In Jamie S. Flanagan v. The Lincoln National Life Insurance Company, Plaintiff was a nurse practitioner who was unable to work after a lumbar fusion failed and left her with nerve root scarring. She also had spondylolisthesis. Her employer had a welfare benefit plan which included long term disability (LTD) coverage. Lincoln approved her claim for 24 months of LTD benefits after determining she was unable to work in her own occupation.
After 24 months, the definition of disability under the policy changed and Plaintiff had to prove she was disabled from working in any occupation for which she was trained, or her education and experience would allow. Her treating physician submitted medical records documenting her medical condition and her inability to do even sedentary work. Lincoln ignored the physician’s analysis and decided she could work as a nurse consultant or call center nurse. Plaintiff’s administrative appeal of the decision was denied, so she filed this ERISA lawsuit.
The U.S. District Court for the Western District of Missouri, Southern Division, ruled in favor of Plaintiff. It found that Lincoln abused its discretion in denying Plaintiff LTD benefits. The Court ordered Lincoln to award her back benefits with interest as well as attorneys’ fees and costs.
Lincoln’s Denial of LTD Benefits was Unreasonable and Relied on an Outdated Medical Report
Lincoln had the reports of three physicians. One was from Plaintiff’s treating physician dated April 21, 2015, in which he said Plaintiff could not work at all. Another was from Lincoln’s own reviewing physician, dated March 9, 2016, who agreed that Plaintiff could not perform work even at a sedentary level. On April 22, 2014, an occupational therapist conducted a functional capacity evaluation (FCE) and determined Plaintiff could “do less than sedentary work.”
Lincoln ignored this evidence and instead relied on the report of a reviewing physician dated Jun 9, 2104, prior to the subsequent updated medical records and medical opinions. Lincoln also relied on a non-physician vocation report that concluded Plaintiff could do sedentary work, which was totally contradicted by the medical record.
The Court concluded: “Defendant chose to pick only opinions that supported denial of Plaintiff’s benefits, while ignoring treating physician records and the medical opinion of one of its own experts that found Plaintiff is unable to perform work. The Court finds no reasonably objective evaluation of the medical record supports denial of benefits.”
Court Orders Lincoln to Pay Interest on Back Benefits, Plus Attorneys’ Fees and Costs
In addition to holding that Lincoln “abused its discretion in denying Plaintiff’s appeal for benefits,” the Court ordered Lincoln to pay benefits back to the date they were terminated on November 24, 2015, with interest from the date each payment became due.
The Court also found that Plaintiff was entitled to “reasonable attorneys’ fees and any costs expended.”
This case was not handled by our office, but we believe it can be instructive to those whose claim for LTD benefits was denied. If you have a question about this case, or any aspect of your disability benefits, contact one of our disability attorneys at Dell & Schaefer for a free consultation.