The Lincoln and Long Term Disability Insurance Benefits
Long-term disability insurance is intended to help provide you financial protection should you have to miss an extended period of work due to an accident or illness. According to Lincoln’s website, long-term disability insurance from Lincoln Financial Group include “up to 100% predisability earnings with partial disability benefit and part-time earnings”.
Unfortunately, Lincoln does not always pay STD or LTD claims as it should.
Lincoln Disability 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”, it is common for Lincoln to cut-off benefits when the definition changes to the “Any Occupation” period in paragraph number two. Here is typical language used by the insurance company: “The Own Occupation Period for this claim will end on 1/1/2014. 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.”
The Lincoln will summarize your medical records and conclude:
“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 1/1/2014.”
Your payments for benefits will then cease as of that date.
Your Right to Appeal a Lincoln Denial Letter
The Lincoln will explain your right to appeal:
As a reminder, on 8/16/2014, your Own Occupation Period of the policy ends. This means, to qualify for ongoing Total Disability benefits, you must have restrictions and limitations beyond 8/16/2014 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 8/16/2014.
As set forth below, you should contact an experienced long term disability attorney to assist you in filing the appeal.
Contact Information for The Lincoln
You may send documentation supporting an ongoing disability to the address listed on the letterhead of your denial letter. As of February 2014, the mailing address and fax for Lincoln were:
The Lincoln National Life Insurance Company
8801 Indian Hills Drive
Omaha, NE 68114-4066
Toll free phone: (800) 423·2765
Fax: (877) 843-3950
Where to Send Your Appeal
The Lincoln explicitly sets forth what you should do to file an appeal:
“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.”
You should not simply send a letter saying, “I appeal”. You should be including updating medical records and opinion evidence from your treating medical providers to support your appeal.
Hiring an Attorney to Assist You in Your Long Term Disability Claim
Too many claimants seek assistance from an attorney after all of their appeals have been “exhausted” or used up. This is a huge mistake. After your appeals are used up, 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 filled the record with evidence that could be used in a federal lawsuit, such a mental or physical capacity evaluation from your treating doctor.
An experienced attorney will help you prepare the best evidence for your claim and help you file the appeal in a way that will maximize the chance for you to be put back on claim.
Mr. Ortiz is an experienced long term disability attorney. He has handled numerous claims against The Lincoln and offers free consultations in claims where you have been wrongfully denied (or terminated) LTD benefits. Contact us today at 850-308-7833 to see what we can do to help you or your loved one.