Overcome Lincoln Termination of Claim

LINCOLN TERMINATES LONG TERM DISABILITY CLAIM BASED UPON MANIPULATION OF IME DOCTOR WE FIGHT BACK AND OVERTURN ON APPEAL

A claimant was being paid benefits by Lincoln, due to his neurological issues and ongoing impairments.  After being paid benefits throughout his own occupation period, Lincoln Financial sought to terminate the claim, despite support from his treating medical team.  Lincoln was tired of paying this expensive claim that was a legacy policy from Liberty Life – sold to our client prior to Lincoln’s purchase of Liberty Life.  

Lincoln decided its best approach was to seek an examination with a hired doctor, through a well known insurance pandering company. Unrepresented at the time, the man thought that the examination appeared to go well, but unbeknownst to the claimant, Lincoln had conducted clandestine surveillance and utilized the surveillance to influence the doctor’s opinion.  

The doctor had previously determined impairments existed, but after being cajoled into incorporating the surveillance, the IME report changed, which allowed Lincoln to then terminate his claim.  Despite admitting that his prior high level work as a financial executive was unable to be performed, Lincoln was not stopped from “identifying” a closely parallel job to make him ineligible for further benefits.   He was shocked at the process, and the events that unfolded.

The claimant realized he needed an experienced disability insurance attorney. Once retained, we were able to decipher the timeline of events and knew that the doctor’s opinions were radically altered following his forced consideration of the surveillance.   We meticulously reviewed the surveillance, and appreciated that it did not match our client’s version of events.   It appeared the surveillance was overblown and was championed by Lincoln as significantly more reflective of ability than the medical records and the examination conducted.  

We recognized that Lincoln was unhappy with the initial report, and that Lincoln undertook efforts to change the “independent” doctor – and had succeeded.  This conduct was apparent, and needed to be developed.  Our appeal focused on these issues, took the surveillance apart through expert analysis, to demonstrate that editing of the surveillance video was used to undercut the viability of his claim.  

Armed with this support, we interfaced directly with the doctor, seeking further “clarification” of his opinions, and an explanation for the 180 degree turn made following the prodding by Lincoln.  We did not expect the doctor to respond, and when the doctor failed to support his opinions when faced with the difficult issues, Lincoln’s support crumbled.

We buttressed our appeal by securing a vocational expert to address our client’s functional capacity issues and limitations, and to address whether he was employable — he was not.  Our vocational expert’s report was enriched through an interview with our client, to further develop the issues, and when coupled with the medical records, we were able to provide specific functional issues and deficits which informed the opinion.  

Faced with this mountain of rebuttal evidence and support, Lincoln was compelled to readily capitulate.  Our client is now getting his monthly benefits as per the terms of his LTD policy, with a reinstated and insulated long term disability insurance claim.  

Let’s start by defining individual or private disability insurance. 

Individual long term disability insurance, also known as private long term disability insurance, is a policy designed to ensure a guaranteed income if you become disabled and cannot work. These policies are typically purchased through an insurance agent or broker by high-income wage earners.   Often, they are offered and sold to medical professionals as early as residency programs, offering coverage to grow with one’s increasing income.

These policies are not inexpensive but are invaluable if you need them. Each disability insurance policy contains numerous provisions concerning when a claim may be filed, what standards must be met to be considered disabled and what information must be supplied with a claim.  Provisions such as Notice of Claim and Proof of Loss are important terms to understand during this process.  The definition of disability, and what one can or cannot do if disabled is critically important to know while navigating a claim.

A private disability policy is likely to have a more thorough provision regarding paying benefits if you are unable to work in your own occupation versus any occupation. This is something to review carefully, especially if you have undergone years of training and invested significant resources in your occupation. Anyone who has attended graduate school for any advanced training, including attaining an MD, MBA, law degree, etc., should have a long term disability insurance policy in place that covers their own occupation.

While it’s relatively easy to purchase a disability insurance policy, it’s not always easy to collect when you have a claim. Many people with long term disabilities have their rights to these benefits challenged by insurance companies seeking to deny their claims and control liabilities. 

Some disability insurance policies are better than others, and some companies are better than others when a claim is presented. You may have invested thousands of dollars in buying a private disability insurance policy with the reasonable expectancy that the company will pay benefits when you file a claim.   To best ensure that this will occur, knowing the terms of the policy is vital, as it is metaphorically the road map to the treasure chest.

When disability insurance companies deny a claim or intensify the level of information requests, to the degree that it seems suspicious, professionals turn to Newfield Law Group.  Jason Newfield is a seasoned disability attorney with a track record of success based on more than twenty years of practicing in this area of law.

How can you protect your long term disability claim when you own a private or individual policy?

Understand that once you file a claim, the insurance company begins a fact-finding mission to seek information to use against you, in an effort to undercut your claim and the support you have presented. You may start receiving requests for financial records, scheduling reports and a host of materials that may not seem relevant. The insurance company is starting to gather information to find a reason to deny your claim.

You may also be asked to undergo one or more medical examinations. If you are asked to go for an IME – Independent Medical Examination— you should contact an experienced disability insurance attorney to address your rights and help guide this process.  It is possible the insurance company has already decided to deny your claim and is simply gathering as much evidence as possible to support its denial.  Often, companies will utilize the same doctors over and over, and one cannot expect fairness in that process.

You need to be aware that certain medical conditions invite closer scrutiny by the private disability insurance company. These include conditions where a diagnosis is made based on clinical evidence, rather than diagnostic imaging or other objective evidence.  Chronic Fatigue Syndrome (CFS), Lyme Disease, Fibromyalgia, Vestibular Dysfunction and Psychiatric disorders all raise a red flag for individual disability insurance claims. 

If your organizational skills are not great, you will need to enlist the help of a trusted family member or friend or a disability insurance attorney to manage your claim. Every single phone call, email, text, or in-person visit by the insurance company needs to be carefully documented. Make sure to get the name and phone number, extension, and email address for anyone you have contact with. Make careful notes of the interaction; you will need more than the day/date/time. Include the topics discussed, the promises made and the tone and tenor of the conversation.   Often confirming the discussion with a claim analyst, in your own language, can help to shape the claim favorably.

Understand the insurance company has a large team of administrators, medical personnel, and lawyers to protect itself and not for your benefit.  Your future deserves the same level of protection, which is why a disability attorney is an important resource to have on your side.

If you have questions about how your private claim is being handled or are concerned about filing a claim for individual disability insurance, you are invited to call disability attorney Jason Newfield at 877-406-7883 to learn more about your claim and how the Newfield Law Group can help.

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