Lincoln Financial Group offers long-term disability insurance that is intended to provide financial protection in case 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 disability insurance from Lincoln, “your benefits continue for the policy’s benefit period or until you are no longer disabled, whichever comes first.”
Unfortunately, many claimants receive Lincoln Financial disability denials instead of the disability insurance benefits they were counting on. Lincoln Financial is a business, and they make money by not paying disability insurance claims.
The same company that is responsible for paying claims is also responsible for determining whether a claim meets the eligibility requirements as defined by the policy. This is a clear conflict of interest, and 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 Lincoln Financial continues to deny your claim for benefits.
Top Reasons Why Lincoln Financial Disability Claims Are Denied
How Long Does Lincoln Long-Term Disability Last?
Most policies will pay benefits until a claimant reaches their Social Security Normal Retirement Age or the maximum benefit period outlined in the policy (usually age 65 if a claimants’ disability began before age 60). A claimant must continuously meet the definition of disability as defined in the policy.
However, most policies have exclusions that apply to certain conditions, such as mental health disorders and chronic fatigue syndrome. Claimants who suffer from an excluded condition may only be eligible to receive disability payments for a limited period of time, often 24 months. A disability caused by substance abuse may also be limited to 24 months.
Lincoln Financial Disability Claim Denial Letters
Lincoln will typically begin its denial letters with the definition of “Total Disability”. Here is a definition of disability that was sourced from a Lincoln Financial disability insurance policy:
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.
Own Occupation vs. Any Occupation
Even if a long-term disability insurance claim was previously approved during the “Own Occupation” period, it is common for Lincoln Financial Group to terminate 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 the outcome of 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 disability insurance payments from the insurance company will then cease as of the date provided by Lincoln Financial.
Your Right to Appeal a Lincoln Financial Disability Denial Letter
If the insurance company denied your claim you have the right to file an appeal. Lincoln will explain your right to appeal its decision on your disability insurance claim in the denial letter. The following language is pulled from an actual Lincoln denial letter received by one of the disability insurance claimants we represent:
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.
Should I Hire an Attorney to Help Obtain Long-Term Disability Benefits from the Insurance Company?
Disability insurance claimants should contact experienced Lincoln Financial disability insurance lawyers for a case evaluation. You will need experienced legal counsel to assist you with the long-term disability appeals process. Too many claimants wait to seek assistance from an attorney until 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. The judge is only allowed to review the same records that the insurance company reviewed.
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. You will not receive benefits unless you have properly supported your claim medical evidence.
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. The insurance carrier will explicitly state what you must 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.
Risk Services
The Lincoln National Life Insurance Company
PO Box 2337
Omaha, NE 68103
Fax: 402-361-1460
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 objective evidence as well as opinion evidence from your treating medical providers to support your appeal.
If you get overwhelmed, experienced lawyers can assist you in obtaining this evidence, writing your appeal, and submitting everything to the insurance company on your behalf. It is never too late to seek out an attorney to help with your legal claim.
Do I Have to File Multiple Appeals to Get My Disability Insurance Benefits?
If Lincoln continues to avoid paying benefits then you may be able to file a second appeal. Depending on the terms of your disability policy, the second appeal could be 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 so that you can obtain your rightful disability benefits.
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 additional documentation in support of your Lincoln Financial disability claim.
ERISA law, also known as the Employee Retirement Insurance Security Act, is the federal law that governs most disability insurance claims, states that the federal judge is limited to reviewing the information that was previously submitted in support of your claim for disability benefits from Lincoln Financial.
Please note that the language above doesn’t mention this important detail. This is common practice among insurance companies and should help to reinforce that the insurance company is not your friend.
Again, this is why it is so important to obtain help with your Lincoln Financial long-term disability claim from an experienced law firm immediately after the initial denial or while you are still in the appeal stage of your disability insurance claim. Your entire claim file will be up for review, but this will not do you any good if the file does not contain all of the relevant records from your treating physician.
An insurance attorney will ensure that Lincoln receives all of the evidence needed to support your claim is submitted to the insurance company and that the decision to pay your long-term benefits 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 file an administrative appeal before filing a lawsuit.
If you are unsure whether you have a group policy or an individual policy then you should contact an attorney immediately after you receive notice that your claim has been denied or terminated.
Hire a Lincoln Financial Disability Attorney to Help with Your Claim
The prospect of having to take on the insurance company alone can be very intimidating for a claimant. An experienced attorney will have experience with a major disability insurance carrier 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 benefits.
Mr. Ortiz is an experienced long-term disability attorney who has recovered millions in benefits. He has handled numerous disability claims for Lincoln Financials’ long-term disability benefits and will represent claimants anywhere in the United States.
He and his legal team at the Ortiz Law Firm are ready to fight for the financial security that you deserve and will not give up until you receive disability benefits. We will do everything we can to make this complicated process easier so that you can focus your attention on your health. We only charge attorney fees if your claim is successful, so there is no risk in hiring an attorney to help with your claim.
Lincoln Financial Acquired Liberty Mutual Disability Insurance Products
In May of 2018, Lincoln Financial acquired Liberty Life Assurance Company of Boston. As stated on the Liberty Mutual 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 firm will also handle long-term disability claims (and some short-term benefits 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 insurance companies.
Request a Free Legal Consultation
If your long-term disability insurance claim has been wrongfully denied or terminated then you should contact Ortiz Law firm to schedule a free consultation. Call Ortiz Law Firm today at (888) 321-8131 to schedule a free consultation. The consultation is free, and there is no obligation for you to form an attorney-client relationship with our firm.