Long Term Disability Law Blog
When someone becomes disabled and unable to work, they may turn to their disability insurance for financial support. Unfortunately, not all claims are approved. Such was the case for Ms. A., whose disability claim was denied by Lincoln, her insurance provider. According to Lincoln, Ms. A.’s occupation as a “Medical Social Worker” was classified as sedentary work, meaning her job primarily involves sitting. Based on this classification, Lincoln denied her claim. However, Ms. A.’s actual job duties were closer to that of a Coordinator of Rehabilitation Services, which is classified as a light work occupation. This classification involves walking or standing to a significant degree, not just sitting.
Ms. A. did not take this decision lightly and took action to appeal the decision. She underwent a Functional Capacity Evaluation (FCE) to assess her ability to work. The FCE identified various limitations in her mobility, strength, and positional tolerance, among other factors. The results of the FCE concluded that Ms. A.’s abilities and tolerances fell below those associated with sedentary level work. She could not safely lift or carry any weight and could not productively sit, stand or walk without extended rest breaks in between.
PA-C Sanchez, who reviewed the FCE results, confirmed Ms. A.’a functional impairments. He attested to her inability to perform the main duties of her occupation as a Care Transitions Coordinator due to her chronic medical conditions and associated deficits. In addition, he confirmed that Ms. A. will experience good and bad days, require frequent unscheduled interruptions of work, frequently miss work, and be an unreliable employee.
Based on these findings, Ms. A. requests that Lincoln overturn their erroneous decision to deny her claim for benefits, approve her claim for long term disability benefits, forward back benefits owed, and reimburse premiums paid after disability onset. She also requests a copy of any reports created by Lincoln or its agent concerning her claim so that she may respond accordingly prior to the final determination on her claim. Additionally, she requests contact from Lincoln to arrange conferences with her treatment providers if necessary.
It is unfortunate that Ms. A. had to go through this process to receive the support she needs. Still, it is essential to recognize that insurance companies often rely on generic occupational classifications rather than considering the actual job duties of the claimant. In this case, Ms. A.’s FCE results provided concrete evidence of her functional impairments, and her treating provider confirmed her inability to perform her job’s main duties. Therefore, it is crucial to consider all available evidence before denying a disability claim.