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Lincoln overturned its previous denial of LTD benefits for Escalation Engineer

Our client, Mr. E, formerly worked as an Escalation Engineer for a national data services and data management company. For many years Mr. E suffered from chronic debilitating effects of multiple physical conditions and ailments, including Chronic Intractable Migraines, which left him with debilitating physical and cognitive impairments. Mr. E was unwilling to give up his career and worked as long as he possibly could. As a result of his serious medical conditions and associated restrictions and limitations, Mr. E was forced to stop working in May of 2017 and apply for disability benefits under his company’s Short and Long Term Disability (LTD) Policies, both of which were administered and funded by Lincoln.

Lincoln found Mr. E to be totally disabled and approved his STD claim through the 90-day maximum benefit period which ended in August 2017. With the expiration of the STD benefits Mr. E’s claim was submitted for continued payment under Lincoln’s LTD Policy, with the same definition of disability.  After paying Mr. E LTD benefits for more than 1 year, Lincoln denied further benefits effective September 2018 on the basis that he allegedly no longer met the Policy definition of “Disability.” Specifically, Lincoln determined that “[Mr. E] can perform the substantial and material acts of [his] occupation.” After receiving the denial, Mr. E contacted Dell & Schaefer and discussed his case with Attorney Jay Symonds, who identified several significant issues in Lincoln’s denial letter and in the evidence it relied on and agreed to prepare and submit Mr. E’s ERISA appeal with the assistance of his appeal team.

The appeal addressed all of Lincoln’s short-comings and reasons for denial. In particular, Lincoln ignored key medical records which clearly established that Mr. E had undergone multiple brain surgeries due to a pituitary tumor which lead to his development of debilitating, incapacitating headaches (migraines). The records also confirmed that Mr. E’s headaches did not change following surgery and radiation for the tumor. Rather, Mr. E suffers from multiple headaches per week that can last several days. Subsequent neurologic examinations were abnormal with anxious and stammering speech and although Botox treatments provided some relief his debilitating headaches continued. Mr. E was then referred from an MRI of the brain and stem. The MRI confirmed the presence of enhancing tissue within the sella turcica, which represented residual pituitary tissue/tumor.

Next the appeal addresses Lincoln’s failure to properly and accurately assess the material and substantial duties of Mr. E’s occupation as an Escalation Engineer. Specifically, Lincoln’s vocational reviewer incorrectly and unreasonably considered only the physical requirements of Mr. E’s occupation to the exclusion of the required interpersonal and intellectual requirements. By reducing Mr. E’s occupation to just the physical demands of whether he was capable of sitting, standing, walking, etc., Lincoln contradicted the clear and unambiguous terms of the LTD Policy in violation of relevant case law and ERISA’s requirement that Lincoln conduct a full, fair and thorough investigation of his claim.

And finally, the appeal noted that the Department of Veterans Affairs (VA) and the Social Security Administration (SSA) both found Mr. E to be totally disabled. In fact, he was given a 100% disability rating by the VA, which is assigned when the impairment is sufficient to render it impossible for the average person to follow a substantially gainful occupation. Further, the SSA awarded Mr. E benefits based on a comprehensive, in-person, medical evaluation by a board certified physician.

Just 1 week after filing his appeal, and after reviewing hundreds of pages of exhibits and medical records, Lincoln overturned its decision to terminate benefits, paid full LTD back benefits and reinstated Mr. E’s LTD benefits. Attorney Symonds continues to represent our client to best ensure that Lincoln will not terminate his benefits again. Feel free to call our disability attorneys for a free consultation.

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FAQ

Do you help Liberty Mutual claimants nationwide?

We represent Liberty Mutual 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 Liberty Mutual disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Liberty Mutual. 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 Liberty Mutual.

How do you help Liberty Mutual claimants?

Our lawyers help individuals that have either purchased a Liberty Mutual 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 Liberty Mutual:

  • 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.

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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.

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