Nick Ortiz: Hi, I’m Nick Ortiz. I’m a board-certified disability insurance attorney. Today I’m here to talk to you about Lincoln Financial Group and the specific reasons why Lincoln Financial may deny long-term disability claims. Please note that these are not presented in any particular order of importance.
Number one, Lincoln Financial says there is insufficient medical records to support the claim. So, for example, the insurance company may have requested medical records from your doctors and the doctors never got around to providing the records to the insurance company.
Number two, Lincoln Financial says there is insufficient objective medical evidence. They may have medical records but they argue that those medical records don’t support the disability. The types of objective evidence they’re looking for are X-Rays, MRIs, CT scans, and the like.
Number three, Lincoln Financial says that your medical condition is non-verifiable or based primarily on self-reported symptoms.
Number four, your doctors didn’t return forms or questionnaires or attending physician statements to the insurance company that give opinions about your limitations.
Number five, the peer review physician hired by the insurance company issues a report stating that the peer review physician does not agree with the findings of your doctors.
Number six, Lincoln Financial may review your medical records and conclude that you’re exaggerating your symptoms.
Number seven, the insurance company hired a private investigator to conduct video surveillance and they’re gonna argue that the video surveillance is inconsistent with your purported limitations.
Number eight, you’d better believe that the insurance company is reviewing your social media, for example, Twitter, Facebook, Instagram, LinkedIn, and they may point out that some of your posts are inconsistent with your disabilities.
Number nine, they may deny your claim due to missed deadlines. So, for example, A, the initial application was filed too late. B, your proof of loss in support of your claim was too late, or C, you did not file an appeal in time, typically within 180 days.
Number 10, they may deny you based on a pre-existing condition exclusion.
Number 11, the insurance company may deny your claim based on a specifically-excluded condition. In other words, your disability is specifically listed as a condition that does not qualify for benefits in the policy.
Number 12, your medical records and other documentation provided in support of your claim does not meet or satisfy the definition of disability under the policy or plan.
Number 13, over time there may be a change in the definition of the term disability, for example, from own occupation to any occupation, after six, 12, or 24 months.
Number 14, you may be partially disabled but not totally disabled under the policy.
Number 15, the insurance company may argue that you are not working due to your own choice and not wanting to work and not due to a medically-disabling condition.
Number 16, most group plans are covered by a law called ERISA, E-R-I-S-A. This law very heavily favors the insurance companies and they know that.
If you’ve been denied due to one or a combination of these reasons, then we encourage you to give our office a call. We have experience in all of these reasons as to why an insurance company may deny an LTD claim. You can call us at 850-898-9904 for a free consultation if you’ve been denied benefits.
I also wrote a book called The Top 10 Mistakes That Will Destroy Your Long-Term Disability Claim. I’m making a copy of that book available for free at www.FreeLTDBook.com. Thanks for listening.