A Federal Court recently ruled in favor of a man denied long-term disability benefits by Lincoln. The court agreed with his disability attorney in this ERISA Lawsuit and ordered reinstatement of LTD benefits along with past due benefits with interest.
The Facts of the Case Against Lincoln National Life Insurance Company
Plaintiff was employed by Genzink Steel as a steel fabricator. Plaintiff applied for disability in April 2000 as a result of neck problems and pain arising from injuries, including an auto accident suffered in 1998.
Plaintiff’s treating physician diagnosed Plaintiff with “cervical disc disease/L paracentral herniated disc C-4+5” in May 2000. Plaintiff underwent spinal surgery in July 2000, successful in relieving pain in his left arm, but not in his neck and triceps.
Plaintiff’s neurosurgeon referred Plaintiff to a Pain Clinic from July through November 2001, but this did little to relieve the pain.
Plaintiff’s LTD benefit was approved to start on July 24, 2000. Plaintiff received LTD benefits for the first two years of disability on the basis that he was disabled from his own occupation as stated by the terms of the Plan.
Terms of the Plan had Lincoln initiate its review of the Plaintiff’s qualification for continuing benefits under the “any occupation” definition; Plaintiff met these requirements each time Lincoln requested updated information and proof from his treating physician. This physician also reported all of the numerous calamities that befell the Plaintiff between July 2004 to December 19, 2007, including a compression fracture in Plaintiff’s back, an elbow fracture, and a diagnosis of diabetes.
Plaintiff was regularly checked from September 23, 2003 to February 12, 2008, with each time the Plaintiff being designated as eligible for LTD benefits due to being unable to work as a steel fabricator and not being easy to retrain for another occupation.
On May 14, 2008, Plaintiff was sent a list of 6 possible job alternative for his former occupation of steel fabricator. It was reported that a full report would be sent next to see if Plaintiff could handle the restrictions/limitations that came from sitting regularly due to his condition.
Denial of Lincoln Disability Benefits Claim
On June 4, 2008, Plaintiff received letter from Lincoln that his benefits would be terminated as of July 1, 2008 on the grounds that the Plaintiff was not limited from working in a sedentary capacity based on 2003 and 2005 Functional Capacity Evaluation and from medical records provided by his treating physician.
Plaintiff filed an appeal of the denial on October 27, 2008, including medical reports and a report by the treating physician that refuted the Defendant’s claim of the Plaintiff being able to work in a sedentary position.
Lincoln had Plaintiff submit to an Independent Medical Evaluation (IME) with a neurosurgeon. This physician determined that while the Plaintiff did have advanced degeneration of the spine, he would likely be able to work a sedentary position.
As a result of that IME and the conclusion that Plaintiff was not totally disabled to continue receiving LTD benefits, Lincoln denied Plaintiff’s appeal via letter on February 11, 2009.
Results From Lawsuit Against Lincoln
After careful consideration of the parties’ briefs and the Administrative Record by the Court, the Court concludes that the Plaintiff’s motion for judgment should be granted and the Defendant’s motion should be denied based on the following reasons:
- The Plan cannot be construed to require more than one appeal as the Defendant claims, thereby making where the Plaintiff had exhausted all administrative appeals before filing this lawsuit
- Lincoln does not provide a reasonable basis for terminating the LTD benefits to the Plaintiff, as there is too much reliance on their own medical expert, Dr. Carr, and there is an apparent conflict of interest between Lincoln and its own financial status
- The 2003 and 2005 vocational assessments give no indication that Plaintiff was capable of sedentary work, yet, came to this very conclusion in 2008 without evidence that Plaintiff’s condition had improved
The Court did side with the Defendant’s position on the following issue:
- Lincoln did receive the discretion to decide whether benefits are granted or not when it acquired Canada Life
Judgment Ruled By The Court
Plaintiff is to have LTD benefits reinstated, along with receiving all past due benefits with interest. The Plaintiff may also file an appropriate motion for attorney costs and fees.