Navigating Lincoln Financial’s Long-Term Disability Appeals Process: Responding to Independent Physician Reviews

When appealing a long-term disability (LTD) claim denial with Lincoln Financial Group, claimants often encounter an independent physician review. Lincoln, like many other insurance companies, uses these independent reviews to re-evaluate a claimant’s medical condition and determine if it is consistent with the reported functional limitations. Here, we’ll explore Lincoln’s physician reviews, including what to expect from an independent review and how to prepare a strong response.

Why Lincoln Uses Independent Physician Reviews

During the appeals process, Lincoln Financial Group often uses “independent” physicians to review a claimant’s medical records. [Note: We prefer to call these “compulsory” reviews, as the reviewing physicians are not all that “independent”.]

These reviewers are not affiliated with the claimant’s treating providers and instead are supposed to provide an “impartial” perspective focused on the medical record and any associated functional limitations. Lincoln relies on these reviews to verify that the claimant’s reported symptoms and impairments are supported by objective medical evidence.

Independent reviewers examine physical, cognitive, and psychological symptoms, depending on the nature of the claim, to determine if any medical conditions are severe enough to limit or prevent the claimant from working. By involving an outside medical professional, Lincoln aims to have a basis for deciding whether a claimant’s medical records support their reported disability.

Common Questions Asked in Lincoln’s Independent Reviews

To gain a clear understanding of a claimant’s functional capacity, Lincoln will ask the independent medical examiner specific questions. Typical questions or requests may include:

1. Identify the primary impairing diagnosis(es).
2. If applicable, identify clinically significant comorbid diagnosis(es).
3. Taking into consideration the entire clinical picture, including standards of care and evidence-based medicine and any medication or other treatment side effects, please describe how each supported level of impairment translates into restrictions and limitations from January 1, 2024 to current and beyond, and comment on the expected duration.
4. Do medical records support any restrictions and limitations (R&Ls) that were recommended by treating providers for the timeframes in question?
5. Is the medical management recommended by the provider and/or followed by the claimant clinically reasonable and consistent with the apparent severity for the reported condition?
6. Based on this claimant’s medication list, are there any side effects from any of the medications that would have an impact on occupational functioning?
7. Are there any non-medical circumstances identified in the medical record (e.g. workplace conflicts, child or elder care issues, or legal issues) that may adversely impact work?

By obtaining answers to these questions, Lincoln seeks to develop a complete picture of the claimant’s limitations.

Are Lincoln’s Independent Doctors Truly “Independent”?

As referenced above, while Lincoln Financial Group and other insurers commonly refer to these evaluations as “independent” medical reviews, the impartiality of these reviewers is questionable. Although independent physicians are not directly affiliated with Lincoln, they are hired and paid by the insurance company to conduct these reviews, which can lead to potential bias. These physicians may feel pressure, whether explicit or implicit, to produce results that are consistent with the interests of the insurance company, particularly if their continued employment depends on favorable outcomes for the insurer.

In addition, insurance companies, including Lincoln, often select reviewers who have experience in conducting disability file reviews. While this experience is valuable, it can sometimes lead reviewers to favor ratings that minimize the severity of a claimant’s impairments or emphasize a lack of objective findings in the medical record. This can work against claimants whose conditions are subjective in nature, such as chronic pain or certain psychological impairments, where objective evidence may be limited.

At the Ortiz Law Firm, we understand this dynamic and know how to challenge biased or incomplete evaluations. We work with claimants to obtain robust, objective evidence from treating physicians to counter potentially biased findings in the independent review, ultimately strengthening the claimant’s case. By addressing these issues directly on appeal, we help to ensure that the claimant’s full medical picture is fairly considered.

Responding to Review Findings

Once the independent review is complete, Lincoln will typically provide the claimant with a copy of the report and allow 21 days to respond. During this time, the claimant should carefully review the physician’s findings and may wish to take the following steps:

1. Work with Treating Doctors: Share the independent review with the claimant’s primary care provider or specialists who can provide relevant insight. It may be beneficial for these providers to address any inconsistencies or offer counterpoints to the conclusions of the independent review.
2. Provide Supplemental Medical Evidence: Provide recent medical records, test results, or additional evaluations that support the claimant’s reported limitations. For example, if the review minimizes the severity of a physical condition, providing records of specialist visits or additional diagnostics may strengthen the claim.
3. Write a Detailed Personal Statement: The claimant may also wish to provide a personal statement detailing the day-to-day impact of their condition on their functional abilities. This can highlight limitations that may not be fully appreciated from the medical records alone, such as the claimant’s difficulty in performing work tasks due to chronic pain or fatigue.

Lincoln’s Deadlines and Extension Policy

It’s important for claimants to respond within the 21-day window [or whatever window of time identified by Lincoln] to avoid losing the opportunity to submit additional evidence. Lincoln may extend the appeal period by 45 days under special circumstances, such as when the claimant needs more time to gather relevant documentation. However, if the claimant doesn’t submit a response by the deadline, Lincoln may make a final decision based on the information already on file.

Ortiz Law Firm Can Help with Long-Term Disability Appeals Nationwide

While Lincoln’s independent physician reviews can feel like an additional hurdle, they are also an opportunity for claimants to strengthen the legitimacy of their disability claim. A well-prepared response, supported by medical evidence and relevant personal insight, can make a strong case for the need for long-term disability benefits. By proactively working with treating providers to resolve any discrepancies and submitting comprehensive documentation, claimants increase their chances of a favorable outcome in the appeal process.

Navigating the complexities of a long-term disability appeal, especially when dealing with independent physician reviews, can be overwhelming. At the Ortiz Law Firm, we specialize in helping individuals appeal denied LTD claims to secure the benefits they deserve. Our team has extensive experience with insurance companies, including Lincoln Financial Group, and understands the tactics they use to deny claims.

The Ortiz Law Firm represents clients nationwide in long-term disability appeals. With a deep understanding of ERISA laws and LTD insurance policies, we can handle every aspect of the appeals process—from gathering evidence to handling independent medical reviews. Our goal is to provide compassionate, effective representation that increases your chances of a favorable outcome.

If you’re facing a denial or need assistance with a Lincoln Financial Group long-term disability appeal, contact the Ortiz Law Firm today to learn how we can help you protect your right to disability benefits. Call (888) 321-8131 to schedule a free case evaluation.