An electrical engineer employed at a major scientific facility came to us after his claim had been terminated by Lincoln, despite ongoing evidence of severe impairment resulting from significant pelvic floor dysfunction. Our job was to demonstrate that Lincoln’s vacuous words that they conducted a complete review of the materials was untrue, and that our client’s impairments were well supported.
After a long period of time suffering from his condition, the engineer had to stop working and his claim was initially accepted. Lincoln shortly terminated the claim based upon its playbook of seeking a paper only medical review. We have represented many Lincoln claimants so we know well the strategy of providing the reviewer with selective documents and pressing the reviewer to focus on isolated pieces of evidence while excluding more persuasive evidence. This was not the action of a neutral fiduciary. Our appeal cited how Lincoln bragged about its claim operations becoming “more effective” through its corporate earnings reports.
To effectuate its claim termination, Lincoln had engaged a well-known insurance doctor, Dr. Greer Richardson, who claimed to have made efforts at contacting my client’s providers. This is another strategy used by Lincoln, and we proved that the doctor was not telling the truth.
Determining what was needed to overcome the termination, we strategized the claim approach with our client to marshal powerful support. Utilizing an array of forms with his providers, and for self-reporting, we provided compelling evidence to buttress the significant medical issues that existed. Newfield Law Group articulated the connection between his functional limitations and deficits with his occupational requirements.
We worked with our client and his healthcare providers to undercut each prong of the claim denial– treating the denial as a foundation of a home that we needed to tear down.
The Disability: Pelvic Floor Disorder
PFD is far more debilitating and painful than the inability to control one’s ability to urinate or defecate and has serious long-term implications for general health and well-being. Pelvic Floor Disability can be treated with physical therapy, biofeedback, medication and trigger point injections but treatment is not always effective. PDF impacts bowel, bladder and sexual function, all of which can lead to someone not being able to leave their home. PFD can also lead to loss of core stability, posture, impaired mobility and balance. Daily tasks like lifting, walking or exercising become challenging. In severe cases like that of the electrical engineer, the chronic pelvic pain, emotional distress and mobility limitations led to a significantly reduced quality of life.
Newfield Law Group Works with Claimant’s Physicians to Build a Strong Appeal
The engineer’s healthcare providers were able to provide the nexus between the impairments and his functionality and Newfield Law Group bridged that critical information. provided significant support for how and why his chronic pain issues were so impairing, despite being unable to see such challenges through any objective measures.
Using a huge number of supportive statements, from family members, friends, and co-workers, we showed how dramatically limited our client’s life had become because of his impairments.
Lincoln initially sought to conduct a post-appeal examination of our client and when we objected to the process, it reverted back to another paper only medical review. We attacked the review and provided significant amount of updated medical reports and records to support the continued impairment and secure the claim reversal for our client, whose claim has been reinstated, with benefit arrears released to him.
The collaborative effort with our client and the much appreciative unwavering support from his providers helped to unlock the door to his justly due benefits.
A few items from the appeal we feel are anyone who has a long term disability insurance policy with Lincoln needs to keep in mind:
There are many court cases, including U.S. District courts, where judges have found Lincoln’s decisions to deny LTD benefits to be arbitrary and capricious. If your claim has been denied, you are not alone and your claim has merit. Don’t give up without a fight.
The courts have also underscored Lincoln’s strategy of selecting documents to support its denial while dismissing medical records that show clear evidence of a person’s disability. Ignoring any portion of a medical record to deny a claim is not only wrong, but also illegal. The insurance company is a fiduciary to their claimants, meaning that it has a legal obligation to put the claimant’s interests above its own. Clearly this is not how Lincoln Insurance operates.
The appeal created for the engineer by Newfield Law Group brought clarity to the strategies used by Lincoln:
- Reliance exclusively and entirely on a biased paper review by the consultant who is paid by Lincoln.
- Reliance on selective portions of the medical record to the exclusion of more persuasive information supporting the claimant’s disability.
- Ignored the consistent and supportive opinions of the claimant’s treating physicians, many of whom have been involved with the case for many years.
- Failed to conduct an appropriate vocational assessment.
The list of cases where Lincoln and other long term disability insurance companies have wrongfully denied claims, including MetLife, Unum, Group Life Assurance, Continental Casualty and Reliance, is a testament to the efforts of long term disability insurance attorneys who go to bat for clients. Newfield Law Group represents people who have spent years working and paying long term disability insurance premiums, only to be denied when they file claims.
After a long and successful career, the electronic engineer was reluctant to leave the workplace but was unable to continue. Newfield Law Group fought back to get the financial benefits promised by Lincoln when the engineer signed on for benefits but was denied shortly after the claim was filed.
If you have a long term disability insurance policy with Lincoln National Life Insurance Company and are concerned about filing a claim, or if your claim has been denied or terminated, you are invited to contact Jason Newfield for a free consultation ab2out your situation.