Last Updated: December 19, 2023 | Reviewed and Edited by: Ortiz Law Firm
Table of Contents
Lincoln Financial Group is one of the largest disability insurance providers in the U.S. Companies like Lincoln Financial don’t become giants by easily paying out claims. Their profit comes from not paying out disability claims. These companies use their vast resources and the fine print in policies to protect their profits, sometimes leaving individuals stranded during their times of need.
This unfair power dynamic highlights the critical need for skilled legal representation during the appeal process. At Ortiz Law Firm, we are committed to justice and advocating for our clients. We specialize in appealing long-term disability insurance claim denials.Get a Free Case Review
Lincoln National’s Troubled History
Lincoln National Corporation, a prestigious Fortune 250 company, oversees various insurance and investment management businesses, each operating as a subsidiary. The key subsidiaries under its vast umbrella include:
- Lincoln National Life Insurance Company
- Lincoln Life & Annuity Company of New York
- First Penn-Pacific Life Insurance Company
- Lincoln Financial Distributors
- Lincoln Financial Advisors
It operates under the official name of Lincoln National Life Insurance Company (Lincoln National) but was formerly known as the Lincoln Life Insurance Company. In 2018, Lincoln Financial acquired Liberty Life Assurance Company of Boston. Offering both group short-term and long-term disability insurance, Lincoln Financial extends its coverage to over two million workers.
Over the years, Lincoln Financial has been at the forefront of numerous disputes due to its approach to handling individual and group long-term disability claims. Specifically, there have been wrongful claim denials, unwarranted delays, and abrupt terminations of legitimate claims.
The primary role of disability insurance is to offer reliable support for policyholders when they face disabling events that prevent them from fulfilling their work duties. These disabilities could range from mental health conditions and chronic illnesses like fibromyalgia or Lyme disease to physical impairments such as traumatic brain injuries.
Regrettably, there are circumstances where insurance providers, including Lincoln Financial, have been known to purposefully stall or reject valid claims. This unscrupulous behavior has led to a series of lawsuits filed by policyholders, where it has been suggested that Lincoln Financial has unjustly refused rightful claims. Some of these legal challenges have indeed found substantive grounds for these accusations.
We specialize in disputing claim denials from Lincoln Financial. Our team can clarify the reasons behind your claim’s rejection, inform you of your legal rights, and strategize the best course of action, whether that involves an appeal or a lawsuit.
One significant event unfolded in April 2015 when the New York State Department of Financial Services conducted an exhaustive probe into Lincoln Financial’s conduct. The investigation underscored the company’s participation in unfair claim settlement practices, criticizing its failure to maintain promptness, fairness, and impartiality standards, thereby violating New York’s insurance laws.
The company’s dubious past further unraveled when an internal audit in June 2008 uncovered significant misconduct in Lincoln Financial’s claim processing department. Alarmingly, high-level executives reportedly overlooked these findings, failing to institute effective reforms. This lasted from June 2008 to June 2014, leading to a substantial surge in unresolved claims.
Lincoln Financial Disability Denials
Receiving a disability claim denial from Lincoln doesn’t mean your journey is over. You have the right to challenge a denial, but first, you must understand why your claim was denied.
Language Used in Lincoln Financial Denial Letters
If Lincoln denied your initial application for LTD benefits, you might have received a letter that states, “Having carefully considered all of the information submitted in support of [the claimant’s] claim, our position remains that proof of her continued disability in accordance with the Policy provisions after December 31, 2022, has not been provided. Therefore, no further benefits are payable,” or something like, “We have completed a thorough review of your eligibility for LTD benefits and have determined that benefits are not payable.”
If Lincoln previously paid you LTD benefits, you may have received a termination letter that said, “We have completed a thorough review of your eligibility for benefits and have determined that benefits are not payable beyond December 31, 2022. Group Policy No. 123456789 requires that to be eligible for benefits, you must meet the following definition of disability.”
The following is an example of a definition of “disability” or “disabled” from a Lincoln disability insurance policy:
‘Disability’ or ‘Disabled’ means:
i. if the Covered Person is eligible for the 24 Month Own Occupation benefit, ‘Disability’ or ‘Disabled’ means that during the Elimination Period and the next 24 months of Disability the Covered Person, as a result of Injury or Sickness, is unable to perform the Material and Substantial Duties of his Own Occupation; and
ii. thereafter, the Covered Person is unable to perform, with reasonable continuity, the Material and Substantial Duties of Any Occupation.
‘Own Occupation’ means the Covered Person’s occupation that he was performing when his Disability or Partial Disability began. For the purposes of determining Disability under this policy. Liberty will consider the Covered Person’s occupation as it is normally performed in the national economy.
Top Reasons Why Lincoln Financial Denies Disability Claims
Common reasons why Lincoln denies disability claims include:
Understanding the Concept of Bad Faith Denial
Insurance companies are legally bound to operate in good faith, treat their policyholders fairly, and review claims objectively. However, many use ‘bad faith’ practices, deliberately denying legitimate claims or delaying payments. Identifying these unethical tactics is crucial, and Ortiz Law Firm specializes in exposing such maneuvers, holding companies accountable, and ensuring clients receive their due compensation.
Bad faith claims and lawsuits may result from:
- Unwarranted denials of disability benefits.
- Neglecting to assess a claim with an intention to pay benefits properly.
- Delaying a decision on a claim beyond a reasonable timeframe.
- Not providing pertinent details to the individual submitting the claim.
Note: Specific legal claims for “bad faith” may not be available in many group plans governed by ERISA.
Strategies to Avoid a Lincoln Financial Disability Claim Denial
To increase your chances of a successful Lincoln Financial disability claim, consider a proactive approach:
- Maintain Consistent Medical Visits: Ensure you continue your treatment. If the insurance company asks for recent medical records, having a comprehensive file on hand is beneficial.
- Proactively Supply Medical Proof: Don’t solely rely on Lincoln to obtain your medical records, even if they have an authorization form. Be proactive in providing these documents.
- Verify Your Medical Records: Scrutinize your records before submission. If you spot inaccuracies, request your healthcare provider to make the necessary corrections.
- Document Symptoms and Limitations: Keep a detailed record of your health issues and their impact on your daily functions, then share this with your doctor so it becomes part of your medical file.
- Seek Objective Tests: If feasible, undergo evaluations like a functional capacity examination or psychological tests. These can counter any implications that you might be exaggerating your condition.
- Anticipate the Shift in Disability Definition: Insurance companies often change the definition of disability, usually at the claim’s one or two-year mark, which could prompt a denial. Continue your treatment and consider additional testing to substantiate your disability under the new criteria.
RELATED POST: 10 Tips to Maintain Approval of Your LTD Benefits
Appealing a Lincoln Financial Disability Denial
When your claim is denied, you have the right to file an internal appeal. Your denial letter should specify your appeal rights and deadlines. Typically, you have 180 days to act.
Under the Employee Retirement Income Security Act (ERISA), applicable to most employer-sponsored plans, you must exhaust your insurer’s internal appeal process before you can sue. This might entail multiple appeals based on your policy’s terms.
Ortiz Law Firm specializes in navigating these complex procedures while preparing a comprehensive long-term disability appeal package.
It’s important not to wait until you’ve used all appeals before consulting an attorney. Once you’ve “exhausted” your appeals, you can’t add new evidence to your case file, which is crucial for the judge’s review. An attorney can review your denial letter and ensure you understand why your claim was denied, what you must prove to win your claim, and the appeal procedures you are required to follow.
Not all disability claims fall under ERISA. If ERISA does not govern your policy, you might not need to appeal before filing a lawsuit. Non-ERISA policies include those purchased privately or provided by government or church employers.
Understanding the Lincoln Financial Disability Appeal Process
Here’s what the appeal process generally involves:
- Analyze Your Denial Letter: Understand why your claim was rejected.
- Note Your Appeal Deadline: Mark this date on your calendar to avoid missing it.
- Obtain Your Claim File: Request all relevant documents from Lincoln Financial.
- Seek Legal Advice: A disability insurance attorney can clarify your options and best action.
- Assess Missing Information: Review your file to identify gaps in your medical records or other evidence.
- Gather Updated Medical Records: These should come directly from your healthcare providers.
- Compose and Send Your Appeal: Ensure your appeal letter is comprehensive and submit your packet before the deadline.
FREE RESOURCE: Appeal a Lincoln Financial Disability Denial with our Disability Insurance Appeal Guide
The Necessity of Rigorous Documentation in Disability Claims
Your success leans heavily on the thoroughness of your documentation. At Ortiz Law Firm, we stress the importance of retaining every piece of relevant communication, medical records, and policy documents. This detailed collection of proof guards against insurers capitalizing on informational voids, forming a sturdy base for your appeal or subsequent lawsuit.
If the appeal process overwhelms you, legal professionals can advocate for you, help compile evidence, draft your appeal, and handle submissions. It’s advisable to seek legal assistance early in the process. Contact us for a free case review today.
Filing a Lawsuit Against Lincoln Financial
Once you have exhausted your administrative appeal rights, you can file an ERISA lawsuit in federal court. Here is an example of language used by Lincoln Financial when a claimant has exhausted their appeal rights:
“At this time, [claimant’s] administrative right to review has been exhausted, no further review will be conducted by Lincoln and her claim will remain closed,” or something like, “you have exhausted all rights of appeal, and your administrative file is now closed.”
The letter will then provide information regarding a lawsuit:
“If your plan is subject to ERISA, you may have other voluntary alternative dispute resolution options, such as mediation. One option is contacting your local U.S. Department of Labor Office and State insurance regulatory agency. In addition, you have the right to pursue litigation and request copies of records and other information relevant to the claim free of charge.
The employer’s plan has a contractual limitations period of three years, which means that a lawsuit must be brought within three years after the date written proof of claim or proof of continued disability was required. The date on which the contractual limitations period expires for this claim is [date].”
The sample language above does not state that you cannot submit additional documentation to support your claim. This is a common practice among insurance companies and should help to reinforce that the insurance company is not your friend.
Federal Court Cases Against Lincoln
Although we were not involved in the federal court cases listed below, we have summarized them to help claimants better understand how disability law is interpreted and how the Court decides such claims.
- Till v. Lincoln – Claimant Failed to Provide Adequate Documentation to Support Claim
- Zerangue v. Prudential – Case Dismissed Because Claimant Did Not Apply for Benefits
Leverage the Skill and Experience of the Ortiz Law Firm
Engaging in legal warfare with insurance giants requires a comprehensive strategy that includes negotiations, administrative appeals, and courtroom battles (when necessary). The Ortiz Law Firm is highly skilled in this area and isn’t afraid to challenge unfair insurance tactics.
With in-depth knowledge of complex regulations like ERISA and a track record of challenging invasive surveillance and inadequate settlement offers, the Ortiz Law Firm is a formidable advocate for claimants. We can help with claim denials or disputes about the following:
- Unjustifiable Payment Delays: Insurance carriers must process legitimate claims within an acceptable timeframe, although the specifics vary based on individual circumstances and policy requirements.
- Negligence in Responding to Policyholder Queries: Lincoln Financial must maintain transparent, prompt communication with their policyholders, fulfilling or acknowledging their requests for information without delay. Documenting all your requests for information and any responses received is advisable.
- Excessive Requests for Information: Occasionally, disability insurance providers resort to exhaustive information demands, intending to make the claim process so taxing that claimants give up on their claims. This barrage of requests could lead to missed deadlines, giving insurers an excuse to deny your claim. In such instances, consulting with a disability denial lawyer can provide necessary guidance.
- Independent Medical Examinations (IMEs): Lincoln Financial might order an IME to learn more about your condition and any resulting restrictions or limitations. These examinations, typically conducted by medical professionals outside the claimant’s treatment circle and potentially biased towards the insurance company, are occasionally executed in bad faith.
- Functional Capacity Evaluations (FCEs): Lincoln Financial may utilize an FCE to evaluate your capability to perform work-related tasks, correlating your medical status to occupational requirements and workplace conditions. These assessments may sometimes contradict your physician’s opinion, producing questionable outcomes. Retain all documents that may help support your claim.
- Lincoln Financial’s Failure to Comply with ERISA: Group disability employee benefit plans offered by private employers or labor unions are regulated by the Employee Retirement Income Security Act of 1974 (ERISA). ERISA law includes specific reporting and disclosure mandates and restrictions on certain transactions. If Lincoln Financial’s claim backlogs or operational inefficiencies hinder your claim’s processing, legal recourse is available to hold them accountable.
- Ignoring Updated Medical Evidence: Despite the discretionary clauses in their policies, Lincoln Financial’s decision to overlook your treating physician’s opinions and recommendations while assessing your claim doesn’t render you powerless. Such disregard can be challenged—potentially identified as bad faith in individual policies or deemed arbitrary and capricious in group policies.
- Covert Surveillance Practices: Insurance providers can pay private investigators to follow and record claimants to turn up evidence that contradicts their disability claims, particularly those involving invisible conditions such as fibromyalgia, a mental disorder, or a migraine headache disorder. A claim denial due to surveillance at your residence warrants consultation with a knowledgeable disability insurance lawyer.
- Underwhelming Settlement Offers: If you receive a settlement offer for your claim, you have a critical decision to make—whether to accept or refuse it. Given insurers’ propensity for minimal payouts, initial offers tend to be extremely low. They are hoping you will accept it without question. An adept disability insurance attorney may be able to negotiate a more favorable settlement amount.
- Dissemination of Incorrect Policy Language and Provisions: Lincoln Financial is responsible for accurately updating you on any modifications to your policy’s terms and conditions, a standard procedure across all policies. Misrepresentation on their part could entitle you to additional benefits.
Dealing with an unexpected disability can cause serious financial stress for you and your family. This often leads to a crucial question: How can they pay for the help of a specialized disability insurance lawyer to fight for the coverage and benefits they deserve when they are already struggling financially?
We handle long-term disability claims on a contingency fee basis. This eliminates the need to provide payment upfront — you don’t have to pay a fee until we win your claim.
We cover the initial expenses for your case, including costs for getting medical evidence and court fees if your case goes to trial. This approach ensures that expert legal representation is available to more people, regardless of their financial situation.
Our Case Results
Many of the Lincoln claims we handle are approved on appeal. The following are just a sample of some of the claims we have brought to a favorable resolution.
- Senior Analytics Consultant Approved for Disability Benefits: Lincoln initially terminated this short-term disability claim after 11 weeks. The claimant hired us for assistance, so we filed an appeal of the STD denial and an LTD claim. Despite the STD appeal being denied, the LTD claim was approved. We then requested that Lincoln reconsider the STD denial, which was reinstated.
- Lincoln Overturns Termination of “Any Occupation” Claim for Truck Driver: The insurance company initially argued that the driver could work any job despite ongoing symptoms. We appealed, emphasizing the importance of the claimant’s subjective symptoms and the limitations they posed. Shortly after our appeal, Lincoln reversed its decision.
- Benefits Approved for Customer Service Representative with Back Problems: Lincoln only approved this claim for a limited period due to the absence of specific restrictions and limitations identified through physical examination or testing. However, the policy did not mandate objective medical proof. Upon our appeal, the decision to terminate the claimant’s long-term disability benefits was overturned.
Get a Free Case Review
Our expertise spans both individual and group long-term disability insurance claims. We have recovered millions in denied benefits for clients across the United States. We can assist you in your fight against Lincoln Financial by:
- Preventing potential disability denials,
- Crafting persuasive appeals,
- Filing lawsuits against Lincoln Financial Group, and
- Negotiating lump-sum settlements.
We won’t give up until we secure the benefits you rightfully deserve, and you only pay a fee if we are successful. We also offer a free case review so you can discuss the specifics of your claim with an experienced Long Term Disability Attorney—call (888) 321-8131 to schedule your case review today.