After being forced to stop working as a Circuit Design Engineer on May 3, 2011 due to a multitude of severe and progressive spinal impairments including multilevel marked degenerative changes with stenosis, nerve root compression, disc disease at L4/5 and L5/S1 levels and neuropathic pain into the right lower extremity, the claimant filed an application for long term disability benefits with Lincoln Financial insurance company.
Lincoln Denies LTD Application and First Appeal
By way of a letter dated October 11, 2011, Lincoln denied any LTD benefit stating that “the medical evidence received fails to document any significant abnormal findings that would prevent you from performing the main and material duties of your sedentary occupation throughout the above Elimination Period”¦”
Shortly after this initial denial for benefits, the claimant contacted Attorneys Dell and Schaefer for assistance with the Administrative Appeal to challenge Lincoln’s determination.
On April 6, 2012, an Administrative Appeal was timely filed. Unfortunately Lincoln also denied this appeal for long term disability benefits. In its May 21, 2012 denial letter, Lincoln stated that its decision was based on a “paper review” it had conducted by a physician who is Board Certified in Orthopedic Surgery. This “independent” surgeon apparently found that although the claimant “has had five surgical procedures on the lumbar spine,” “information in this file would not preclude claimant from being able to perform sedentary level occupation”¦”. Using this review, Lincoln Financial again found that “the medical documentation does not support that there are restrictions and limitations that would render your client unable to perform his occupation”¦”.
Lincoln Financial ERISA Appeal Submitted To Reverse Claim Denial
After the denial of the first administrative appeal, the claimant and Attorney Alexander Palamara were more determined than ever to prove to Lincoln Financial that its decision was incorrect. Left with one final appeal, both the claimant and attorney hoped to avoid the unnecessary delay that litigation would cause should Lincoln again make the incorrect determination on the client’s claim.
With additional supportive medical documentation and physician support, the second appeal strongly conveyed to Lincoln why their earlier determinations were blatantly false. After submission of the second Appeal, Lincoln finally agreed with the contentions of the client and Attorney Alexander Palamara and awarded the client Long Term Disability Benefits. Our client recently received all the past due benefits that was owed to him for the past 15 months.
Attorneys Dell and Schaefer will continue to handle his claim on a daily basis to insure that the client remains on claim so long as he is disabled from performing his own occupation.
Should you have a similar case or if you have been denied disability benefits by Lincoln Financial, please contact us for a free consultation and review of your claim.
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