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At the Ortiz Law Firm, we understand how devastating it can be to face a denial of long-term disability (LTD) benefits when you’re already battling significant health challenges. One of our recent cases is a testament to our unwavering commitment to helping clients secure the benefits they deserve.
The Challenge
Our client, a former data administrator, became disabled due to a combination of serious health conditions, including myelofibrosis, PTSD, hypothyroidism, diabetes, major depressive disorder, memory changes, and adjustment disorder with anxiety. Although Lincoln National Life Insurance Company initially approved her LTD claim, it later ordered two peer review reports of her file.
Note: A “peer review” in a long term disability claim is when an insurance company hires a doctor or other medical professional to review the claimant’s medical records and provide an “independent” opinion on the severity of the claimant’s disability and whether they are eligible for benefits. A peer review report is often used to deny a claim based on the reviewing provider’s assessment. Essentially, it’s a second medical opinion from a doctor not directly involved in the claimant’s care.
The first reviewer, a consulting psychiatrist, opined that the available medical evidence did not support a functionally impairing condition. The second reviewer, a medical doctor, opined that the medical records purportedly did not support any restrictions or limitations.
Based on these reports Lincoln concluded that the evidence did not support her continued disability and terminated her benefits.
Our Strategy
We refused to let this decision to terminate benefits stand. We prepared a comprehensive appeal, complete with:
- Updated medical records that clearly explained her ongoing limitations and restrictions.
- Residual Functional Capacity (RFC) forms from her treating physicians, confirming her inability to work.
- Personal statements from loved ones who witness her daily struggles firsthand.
- A reminder to Lincoln that Social Security had already found her disabled, and that ignoring the opinions of treating physicians is a strategy the courts do not look kindly upon.
The Result
Lincoln National Life Insurance Company reversed its denial shortly after receiving our appeal, without even resorting to a peer review. They not only reinstated her benefits but also found her disabled under the stricter “any occupation” definition—a major victory for our client.
We Can Help You Through the LTD Appeals Process
If your long-term disability benefits have been wrongly denied or terminated, don’t face the insurance company alone. When the insurance company says no, we say fight back. Call us today at (888) 321-8131 for a free case evaluation and let us help you get the benefits you deserve.