Lincoln Financial Disability Insurance Attorney

Lincoln Financial Group is one of the largest disability insurers in the U.S. Companies like Lincoln Financial don’t become giants by paying claims easily. Their profit comes from not paying out disability claims. These companies use their vast resources and the fine print in policies to protect their profits, sometimes leaving people stranded in their time of need.

This unfair power dynamic highlights the critical need for skilled legal representation during the appeals process. At the Ortiz Law Firm, we are committed to justice and advocacy for our clients. We specialize in long-term disability insurance claim appeals.

Lincoln National’s Troubled History

Lincoln National Corporation, a prestigious Fortune 250 company, oversees various insurance and investment management businesses, each of which operates as a subsidiary. The major subsidiaries under its vast umbrella include:

It operates under the official name of Lincoln National Life Insurance Company (Lincoln National), but was formerly known as the Lincoln Life Insurance Company. In 2018, Lincoln Financial acquired Liberty Life Assurance Company of Boston. Lincoln Financial offers both short- and long-term group disability insurance, providing coverage to more than two million employees.

Over the years, Lincoln Financial has been at the forefront of numerous disputes over its approach to handling individual and group long-term disability claims. Specifically, there have been wrongful claim denials, unwarranted delays, and abrupt terminations of legitimate claims.

The primary function of disability insurance is to provide reliable support to policyholders when they face disabling events that prevent them from performing their work duties. These disabilities can range from mental illness and chronic conditions such as fibromyalgia or Lyme disease to physical impairments such as traumatic brain injury.

Unfortunately, there are circumstances in which insurance companies, including Lincoln Financial, have been known to intentionally delay or deny valid claims. This unscrupulous behavior has led to a number of lawsuits filed by policyholders alleging that Lincoln Financial wrongfully denied legitimate claims. Some of these lawsuits have indeed found merit in these allegations.

We specialize in challenging Lincoln Financial disability claim denials. Our team can clarify the reasons for your claim denial, inform you of your legal rights, and strategize the best course of action to recover your benefits.

A significant event occurred in April 2015, when the New York State Department of Financial Services conducted an extensive investigation into Lincoln Financials’ conduct. The investigation underscored the company’s involvement in unfair claims settlement practices and criticized its failure to maintain standards of promptness, fairness, and impartiality in violation of New York’s insurance laws.

The company’s shady past was further exposed when an internal audit in June 2008 uncovered significant misconduct in Lincoln Financial’s claims department. Alarmingly, senior executives reportedly overlooked these findings and failed to implement effective reforms. This continued from June 2008 through June 2014, resulting in a significant increase in unresolved claims.

Lincoln Financial Disability Denials

Receiving a Lincoln disability claim denial from Lincoln doesn’t mean your journey is over. You have the right to appeal a denial, but first you need to understand why your claim was denied.

Language Used in Lincoln Financial Denial Letters

If Lincoln has denied your initial application for LTD benefits, you may have received a letter that states:

“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 that stated:

“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”.

The Definition of Disability

The following is an example of a definition of “disability” or “disabled” from a Lincoln disability insurance policy:

“‘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.”

Reasons Lincoln Denies Long-Term Disability Claims

Common reasons why Lincoln denies disability claims include:

• Insufficient medical records
• Insufficient objective medical evidence
• Medical condition is non-verifiable or self-reported symptoms
• Your doctors did not complete attending physicians’ statements
• A peer review physician disagrees with your doctor
• Exaggerated symptoms
• Video surveillance
• Social media profiles
• Missed deadlines
• Pre-existing condition exclusions
• Specifically excluded conditions
• You do not meet the definition of disability
• A change in the definition of disability
• Partial disability
• You are out of work by your own choice
• ERISA

Understanding the Concept of Bad Faith Denial

Insurance companies are required by law to operate in good faith, treat their policyholders fairly, and review claims objectively. However, many engage in “bad faith” practices, intentionally denying legitimate claims or delaying payments. Identifying these unethical tactics is critical, and the Ortiz Law Firm specializes in exposing such maneuvers, holding companies accountable, and ensuring that clients receive the compensation they deserve.

Bad faith claims and lawsuits can result from:

• Wrongful denial of disability benefits.
• Failing to evaluate a claim with the intent to pay benefits correctly.
• Delaying a decision on a claim beyond a reasonable period of time.
• Failure to provide pertinent information to the person filing the claim.

NOTE: Legal claims for “bad faith” may not be available in many group plans governed by ERISA.

Strategies for Avoiding a Disability Claim Denial

To increase your chances of a successful Lincoln Financial disability claim, consider a proactive approach:

1. Keep Consistent Medical Appointments: Make sure you keep up with your treatment. If the insurance company asks for recent medical records, having a comprehensive file will be beneficial.
2. Proactively Provide Medical Evidence: Don’t rely solely on Lincoln to obtain your medical records, even if they have an authorization form. Be proactive in providing these records.
3. Review Your Medical Records: Review your records before submitting them. If you find any inaccuracies, ask your healthcare provider to make the necessary corrections.
4. Document Symptoms and Limitations: Keep a detailed record of your health problems and how they affect your daily functioning, and share it with your doctor so it becomes part of your medical record.
5. Seek Objective Tests: If possible, get evaluations such as a functional capacity exam or psychological tests. These can help dispel the notion that you are exaggerating your condition.
6. Anticipate Changes in the Definition of Disability: Insurance companies often change the definition of disability, usually at the one- or two-year mark of the claim, which could result in a denial. Continue your treatment and consider additional testing to prove your disability under the new criteria.

RELATED POST: 10 Tips to Keep Your LTD Benefits Approved

Appealing a Lincoln Financial Disability Denial

If your claim is denied, you have the right to file an internal appeal. Your denial letter should explain your appeal rights and deadlines. You generally have 180 days to act.

Under the Employee Retirement Income Security Act (ERISA), which applies to most employer-sponsored plans, you must exhaust your insurer’s internal appeals process before you can file a lawsuit. This may involve multiple appeals, depending on the terms of your policy. The Ortiz Law Firm specializes in navigating these complex procedures and preparing a comprehensive long-term disability appeal package.

It’s important not to wait until you’ve exhausted all of your appeals before consulting an attorney. Once you’ve “exhausted” your appeals, you can’t add new evidence to your case file, which is critical to the judge’s review. An attorney can review your denial letter and make sure you understand why your claim was denied, what you need to prove to win your claim, and the appeal procedures you need to follow.

Non-ERISA Claims

Not all disability claims are covered by ERISA. If ERISA does not apply to your policy, you may not need to file an appeal before filing a lawsuit. Non-ERISA policies include those purchased privately or provided by government or church employers.

Understanding the Lincoln Financial Disability Appeal Process

Here’s what the appeal process generally involves:

1. Analyze Your Denial Letter: Understand why your claim was denied.
2. Note Your Appeal Deadline: Mark this date on your calendar so you don’t miss it.
3. Obtain Your Claim File: Request all relevant documents from Lincoln Financial.
4. Seek Legal Advice: A disability insurance attorney can help you understand your options and the best course of action.
5. Assess Missing Information: Review your file to identify any gaps in your medical records or other evidence.
6. Gather Updated Medical Records: These should come directly from your health care providers.
7. Write and Submit Your Appeal: Make sure your appeal letter is comprehensive and submit your package before the deadline.

FREE RESOURCE: Appeal a Denial with our Disability Insurance Appeal Guide

The Need for Rigorous Documentation in Disability Claims

Your success depends heavily on the thoroughness of your documentation. At the Ortiz Law Firm, we stress the importance of preserving every relevant communication, medical record, and policy document. This detailed collection of evidence guards against insurers capitalizing on information gaps and provides a solid foundation for your appeal or subsequent lawsuit.

If the appeals process is overwhelming, legal professionals can advocate on your behalf, help you gather evidence, draft your appeal, and handle filings. It’s wise to seek legal assistance early in the process. Contact us today for a free case review.

Filing a Lawsuit Against Lincoln Financial

Once you have exhausted your administrative remedies, you may file an ERISA lawsuit in federal court. Here is an example of the 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 your claim will remain closed,” or something to the effect of, “You have exhausted all rights of appeal, and your administrative file is now closed.”

The letter then provides information about a lawsuit:

“If your plan is subject to ERISA, you may have other voluntary alternative dispute resolution options, such as mediation. One option is contacting your local U.S. Department of Labor Office and State insurance regulatory agency. In addition, you have the right to pursue litigation and 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].”

The sample language above does not state that you cannot submit additional documentation to support your claim. This is a common practice among insurance companies and should help to reinforce that the insurance company is not your friend.

Lincoln Federal Court Case Summaries

The court cases summarized here are intended to help you understand how federal courts decide ERISA long-term disability claims.

• Till v. Lincoln – Claimant Did Not Provide Adequate Documentation to Support Claim

• Zerangue v. Lincoln – Case Dismissed Because Claimant Failed to File for Benefits

Leverage the Skill and Experience of the Ortiz Law Firm

Waging legal warfare against insurance giants requires a comprehensive strategy that includes negotiations, administrative appeals, and courtroom battles (when necessary). The Ortiz Law Firm is highly skilled in this area and isn’t afraid to challenge unfair insurance tactics.

With in-depth knowledge of complex regulations such as ERISA and a track record of challenging invasive surveillance and inadequate settlement offers, the Ortiz Law Firm is a formidable advocate for claimants. We can help with claim denials or disputes involving:

• Unjustifiable Payment Delays: Insurance carriers must process legitimate claims within an acceptable timeframe, although the specifics vary based on individual circumstances and policy requirements.
• Failure to Respond to Policyholder Inqueries: Lincoln Financial must maintain transparent and prompt communication with its policyholders, fulfilling or acknowledging their requests for information promptly. It is advisable to document all your requests for information and all responses received.
• Excessive Requests for Information: Occasionally, disability insurers resort to excessive requests for information in an attempt to make the claims process so burdensome that claimants abandon their claims. This barrage of requests can lead to missed deadlines, giving the insurer an excuse to deny your claim. In such cases, consulting with a disability denial attorney can provide the necessary guidance.
• Independent Medical Examinations (IME): Lincoln Financial may order an IME to learn more about your condition and any resulting limitations or restrictions. These examinations, typically conducted by medical professionals outside of the claimant’s treatment circle and potentially biased toward the insurance company, are occasionally conducted in bad faith.
• Functional Capacity Evaluations (FCE): Lincoln Financial may use an FCE to evaluate your ability to perform work-related tasks by correlating your medical condition with job requirements and workplace conditions. These evaluations may sometimes contradict your physician’s opinion, leading to questionable results. Keep all documentation that may help support your claim.
• Lincoln Financial’s Failure to Comply with ERISA: Group disability employee benefit plans offered by private employers or labor unions are governed by the Employee Retirement Income Security Act of 1974 (ERISA). ERISA contains specific reporting and disclosure requirements and restrictions on certain transactions. If Lincoln Financial’s claims backlogs or operational inefficiencies impede the processing of your claim, legal recourse is available to hold them accountable.
• Ignoring Updated Medical Evidence: Despite the discretionary clauses in their policies, Lincoln Financial’s decision to overlook the opinions and recommendations of your treating physician when evaluating your claim doesn’t leave you powerless. Such disregard can be challenged—potentially as bad faith in individual policies or as arbitrary and capricious in group policies.
• Surveillance Practices: Insurance companies may pay private investigators to follow and record claimants to uncover evidence that contradicts their disability claims, especially those involving invisible conditions such as fibromyalgia, a mental disorder, or a migraine headache disorder. A claim denial due to home surveillance warrants a consultation with a knowledgeable disability insurance attorney.
• Distribution of Incorrect Policy Language and Provisions: Lincoln Financial is responsible for accurately informing you of any changes to the terms and conditions of your policy, a standard procedure for all policies. Misrepresentation on their part could entitle you to additional benefits.

Attorney Fees

Dealing with an unexpected disability can cause serious financial stress for you and your family. This often leads to a critical question: How can they pay for the help of a specialized disability insurance attorney to fight for the coverage and benefits they deserve when they are already struggling financially?

We cover the initial costs of your case, including the cost of obtaining medical evidence and court costs if your case goes to trial. This approach ensures that expert legal representation is available to more people, regardless of their financial situation.

Our Case Results

Many of the Lincoln claims we handle are approved on appeal. The following are just a few of some of the claims we have brought to a favorable resolution.

• Senior Analytics Consultant Approved for Disability Benefits: Lincoln initially terminated this short-term disability claim after 11 weeks. The claimant hired us to assist, so we appealed the STD denial and filed an LTD claim. Although the STD appeal was denied, the LTD claim was approved. We then asked Lincoln to reconsider the STD denial, which was reinstated.
• Lincoln Reverses Termination of “Any Occupation” Claim for Truck Driver: The insurance company initially argued that the driver could perform any job despite ongoing symptoms. We appealed, emphasizing the importance of the claimant’s subjective symptoms and the limitations they imposed. Shortly after our appeal, Lincoln reversed its decision.
• Benefits Approved for Customer Service Representative with Back Problems: Lincoln only approved this claim for a limited period of time because there were no specific restrictions and limitations identified by physical examination or testing. However, the policy did not require objective medical evidence. Upon our appeal, the decision to terminate the claimant’s long-term disability benefits was overturned.

Get a Free Case Review

Our experience includes both individual and group long-term disability insurance claims. We have recovered millions in denied benefits for clients throughout the United States. We can help you in your fight against Lincoln Financial by:

• Evaluating why your claim was denied,
• Preparing persuasive appeals, and
• Filing lawsuits against Lincoln Financial Group.

We don’t give up until we secure the benefits you rightfully deserve, and you only pay a fee if we are successful. We also offer a free case review so you can discuss the specifics of your claim with an experienced long-term disability attorney—call (888) 321-8131 to schedule your case review today.