If your Lincoln Financial disability claim was denied, you must submit an appeal that’s written to win. In this article, we talk about Lincoln’s claim handling practices and share insights into how to appeal to Lincoln most effectively.
If you believe Lincoln treated you unfairly or made a mistake, Marc Whitehead and Associates may be able to help. Our practice is devoted to helping disabled individuals nationwide win their rightful disability benefits.
Most Lincoln Financial Disability Claims Are Governed by ERISA
A core business area of Lincoln Financial is Group Protection, including short term and long term disability insurance. Lincoln largely sells disability plans to employers who offer benefits to employees through the worksite.
The vast majority of Lincoln Financial disability claims and appeals are regulated by the federal law known as ERISA, which stands for the Employee Retirement Insurance Security Act.
This is important because you’ll need to comply with many complex regulations. ERISA creates unfair advantages that favor insurance companies and do little to protect the consumer against wrongful disability claim denials. The insurers know this. You need the support of an ERISA disability lawyer working for you throughout the appeals process.
In most cases, the insurance company:
- Underwrites the disability insurance policy;
- Serves as the Plan Administrator. This means Lincoln handles all aspects of the claim review. It processes, manages, and ultimately resolves (pays or closes) the claim;
- Serves as fiduciary of the plan, meaning Lincoln is the responsible party that makes sure the plan administrator (also Lincoln) gives you a “full and fair review.”
Under ERISA rules, disability insurance providers rarely face legal penalties to hold them accountable for unfair dealings. If the judge rules in your favor, usually the most a court can do is to order the insurance company to pay the benefits you are due, maybe pay some costs, and in some cases pay your lawyer’s fee.
What Is an Administrative Appeal?
If your Lincoln Financial disability benefits were denied, you have the right to petition the decision. The appeal is the procedure you must follow. ERISA law requires that, before you can take the company to court, you must first submit one or two administrative appeals to the insurance company.
The appeal allows you to submit additional documentation and medical evidence to strengthen your claim. It is through the appeals process that many denials are overturned and claimants eventually receive their benefits.
What many people are not prepared for is how complicated the appeals process can be, and the importance of seeking legal counsel immediately.
Sending a letter back to the insurer saying you are appealing their decision—even if you attach a doctor’s statement saying that you are disabled—is not enough to overturn a denial.
How Do I Appeal a Lincoln Financial Disability Claim Denial?
Be Prepared to Submit Two ERISA Appeals before Filing a Lawsuit
Disability plans from Lincoln Financial typically require two mandatory administrative appeals before you can file a lawsuit against the company.
For example, Lincoln denies your application for benefits, or benefits were awarded and then terminated. At this point, your only way to fight back is to file an appeal to the company. If Lincoln denies the first-level of appeal, you must file a second and final appeal. If the second appeal is denied, then you may file suit.
All appeals are given time frames that must be met. Failure to follow Lincoln Financial’s disability appeals process can cost you to lose your rights to benefits.
Lincoln’s denial letter will tell you that you have 180 days to appeal the first level of appeal. Within 45 days of receiving your appeal, the company will respond to you advising if they have reached a decision (benefits are granted or denied) or if they need more information from you (which creates an extension.)
If Lincoln denies your first appeal, then you need to pursue the final administrative appeal by the date they specify. In this second level of appeal, be prepared for the insurance company to take up to two more extensions.
Tips on Appealing Your Lincoln Financial Disability Denial
The appeal becomes part of the “administrative record” which is the crux of your case. The administrative record holds every form, letter, questionnaire, physician’s statement, doctor’s note, vocational evaluation, functional capacity evaluation, medical illustration, witness statement, or other evidence in one complete package.
Trying to appeal on your own, without expert legal help, only invites mistakes that can permanently damage your claim. You have some major hurdles to overcome:
- You are appealing straight back to Lincoln Financial Group who denied your claim initially. The company decides again whether to approve or deny the claim.
- Under ERISA rules, your appeal is the last chance you will have to submit evidence to support your claim. If you are forced to sue and your case goes to court, only in rare circumstances can new evidence be entered. In short, the judge can only review the same records that the insurance company denied.
- In most ERISA lawsuits, the standard of review is about the insurance company’s “abuse of discretion.” At this point, the judge is not considering whether you are disabled or not. The judge wants to know if Lincoln acted reasonably in denying the claim, or if the company abused its discretion by denying benefits.
Your appeal has the difficult burden of proving the extent of your impairments and your inability to return to work, in a way that no reasonable person would deny.
How Does Lincoln Financial Deny Disability Benefits?
While every case is unique, below are common examples of Lincoln Financial disability claim denials.
Use of Two Appeals to Delay and Wear You Down
With two levels of appeal in Lincoln Financial disability claims, the entire decision takes longer than with most other insurers. You appeal to the company twice, during which Lincoln will take several extensions. This causes you to wade through months of delays, endless requests for additional information, and other troubles before you can finally sue the company.
By denying your first appeal, Lincoln has a shot at reviewing your claim a second time to uphold the denial. The insurer hopes that you will finally give up and abandon your claim.
Deny When the Definition of “Disability” Shifts after 24 Months
In group disability claims, over time there usually is a change in the definition of disability. The definition shifts from own occupation to any occupation, often after 24 months.
During the “own occupation” you can receive disability benefits if you are unable to perform the work you were doing when you became disabled. Once the “any occupation” definition kicks in, you can only receive benefits if you are unable to do ANY type of work.
This is a much harder definition for a claimant to meet. It is at this point that Lincoln Financial disability claims are often reevaluated and benefits are denied or terminated. An ERISA attorney will review and confirm your work history, training, and education to determine whether you can perform the duties of the jobs the insurer is claiming you can do.
Rely Solely on Paper Medical Reviews by Hired Doctors
Many insurers, including Lincoln, perform “paper only” medical reviews of your records. They hire a third-party doctor to review your file, without ever meeting with you in person. The problems with a paper-only review are numerous. It is very common that the consulting doctor:
- has insufficient information about your condition
- has never examined you or spoken with you
- ignores medical evidence from your treating physician
- selectively finds (cherry-picks) evidence that works against you
This doctor makes the final judgments about your disability status, stating you can perform gainful work and supporting claim denial. Without attorney representation, you may never realize this occurred.
Deny Based on a Pre-existing Condition
Lincoln Financial disability plans generally contain a “preexisting condition” provision. Typically this says that benefits will not be payable for preexisting conditions that are the cause of your disability during your first year of coverage.
Lincoln will investigate your medical history to determine if you comply with your policy’s requirements. Once you have been covered by your disability policy for 12 months (or other timeframe specified in the policy) the preexisting condition clause no longer applies.
The key is to examine your plan’s exclusions and limitations before you ever submit your disability claim. However, Lincoln may try to interpret the preexisting condition exclusion very loosely. In cases where this becomes a basis for denial, an ERISA attorney may be able to defend your claim against Lincoln’s rendition and get you the benefits you deserve.
Benefits Are Terminated (You Are No Longer Disabled)
Lincoln strongly advocates “absence management” and places great emphasis on back-to-work programs. Helping employees return to work is the right solution for Lincoln Financial disability claimants who are genuinely able to get back to normal work life.
However, return-to-work incentives may eventually lead to benefit termination. This is particularly so if you agree to return to work part-time. By acknowledging you can work, in some cases this opens the door for an insurer to decide you’re able to work full time and deny benefits altogether.
These terminations can often be argued and won by demonstrating that your condition has not improved. If Lincoln unreasonably discontinues benefits for any reason, you have the right to appeal the denial just like you did at the initial application.
Once you start receiving monthly payments, all disability plans call for periodic reviews of ongoing claims. If an insurer finds some way to allege you can return to work, they can terminate your benefits on the basis that you are no longer disabled. Insurers never stop looking for ways to avoid paying benefits. Our monthly benefit protection services are in place to defend your disability benefits for as long your need them.
Marc Whitehead & Associates Will Fight for You
Disability insurers hope that for every claim they deny, very few claimants will seek legal help. If your benefits are denied, don’t lose hope. Our law firm has successfully dealt with Lincoln Financial disability claims many times.
We take care of everything, taking many steps to make a very difficult process as easy as possible for you. Our ERISA lawyers work with your physicians, employer, co-workers, and medical and vocational specialists to obtain the evidence that is vital to your claim.
We’re ready to help you now. To discuss your claim with us at any time, please call: (800) 562-9830 or contact us online for a free legal consultation.
Note: Lincoln Financial Group Has Expanded Its Disability Business
Lincoln Financial Group is the marketing name for Lincoln National Corporation and its many associated companies.
Lincoln Financial recently acquired Liberty Life Assurance Company of Boston from Liberty Mutual Insurance Group, including Liberty’s entire disability insurance business. This greatly expands Lincoln Financial’s footprint in the group disability industry. Lincoln is now a market leader in disability sales, according to the company’s May 1, 2018 press release.
This means long term disability claims previously handled by Liberty Mutual are now managed by Lincoln Financial. Our attorneys are experienced in representing claims against both Lincoln Financial and Liberty Mutual. We are familiar with the disability claims management practices of each insurance carrier.