Long Term Disability Law Blog
Each long term disability insurance policy can be a bit different, even those that are issued by the same disability insurance carrier. Lincoln Financial recently took over Liberty Mutual, and in the process, took on responsibility for many of the short term disability policies Liberty issued and administrated. Because of this, Lincoln Financial can operate a little different than other companies that primarily handle long term disability insurance claims. Learn more about the ins and outs of navigating a long term disability claim with Lincoln Financial and what disability claimants should be able to expect from the process.
GREGORY DELL: Hi, I’m attorney Gregory Dell, here with attorney Stephen Jessup. And we’re going to talk about how to apply for long-term disability, or short-term disability benefits with Lincoln. Although, as I said that, I’m thinking I commonly see mostly long-term disability claims with Lincoln. However, we know that Lincoln Financial took over Liberty Mutual. And we know that Liberty also sold a lot of short-term disability policies. So high likelihood that Lincoln is handling a bunch of short-term disability, as well as long-term.
But in this video, I want to talk about the important things that people need to look out for, and that they should know when applying for these benefits. Now, obviously, we help hundreds of people apply for benefits with Lincoln, and Liberty as well. And we’ve done that in the past, and we’re available to help. But we’re going to give a roadmap as to what to do, because it can be done on your own.
But I want people to be aware of the pitfalls. Because of the fact that I want you to get right into is, what are the implications if you make one mistake that results in a denial?
STEPHEN JESSUP: One of the hardest things now in a Lincoln product, or if it was an old Liberty, they’re calling it Lincoln– they’re slightly different in the way that they’re going to go about handling certain aspects of your claim. But the big thing on a denial, especially if this is a true Lincoln policy, is they have two mandatory levels of appeal.
So what that means, ultimately, is if you don’t get your application right the first time, and you have to go through two appeals with them, they will have up to six months on those appeals alone to conduct a review. So not getting it right with Lincoln on the first go, you could be without benefits for an extremely extended period of time. And just getting awarded short-term, if you do, doesn’t necessarily mean the long-term will get awarded. So then you could be well past the time long-term, and you’ve got to make that application.
So with Lincoln, more so than a lot of the other companies, you really want to make sure you get it right, just from that timing standpoint.
GREGORY DELL: And remember, that six months that you’re talking about is after the elimination period. And the elimination period is how long you have to wait before you’re even eligible for benefits, which is usually 90 or 180 days. So if they deny you, and you have a six-month elimination period– and it’s going to take six months to go through two appeals– you could be waiting a full year before you get benefits. And there’s-
STEPHEN JESSUP: And likely even more. Likely even more than that.
First step is to understand your disability policy language
GREGORY DELL: Yeah. And that’s if you win your appeal. So it could be a long road, so you want to do it right. So first step in doing this thing, in my opinion, is you got to understand the policy language– and specifically, the definition of disability. And why is that the first step in the process of applying for long-term disability?
STEPHEN JESSUP: The first step– the reason being is that you need to know, is your policy covering you from the inability to do your own job, or the inability to do any occupation? More often than not, it’s going to cover you for at least the first 24 months, if you’re unable to do the duties of your own occupation– with the caveat that all the Lincoln policies will have language that says, your regular occupation is not how it’s done for your employer, or at the location that you work at. It’s how it’s done in a global sense, in the national economy. So you want to understand how they’re going to look at you when it comes to disability, and then the parameters of what your occupation is going to mean.
And honestly, I see this more and more with applications. It should be common sense, or you would think it is– make sure you’re going to a doctor. Because a lot of conditions that people go out of work for, they may need to go see a specialist. And sometimes it can take a while to get in. You see this especially with mental-health claims, where people aren’t actively getting treatment but they’re having issues.
And they try to make an appointment with a doctor. And by the time they’re able to get in with that doctor, they may have already filed. So Lincoln’s looking at it– well, we have no medical evidence. So first and foremost, I think it’s really important that the medical is already established before you really consider going out on disability.
When is the best time to file your Lincoln disability benefit claim?
GREGORY DELL: OK. Yeah, I was going to segue into, when do you think is the best time to file for a claim. And I want to give the caveat to people that are watching this video that we often consult with clients while they’re still working. Because unless you get hit by a bus, or have a very serious medical diagnosis of something that you didn’t know about–
STEPHEN JESSUP: Something catastrophic.
GREGORY DELL: Yeah. Then the likelihood is you’ve been working with pain or discomfort through your job. And that’s how 95% of these claims are. You didn’t just wake up and be like, I can’t work at all. And if it does happen– and that does happen. But let’s go with the majority of the claims.
So with that being the case, we’ve consulted you all beforehand and said, here’s what needs to happen. Now, if you’re the type person that wakes up and says, I can’t do this anymore– and you’ve been suffering for six months and you have no medical treatment. And then you call us up and say, yeah, I stopped working the other day. I’m done working. And I haven’t been to a doctor yet, but I know I’ve got really bad back problems and this and that. What’s the problem with that, for that person?
STEPHEN JESSUP: The problem is going to be is there’s no medical information contemporaneous to when they stopped working, to support that they couldn’t work. Because Lincoln is not going to take your word for it. They’re going to see what the medicals say. So the treatment aspect is so important.
And then even if you are treating– you know, like you were saying, you’ve been working with this issue for months and months and months. The argument back from Lincoln is going to be, what changed? If you could do it before, why can’t you can do it now?
GREGORY DELL: They hit you both ways.
STEPHEN JESSUP: Mm-hmm.
GREGORY DELL: And someone’s watching this and hearing what we said– well, OK, I’m thinking of filing. I should go to the doctor. But how much is enough medical support? How do you know?
STEPHEN JESSUP: Well, that’s a really fine line. That’s a very good question. I mean, is one appointment going to do it? I mean, I guess it depends on the medical condition. But we’ll talk in the idea of a back-pain problem– an issue like that– something that isn’t a catastrophic diagnosis. That is a really good question.
And also, you want to build enough rapport with your doctor that your doctor is going to be willing to fill-out forms on your behalf. He’s going to be willing to speak to doctors from Lincoln to support you. So there does need to be a relationship established with the doctor– and then what that doctor is going to be willing to say, and what the doctor puts in the record. So it’s really hard to say how much is enough.
GREGORY DELL: My experience is that the vast majority of the people that contact us don’t want to stop working. It doesn’t make sense that you want to stop working, because you’re not replacing your income. If it was dollar for dollar, then everyone would have an incentive. But disability rarely covers what you were making. The most it pays is up to 2/3 of what you are earning. So you’re already at a loss by getting on disability.
But the other thing I find is that people work through their ailments. And then, like you just said, the insurance company punishes you for that. Because you say, oh, it looks like you did it for six months or a year. Or you say your complaints go back a year and a half ago, when you saw a doctor once, and you haven’t been back. And then you end up going the doctor you know a year and a half later. And then they say, but you didn’t really have any treatment, so how bad could it have been?
A disability insurance claim is only as good as it looks on paper
So these are scenarios that you and I are just bringing up. But that’s where we coach the client to go through and to document. Because we always say, the case is only as good as it looks on paper. And what that means is that when the carrier– in this case, Lincoln Financial– gets the claim, they’re going to look at it. They’re going to send the file out to their nurse or their in-house doctor, and then they’re going to get a medical review back. They’re not going to talk to you, likely. They’re not going to visit with the claimant at all. And they’re going to base their review based on what they see in that file.
So when people call me, I always say, I need to make you look messed-up on paper. Now that may sound offensive to you, or may sound rude. But the truth is that if you don’t look messed-up on paper, then the likelihood is your claim is not going to get approved. So moving forward, when we help the claimant apply, how do we work with their doctor to get the records to the point where it needs to be so that they have appropriate medical support?
STEPHEN JESSUP: The big thing is going to be the documentation specific to your condition. If there are certain tests that can be done to verify what’s going on with the idea of pain condition. So you got radiating pain down into the leg. Do you have MRIs? Do you have EMG, nerve conduction studies? Do you have objective evidence that the doctor can rely on to support restrictions and limitations that are going to apply?
Then it’s also very important that the doctor is viewing it, and understanding that for purposes of the disability, this isn’t about your ability do activities of daily living. It’s specifically to be in the workplace– work with reasonable continuity and things like that. Something I always touch upon with clients too in an application process– because doctors, like you said, understandably don’t like dealing with insurance companies.
More than likely– probably 99% of all the Lincoln policies, with a few exceptions, are going to be governed by the federal law ERISA. And under that, your doctor will never be deposed by a lawyer– will never testify in court. So a lot of doctors are worried that they may get wrapped-up in a long legal battle.
So it’s also educating the doctors as to the fact that the only thing, if it ever ends up in court, that will be considered by a federal judge is what that doctor put in records, or what they wrote in statements. So it’s helping the doctor understand the purpose of what’s happening, and making sure the complaints are being documented. Saying a patient has been saying for several months having issues at work. I’ve recommended reduction in work– maybe taking time off.
And that’s where it comes in, when you said with coaching a client into setting-up for the disability. Because a lot of people are also concerned. My work is struggling. I may not have been to the doctor as much as I should. I’m afraid my employer may terminate me before I can even file a claim. So there are so many moving parts that it can just be really good to get the peace of mind to have it set up in a way to make it presentable. Because you’re right, these people, they don’t want to stop working. It’s no financial incentive to them.
GREGORY DELL: And we could go on. We’ve just scratched the surface. But the point is medical support is essential, and how you work it. And that we’re going to look at it from a perspective of not just one doctor, but as many doctors as we possibly can get to support the claim. And then the claimants, also– people don’t like to complain. But you need to go in and complain to the doctor. Because if it’s not in your records, it doesn’t exist.
Lincoln disability insurance claim forms are generic and addendums should be used
So the other very important step– I would say, step two, is then you finally get to this point where you get these claim documents and you get these forms. And these forms are very generic. When I say they’re generic, I think it’s a problem. And how do you prepare your application so you can get away from the generic nature of the Lincoln Financial claim forms?
STEPHEN JESSUP: Well, the problem with those claim forms is realistically, even though they will also potentially provide claim forms related to mental-health conditions– so it’s more specific to that. But any physical medical condition, it’s the same form. You could be suffering from migraines. And they want to know how much you can lift, how much you can sit– things that aren’t necessarily being impacted by the condition.
So with these claim form, some people feel that’s important, to squeeze it all into little lines. But we do addendums. We do attachments, to be able to elaborate and explain more, but also not explain too much. Because remember, they’re going to rely on all this stuff. So it’s providing the information in a concise way, that’s encompassing what’s really going on. So addendums to the application documents are very important.
GREGORY DELL: OK. And one of the most important addendums that we always do, that goes in-line with understanding the definition of disability– which we started this video out talking about– is how the claimant describes their occupational duties. Why is that so important?
STEPHEN JESSUP: Well, because every insurance company– and Lincoln is no different– is going to try to strip it down to the physical components of the job. For instance, we’re lawyers. The Department of Labor says we have sedentary jobs. Lincoln would pay lip service to some of the duties we have to do in a generic sense. But they’re always going to go back– it’s sedentary, and we think you have the physical ability to use sedentary work.
So you want to hit, very early on, the dialogue of what those actual occupational duties are. Because if all of us just had to sit for a while and lift up to 10 pounds to do our jobs, work would be really easy. So it’s really focusing the dialogue. And if you have a generic description from your employer, they may even classify your job incorrectly under the National Economy Standards.
So it’s really important to have that and document it in the file. Just also in the event, it’s extra security. In the event they do deny the claim, that’s deeply embedded in the file from the get-go. And it could be something a judge would take into consideration later on.
GREGORY DELL: All right. And the other thing we’ll do is you can think about getting things like support letters from your employer– your boss, your supervisor, your coworkers, family members. And there’s a strategic manner in which those should be drafted as well. Because the carrier always says, like you said before, well, what was going on beforehand? We can’t tell from the medical records.
But it’s helpful to have a peer review from those people I just mentioned, to say, yeah, so-and-so was suffering. So-and-so had difficulty with this. Because then they pull those employer reviews. And employers often tend to write positive employer reviews, that don’t necessarily represent the weaknesses of the person they have. And then they’ll say, well, all of your employer reviews were consistent.
So there’s so many different– I mean, we’re just throwing out scenarios. But there’s hundreds of different angles to look at, of all the scenarios that we’ve seen, of how Lincoln Financial is going to look at this claim, that a person can make a mistake.
Selecting the date of disability is an extremely important factor for claim approval
STEPHEN JESSUP: I think it’s almost in a way like– you’re basically in summary is, they’re not looking for ways to approve your claim. They’re looking for ways to deny your claim.
GREGORY DELL: Right. And then in terms of putting it all together– at the end of the day, you take all this information. And how important is it to determine the date of disability?
STEPHEN JESSUP: Extremely important. You want to make sure that it’s coinciding with times and dates of treatment. Some people, like we said, they file for disability, then they go see the doctor. So having a setup to the story of where the problems are in laying in it– how do you approach the employer with it? Often with some of my clients, we’ll say, well, listen, you’re having issues. And if you’re concerned about your job being on the line, if you have vacation time or sick time, put it in. They don’t need to know why you’re going out. But if that first day you miss, you can use that as a date of disability.
So strategically planning it in a way to not only protect you with your employer, to make sure that they don’t fire you– and then you’re not without coverage– but also just setting it up so there is a clear line as to why this is happening now. Because most people don’t think to do these things. They think, I’m going to work. And you know, I can’t do it anymore. My insurance company is going to do the right thing by me.
GREGORY DELL: So I want to talk about, like, 20 other issues that deal with the applying.
STEPHEN JESSUP: There’s a lot.
GREGORY DELL: Because it’s the foundation of everything that goes on. And then we can make it so good in the beginning, and eliminate all the problems from when the other people call us when they’ve been denied. We can’t recreate time, but we can create the record. We can write the script per se, and really present you in the light most favorable to support your claim.
So easy process to work with us, especially at this stage. The easiest thing to do is give us a call, or fill-out our free consultation form. We’re going to ask you to provide us with a copy of your disability insurance policy from Lincoln Financial. We’re going to review that policy and set a free phone consultation with you, which is no obligation whatsoever.
And right after that phone call, based upon speaking with you and reviewing your policy, we’re going to lay out a roadmap and let you know if we think we can help you. We’re going to let you know right away what we charge. We often charge in these situations a small percentage of your monthly benefit, which is a flat-fee– which clients really appreciate, because they want to be locked-in on a flat-fee and not get stuck with thousands and thousands of dollars of a bill one month that could far exceed the monthly benefit.
So we like to work on a flat-fee, of something that’s going to continue into the future. Because of the fact that once you get approved, Steve, there’s no guaran– this isn’t like you got approved, just like you applied for or pay your premium. No, you got approved, and they’re going to evaluate it month after month after month. And we stick with you throughout that process, because we want you to continue to get paid for as long as you think you need this policy.
So we represent claimants all over the country. We’ve spoken to thousands of Lincoln Financial claimants all over the place, and we’ve litigated against them all over. So we’re fully experienced in handling these cases everywhere. We appreciate you considering our law firm. And whether you speak to Stephen or myself, we’re thankful for the opportunity to speak with you.
As you’ve now learned, handling a disability claim with Lincoln Financial involves a number of different moving parts. Trying to navigate this process without an attorney can be frustrating and may delay the resolution of your claim. Whether you’re thinking of filing a disability claim with Lincoln or have already filed a disability insurance claim and wonder whether you need some help proving you’re entitled to disability insurance benefits, the attorneys at Dell & Schaefer have the experience and expertise you need. Give us a call today to set up your FREE consultation with a member of our nationwide network of skilled long term disability attorneys.