Long Term Disability Law Blog
Gregory Dell and Alexander Palamara discuss a successful long-term disability appeal against Lincoln Financial for an occupational therapist who was disabled due to severe back issues, chronic fatigue, fibromyalgia, and headaches. Lincoln initially approved the claim but denied benefits after 24 months, invoking both the mental health limitation provision and the change in the definition of disability from “own occupation” to “any occupation.” Despite the claim being primarily physical with clear objective evidence, Lincoln relied on an independent medical examination where the doctor spent only 13 minutes with the client — yet claimed to have conducted both a full examination and a functional capacity evaluation in that time. Lincoln then used that report to have a vocational consultant identify sedentary jobs the client could supposedly perform.
The appeal strategy focused on exposing the inadequacy of Lincoln’s review while building an overwhelming body of supporting evidence. The attorneys obtained updated medical records and letters from treating providers, arranged a proper seven-hour functional capacity evaluation that showed below-sedentary capability, and included a Social Security disability approval that had been granted just months before Lincoln’s denial under a very similar standard. By highlighting the absurdity of a 13-minute exam being used to override extensive treating physician evidence and a federal disability determination, the appeal was approved within approximately 60 days, with all back benefits paid in full.
Palamara emphasizes that winning the appeal is only the beginning — ongoing claim management is essential to prevent a future denial. The attorneys continue ordering updated medical records, ensuring proper documentation from treating providers, and monitoring the claim to keep Lincoln from finding a basis to terminate benefits again. The client’s benefits are now set to continue until age 67 or until she can return to work.