Case Overview
The discussion centers on a nurse suffering from severe gastrointestinal issues, including constant bowel incontinence and multiple surgeries. She was initially approved for short-term and long-term disability benefits, but after about 18 months, Lincoln Financial denied her claim. The insurer argued that after surgeries, she should be able to return to light-duty nursing, claiming there wasn’t enough “objective evidence” to justify continued disability.
Appeal Strategy
The Dell Disability Lawyers legal team emphasized both physical and cognitive limitations caused by her medical condition. They arranged a Functional Capacity Examination, which showed she could not sustain full-time work at any level (even sedentary) due to frequent breaks required for incontinence. Limited cognitive testing was also conducted, revealing deficits tied to her physical deconditioning, not just mental health. This avoided being boxed into the policy’s 24-month mental health limitation.
Appeal Outcome
Lincoln initially tried to argue she could do desk-based jobs (like chart nurse or receptionist). On further appeal, her lawyers doubled down on the original medical evidence, challenging Lincoln’s vocational review. Lincoln eventually approved her benefits into the “any occupation” stage, recognizing she could not perform any suitable work.
Key Takeaways
Insurers often deny claims by dismissing subjective symptoms or demanding “objective” proof that doesn’t always exist. Functional capacity exams and carefully framed cognitive testing can strengthen appeals. Many disabling conditions (like gastrointestinal disorders) may not show up clearly in medical tests, but can still devastate a person’s ability to work.
Having experienced legal guidance is crucial, since insurers frequently delay, deny, and push claimants to give up.