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.
