Lincoln Financial Group is one of the largest insurance companies providing disability insurance benefits in the U.S. Technically, it is the Lincoln National Life Insurance Company (Lincoln National) that issues these group and individual disability insurance plans. However, Lincoln National operates under the name Lincoln Financial Group. Having acquired Liberty Life Assurance Company of Boston in 2018, Lincoln Financial continues to grow.
An insurer like Lincoln Financial does not reach this size by paying out claims. Lincoln claims that “benefits continue for the policy’s benefit period or until you are no longer disabled, whichever comes first.” However, Lincoln Financial is still a business, and it makes money by not paying disability insurance claims. Many claims result in claim denials instead of the disability insurance benefits they were counting on.
Fortunately, a Lincoln disability denial is not the end of your claim. You can fight back against an unfair denial of benefits. At Ortiz Law Firm, we have experience handling Lincoln Financial disability claim denials. We can help you understand why Lincoln Financial denied your disability claim and what your legal rights are. As a Lincoln Financial disability attorney, Mr. Ortiz can help you determine the best course of action for your unique situation. Whether you need help preparing an appeal or filing a lawsuit against Lincoln, we are here for you.
Top Reasons Why Lincoln Financial Denies Disability Claims
If Lincoln denied your initial application for LTD benefits, you may have received a letter that states something like:
“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 which said something like:
“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.”
Sample Lincoln policy language states:
“‘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.”
Tips to Prevent a Lincoln Financial Disability Claim Denial
Here are a few tips to prevent a denial:
- Continue receiving regular medical care. You always want to have a backlog of records ready to go when the insurance company requests updated records.
- It is your duty to provide medical evidence. Do not count on Lincoln to request your records, even if you signed a form to release your records.
- Review your records before you submit them to Lincoln. If any of the information is incorrect, you can ask your doctor to correct the records.
- Keep a log of your symptoms and limitations to provide to your doctor. This will help you document your symptoms and limitations in your records, even if your doctor does not specifically state it.
- Obtain objective testing, such as a functional capacity evaluation, if possible. Psychological and testing may defeat any claims that you are malingering or over stating your condition.
- Prepare for the change of disability definition. This is when the insurer is most likely to deny your claim. You need updated treatment and testing to prove you meet the new definition of disability.
- RELATED POST: 10 Tips to Maintain Approval of Your LTD Benefits
What to Do If Lincoln Financial Denies Your Disability Insurance Claim
If the insurance company denied your claim, you can appeal the determination through the insurers internal review process. Lincoln will explain your appeal rights and deadlines in the denial letter. Typically, claimant’s have 180 days to file an appeal.
ERISA, also known as the Employee Retirement Income Security Act, is the federal law. It governs most employer-provided disability insurance plans. ERISA law requires you to go through the administrative appeal process with your insurer before filing a lawsuit. Depending on the terms of your policy, you may have to file two appeals before filing a lawsuit.
Many claimants wait to seek assistance from an attorney until after all of their appeals have been “exhausted” or used up. This is a huge mistake that can destroy your claim.
When your appeals are “exhausted”, you can no longer submit additional documentation in support of your claim. The judge deciding your case can only review the evidence in your claim file. Your entire file will be up for review, but it will only help if the file contains all the relevant evidence.
If you receive a denial letter, you should contact an experienced Lincoln Financial disability lawyer for a free case evaluation.
The Lincoln Financial Long Term Disability Appeal Process
Here is a quick overview of the appeal process:
- Read your denial letter to understand why your Lincoln Financial denied your disability claim.
- Calendar your appeal deadline.
- Request your claim file and policy from Lincoln Financial
- Consult a disability insurance lawyer who can educate you on your appeal options.
- Review your claim file to determine what information about your condition(s) is missing.
- Request updated medical records from your treating physicians.
- Write your appeal letter and submit your complete appeal package before the deadline.
- FREE RESOURCE: Prepare Your Disability Insurance Appeal Like a Lawyer with Our Disability Insurance Appeal Guide
If you get overwhelmed while preparing your appeal, an attorney can take up the fight for you. They can help you by 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.
What If I Have a Non-ERISA Claim?
Group disability claims governed by ERISA law are the most common type of disability insurance policy. However, ERISA does not govern every disability insurance claim. In this situation, you may not be required to file an appeal before proceeding to litigation.
You may have a non-ERISA disability claim if you obtained your policy from:
- An insurance agent or broker,
- A government employer, or
- A church employer.
File a Lawsuit Against Lincoln Financial
Once you have exhausted your administrative appeal rights, you have the right to 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 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 [date].”
Note that the sample language above does not state that you cannot submit additional documentation to support your claim. This is common practice among insurance companies and should help to reinforce that the insurance company is not your friend.
Federal Court Cases Involving Lincoln
Radiologist Technologist Failed to Provide Adequate Documentation to Support Claim
Federal Court Case Dismissed Because Claimant Never Applied for Benefits
How Ortiz Law Firm Can Help With Your Lincoln Financial Disability Claim
If the prospect of taking on the insurance company alone is overwhelming, we can help. We help with Lincoln Financial disability claims by:
- Preventing disability denials,
- Submitting strong appeal packages,
- Suing Lincoln Financial Group, and
- Negotiating lump sum settlement of claims.
The legal team at the Ortiz Law Firm are familiar with Lincoln Financials’ tricks and tactics and will present your claim in the best possible light. We can help you gather the best evidence to support your case and will do everything we can to make this complicated process easier for you.
We have recovered millions in benefits for people throughout the United States. We also have extensive experience going up against Lincoln National/Lincoln Financial. We will not give up on your case until you receive the disability benefits you deserve. There are no costs up front, and we only charge an attorney fee if we are successful.
Nationwide Long Term Disability Attorneys
If you need assistance proving your disability insurance claim, we encourage you to contact us. We handle a wide variety of individual and group long term disability insurance claim denials. We offer a free case evaluation, during which we will review your claim and discuss your options. To schedule your free case evaluation with an experienced disability insurance lawyer, please call us at (888) 321-8131.