mother was diagnosed with complex partial seizures in 2007. She was able to work a couple years after the diagnosis, however it got to the point where she became confused and disoriented. She was and RN and worked as a home health nurse, many days being confused of where she was. June 2010, her neurologist decided it was unsafe for her to work, for her safety as well as the patient she is treating. She has gone down from there. With her condition, there is cognitive impairment, depression, and her balance off. With all this said, she is on numerous medications, that #1 make you drowsy, #2 she has to take twice a day. This is our second round appealing her LTD claim with LFG. I am listed as her contact person, on Friday they leave a muffled voice mail that her appeal was not in her favor. The reason she has a contact person is because when she applied for SSDI they had her have a psych eval and decided that someone had to be her caretaker. That she was unable to account for her $$ & other things. This was told to LFG in my appeal, yet they telle she can work so.e other job. This just makes me so angry. She is still young but unable to fight for herself.

    AprilMar 10, 2014  #14

  • Al Scott,

    There really is no clear cut rule, and this is an issue we raise often. In fact, Greg Dell, posted a recent blog on our site questioning whether or not Cigna’s medical director was even licensed to practice medicine- http://www.diattorney.com/is-cignas-medical-director-john-m-mendez-licensed-to-practice-medicine/.

    Stephen JessupNov 21, 2013  #13

  • Can LFG (which I believe is based in Nebraska) – or ANY Ins. Co. – use as an IME Consultant, a Doctor of Orthopedics, who is ONLY licensed in Georgia, to review claims (and recommend denial of benefits) if the Claimant lives in California?!

    I was told that Doctors use a loophole of sorts, whereby they (use different physician to) consult on a limited number of claims – so as not to raise “red flags.” This suspiciously controversial addendum to their provided credentials certainly caught MY eye, for a the good it will do me).

    I am insensed that LFG gets away with trumping reems of medical documentation from Kaiser Permanente physicians with the findings and opinions of (first,) an RN and (secpnd,) some out-of-state doctor, who is either retired (not practicing medicine “hands on,” or ostensibly, staying current with orthopedic procedural advances and likewuse with implants and prostheses. Case in point, I am a recipient of the recalled DePuy ASR Hip implant, which is already showing signs of loosening, although I regard that a separate matter with separate recourse as I am on file with DePuy’s Third-Party administrator, Broad spire Claims.

    So – what IS the law about such a Doctor overriding the medical findings of mulriple practicing, licenced clinicians who have performed 7 TJR surgeries on me and examined me INNUMERABLE TIMES, whereas they (LFG) have not requested or conducted a true IME, as their medical consultants appear to be salaried employees of LFG, based on their letterhead.

    Thank you for your time and any input you may be able to provide.

    Sincerely,
    Al Scott

    Al ScottNov 20, 2013  #12

  • Teri,

    If you are currently in the middle of a legal action with Hartford I would assume you have an attorney. As such, I would have to refer you to your attorney for any legal questions as they relate to your case.

    Stephen JessupNov 20, 2013  #11

  • I am in the middle of a suit against Hartford Insurance. I have multiple problems with DDD, severe neck stenosis, pudendal pain and numbness in my feet and hands and underlying fibromyalgia. I was in a job where I was driving over 75% of the time and my body just gave out. I was approved for short term disability but no improvement with pain. Hartford approved me for LTD disability and then cut me off after 7 months after aggressive video monitoring of me “walking” in my neighborhood for less than an hour. They never had their Dr.’s look at me and told me to go back to my old occupation while on class 5 pain meds to drive a vehicle over 200 miles a day. At the time I was cut off I was not yet unemployed for a year and had to wait to apply for SSD and still waiting for denial or approval. I had no choice but to apply for Unemployment in between my application for SSD and getting cut off from LTD, as I have no monies coming in, no medical insurance and my back and neck issues have gotten worse. Will applying for unemployment cause a problem in my case against Hartford for seeking my LTD payout benefits. I live in CA. Thank you.

    TeriNov 18, 2013  #10

  • Lisa,

    Typically, if you were treating for a medical condition in the 3 months prior to the effective date (or whatever period of time designated in the policy) your condition could be considered pre-existing. However, if you have been effectively covered under the policy for 12 months before filing a claim, the condition will not be considered pre-existing for purposes of the exclusion of coverage.

    Stephen JessupJun 6, 2013  #9

  • Does this mean even after receiving treatment in the 3 months prior for my condition and being employed 12 months, it is still a pre-existing condition? It started before I worked there…

    PRE-EXISTING CONDITION EXCLUSION

    The Policy will not cover any Total or Partial Disability:

    1. which is caused or contributed to by, or results from a Pre-Existing Condition; and
    2. which begins in the first 12 months after the Insured Employee’s Effective Date.

    LisaJun 5, 2013  #8

  • Tina,

    Great news! Make sure you continue to document your medical condition with your doctors as your claim will be reviewed on a monthly basis.

    Gregory DellOct 25, 2012  #7

  • As I was sending this letter I received a call from Lincoln reversing my denial… Yeah. So my advice is don’t give up.

    TinaOct 24, 2012  #6

  • I have been dealing with Lincoln for 6 months and am amazed at the way they have treated me. Their 45 day extension was yesterday and nothing. I live in Utah and have also applied for Social Security Disability. I am so depressed and feel they’re just trying to wear me down so I will give up. I have had 4 back surgeries in the last two years along with RA, OA, fibromyalgia and depression. I would like nothing more than to return to work, but when I told her I couldn’t handle part time yet, my supervisor said that she needed someone in my position that could do the whole job. I told her I didn’t know if I would ever be able to do the whole job and next thing I know I’ve lost $1500.00 in net income and have an additional $700 on Cobra insurance and getting nothing from Lincoln.

    TinaOct 24, 2012  #5

  • Idol, the SSDI standard for disability and disability policy standards are often different. A disability insurance company can stop paying benefits at any time. An approval of disability insurance benefits does not mean they will continue until age 65. An approval of social security disability benefits is a factor that a disability insurance company must take into consideration.

    Gregory DellJul 26, 2011  #4

  • In reading these post – I see nothing said about Social Security benefits. If these people are disabled – aren’t they eligable for SS Disability? And I also thought Long Term Disability was until your 65. How can they just cut it off? How can a company who has received payments from hard working people trying to plan for the unexpected do this to people in the worst times of their lives? I don’t know how they calculated payments but I do think they purposely overpay just to want it back at the most inconvenient time: when a person is diagnosed with a terminal illness. You’re told you can get Social Security Disability, but no one tells you that you have to notify the Insurance Company. They shouldn’t be put in the position of having to repay thousands of dollars back because of a fault of the Insurance Company’s “overpayment” when trying to keep insurance premiums paid, taking care of prescriptions and co-pays, not to mention the regular bills that need to be paid. It’s hard enough on a person to just try to live a life as normal as you can in between chemo treatments, tests, doctor appointments and being in constant pain. And knowing you are slowly dying. I am totally disgusted how the old and the dying are treated.

    Idol PlanteJul 25, 2011  #3

  • Linda, you have a lot of options for dealing with Lincoln Financial. If your claim has been denied then you must appeal within the time frame provided in your policy. It is usually 180 days. You also have protection available for the department of insurance in your state and also the department of labor. Contact us and we can discuss your options.

    Gregory DellMay 25, 2011  #2

  • I don’t know what to do any more. I am so tired of fighting Lincoln. They have held my benefits for several reasons throughout the years, usually about x2 a year. Once because the benefit specialist went out on maternity leave (3 months). But this last time they were held, no notice, and after they had made a cash offer I refused. They knew I had recently gone through a divorce and now had no supplementary income to fall back on. I have had to move out of my house and rent it for fear of loosing it. I have rented an apartment and am now in jeporady of being homeless. I can’t even comprehend this. I have worked all my life. I have raised 3 children, 2 graduated from college (R.N. & P.T.) this may and one retired from the navy (sharp shooter for navy seals), my mother is retired Lt. Col. from Army. I come from good stock, not a dead beat like I am treated. SSI Admin. classified me permanently disabled. I have a $300,000.00 policy that I paid into for approximately 12-15 years. Yet they hold my benefits. They have ruined my perfect credit that I had maintained up til this last time in August 2011. I’m so sad. Isn’t there something I can do?

    Going to bed in tears as usual. This is not how I pictured life for me at this age. And it is so embarrassing. Don’t want to burden my children, I don’t want them to know this is going on.

    Linda KelleyMay 25, 2011  #1

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