Lincoln Financial Group offers long term disability insurance that is intended to provide financial protection should you have to miss work for an extended period of time due to an accident or illness. According to Lincoln Financial Group’s website, with long term disability insurance from Lincoln, “your benefits continue for the policy’s benefit period or until you are no longer disabled, whichever comes first.”
However, Lincoln Financial is a business, and they make money by not paying claims. Many Lincoln Financial disability claims are wrongfully denied or will be wrongfully terminated before the claimant is able to return to work. The Ortiz Law Firm helps with long term disability insurance claims (and some short term disability claims) that have been denied or terminated, so this article and the video below will focus on understanding your disability denial letter, how to prepare and submit Lincoln Financial disability appeals, and filing a lawsuit if the insurance company continues to deny your claim for benefits.
Lincoln Financial Acquired Liberty Mutual Disability Insurance Products
In May of 2018, Lincoln Financial acquired Liberty Life Assurance Company of Boston. As stated on Liberty Mutual’s website
Effective May 1, 2018, Liberty Life Assurance Company of Boston, the underwriting company for Liberty Mutual’s group life, disability, and voluntary insurance products and provider of absence management services, was acquired by The Lincoln National Life Insurance Company. The Lincoln National Life Insurance Company is now responsible for Liberty Life Assurance Company of Boston’s legal obligations including policies, contracts and certificates previously issued. The Lincoln National Life Insurance Company is part of Lincoln Financial Group®, the marketing name for Lincoln National Corporation and its affiliates.
Our disability lawyers will also handle long term disability claims (and some short term claims) that were previously with Liberty Life Assurance Company of Boston. Disability claimants can rest assured that their claim for benefits is in good hands, as our experienced disability lawyers have handled claims with both Lincoln and Liberty Mutual.
Lincoln Financial Denial Letters
Lincoln will typically begin its denial letters with the definition of “Total Disability” under the policy. Here is a typical Lincoln disability definition:
TOTAL DISABILITY or TOTALLY DISABLED will be defined as follows:
1. During the Elimination Period and Own Occupation Period, it means that due to an Injury or Sickness the Insured Employee is unable to perform each of the Main Duties of his or her Own Occupation.
2. After the Own Occupation Period, it means that due to an Injury or Sickness the Insured Employee is unable to perform each of the Main Duties of any occupation which his or her training, education or experience will reasonably allow.
The loss of a professional license, an occupational license or certification, or a driver’s license for any reason does not, by itself, constitute Total Disability.
Even if a claim was previously approved during the “Own Occupation” period, it is common for Lincoln Financial Group to deny disability benefits when the definition of disability reaches the “Any Occupation” period. Here is an example of the language typically used by Lincoln Financial in this scenario:
“The Own Occupation Period for this claim will end on 1/1/2021. Your own occupation was identified at the time benefits were approved and listed as a Physician or Medical Doctor. After a thorough review of the information currently contained in your claim file, we have determined you are capable of performing work in other occupations. Outlined below is the information reviewed which led to our determination.”
Lincoln Financial will also summarize the medical records that were reviewed while deciding your disability claim before concluding the letter:
“In summary, it is our determination that based upon your age, education, training, past work experience and your current abilities, that you are not prevented from performing work in other occupations, even if you can no longer perform your Own Occupation. Therefore, you no longer meet the definition of disability in this policy and benefits will be denied as of 1/1/2021.”
Your payments from the insurance company will then cease as of the date provided by Lincoln Financial.
Your Right to Appeal a Lincoln Financial Long Term Disability Denial Letter
Lincoln will also explain your right to appeal in its denial letter. The following language is pulled from an actual Lincoln denial letter that we have received:
As a reminder, on 8/16/2020, your Own Occupation Period of the policy ends. This means, to qualify for ongoing Total Disability benefits, you must have restrictions and limitations beyond 8/16/2020 that render you unable to work in any gainful occupation (sedentary or otherwise) that your past training, education and experience will reasonably allow. If you believe that your condition prevents you from working in any occupation, please submit medical records, not previously submitted, that will help us evaluate your capacity to work as of 8/16/2020.
Do I Have to File Multiple Lincoln Financial Disability Appeals?
Depending on the terms of your policy you may be able to file a second appeal. Sometimes a second appeal is optional, but not required. In this situation, it is advisable that you get legal advice. In some cases filing an optional appeal may not be beneficial. The terms of each policy and the merits of each case are different, so it is important that you carefully review your policy or get legal advice on your appeal options.
Should I Hire an Attorney for the Lincoln Financial Disability Appeal Process?
As set forth below, you should contact an experienced Lincoln Financial disability attorney to assist you with the long term disability appeal process. Too many claimants seek assistance from an attorney after all of their appeals with the disability insurance company have been “exhausted” or used up. This is a huge mistake.
After your appeals are used up the next step is to file a lawsuit, and you do not have the right to introduce any new evidence in an ERISA lawsuit. If an attorney had been involved in the appeals process, he or she could have used the appeals process to fill the record with medical evidence that could be used in a federal lawsuit, such as a residual functional capacity evaluation form from your treating doctor.
Submitting Your Appeal to Lincoln Financial Group
If you decide to file your own appeal it is important that you carefully review the appeal instructions included in your denial letter. Lincoln explicitly sets forth what you should do to initiate the appeals process. Here is an example of language used by Lincoln Financial:
You, your attorney or a person legally authorized as your representative may request a review of your denied claim. Such request must be made in writing and submitted to us at the address below within 180 days after you receive this denial notice.
The Lincoln National Life Insurance Company
PO Box 2337
Omaha, NE 68103
Your request for an appeal needs to include the following:
• A letter of appeal outlining the reasons for your appeal. This letter needs to include your policy number and claim number.
• Medical records to support your appeal such as office and treatment notes, laboratory results, x-rays and testing results.
Simply sending a letter the Lincoln Financial saying, “I appeal” is not sufficient. You should include updated medical records and opinion evidence from your treating medical providers to support your appeal. If you get overwhelmed, a disability lawyer can assist you in obtaining this evidence, writing your appeal, and submitting everything to the insurance company on your behalf.
File a Lawsuit Against Lincoln Financial Group
As we mentioned above, once you have exhausted your administrative appeals with the insurance company, you have the right to file a lawsuit against Lincoln Financial. Here is an example of language used by Lincoln Financial in past long term disability insurance claims:
You have exhausted all rights of appeal and your administrative file is now closed.
If your plan is subject to ERISA, you may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance regulatory agency. In addition, you have the right to pursue litigation and you may 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 02/15/2022.
When the insurance company says that your administrative file is now closed, that means that you cannot submit any additional information in support of your Lincoln Financial disability claim. Please note that the language above doesn’t mention this important detail. This is common among insurance companies and should help to reinforce that the insurance company is not your friend. The court is limited to reviewing the information that was previously submitted in support of your claim for disability benefits from Lincoln Financial.
Again, this is why it is so important to obtain help with your long term disability claim from an experienced law firm with your claim while you are still in the appeal stage of your disability insurance claim. An insurance attorney will ensure that all of the evidence needed to support your claim is submitted to the insurance company and that the insurance company’s decision to approve or deny the claim is not unnecessarily delayed. The attorney may even prepare a custom RFC form to submit to the insurer. Ortiz Law Firm has a custom form for a variety of disabling conditions.
Group Disability vs. Individual Disability
Most of the information above assumes you were denied disability benefits under a group disability policy governed by ERISA law (the most common type of disability insurance policy, typically obtained as part of a group benefits package with your employer). If you obtained an individual insurance policy directly from an insurance agent or broker, or if you obtained the policy through a government or church employer, then your claim for benefits is not governed by ERISA law. In this situation, you may not have to appeal your claim denial before filing a lawsuit.
Hire a Lincoln Financial Disability Attorney to Help with Your Claim
An experienced attorney will have experience with all of the major disability insurance companies such as Lincoln Financial and will help you gather the best evidence for your claim and help you prepare the appeal in a way that will maximize the chance for you to receive disability benefits. Mr. Ortiz is an experienced long term disability attorney who has recovered millions in disability benefits, and he has handled numerous disability claims against Lincoln and what was formerly Liberty Mutual over the years. He and his legal team are ready to fight for the financial security that you deserve.
Ortiz Law Firm offers a free consultation in long term disability claims (and some short term disability claims) where you have been wrongfully denied (or terminated) LTD benefits. Contact Ortiz Law Firm today at (866) 853-7210 to schedule a free consultation to see what our law firm can do to help you obtain the long term disability benefits you deserve. The consultation is free, and there is no obligation for you to form an attorney-client relationship with our firm.