Most holders of long-term disability (LTD) polices through Lincoln Financial assume they will be able to claim the earned benefits when they actually become disabled. That’s why it comes as a shock to many when they receive an unexpected denied disability claim. What happens next depends almost entirely on how those policyholders file their appeals – and the process is way more nuanced than it appears.
Disability insurance attorney Greg Dell explains that Lincoln Financial is one of the largest group disability insurers in America, having been significantly bolstered by its acquisition of Liberty Mutual in 2018. It’s a powerful company with limitless resources to deny claims, and Dell’s disability insurance law firm has handled literally thousands of appeals against Lincoln Financial/Liberty Mutual and similar disability insurance companies.
Disability attorney Greg Dell provides some game-changing tips and strategies for those who have been denied their benefits and need to file that all-important appeal.
The most crucial thing to address when appealing a Lincoln Financial LTD denial is the medical evidence supporting the claim. According to Disability Insurance Attorneys Dell & Schaefer, the medical support is what the entire claim is based on, and it’s the first and most consequential thing the insurance company looks at. They always fall back on the medical records to make sure they’re consistent with what the claimant is telling them when filling out the claim forms.
As a claimant who’s already been denied on a group disability policy claim, it’s a sure bet the insurance company has requested, received and analyzed your existing medical records. The claim rep from Lincoln will likely be encouraging you to get some additional records and then go ahead and send in an appeal. But that’s the last thing a competent disability lawyer will tell you to do, according to Greg Dell.
“We know that’s basically a trap,” he says. “That’s not the right way to do it because there’s so much more you can do to put in a great appeal.”
Depending on the doctor you’ve been working with to treat your disabling condition, a physician is not always the best at documenting medical records for the purpose of a disability claim. Insurance companies look for very specific things, based on the verbiage in the specific disability policy and on the type of disability you are claiming. Therefore, submitting basic medical records from a doctor isn’t always enough.
That’s what is unique about what a lawyer does when helping a claimant with an appeal versus what the person would be able to do on his or her own. Victor Pena notes that, when the attorneys at Dell & Schaefer handle an appeal, they look for the deficiencies in the medical records. They analyze how the doctor has documented things over time, how they describe the disabling condition, and how it affects the claimant on a daily basis. Wherever the deficiencies in the medical records, the attorney will work on filling those gaps during the appeals process.
Attending Physician Statement
Insurance companies such as Lincoln Financial have what’s usually a two-page attending physician statement form that they send to the claimant’s doctor, requesting that it be filled in and returned. It’s designed to make it easy for the doctor to answer a few questions, but it’s purposefully worded in a way that benefits the insurance company and subtly gives a basis to deny that the person is disabled.
But Greg Dell notes that a law firm like Dell & Schaefer will create a customized physician statement that is specific to the client’s medical condition and his ability to perform his pre-disability occupation. A disability attorney will also know exactly what the insurance company’s in-house or hired medical reviewer is looking for in order to deny the claim.
If the attorney presents the disabling condition in the proper way through the customized physician’s statement, no reasonable treating doctor would disagree or have an issue with signing the statement in support of the claim. The disabled claimant will not always have the expertise to relay to the doctor what is needed for the claim, so a seasoned attorney will be able to establish a professional relationship with the medical team and obtain a targeted response.
Since tying the claimant’s occupation to the disability is such a pivotal component of a successful appeal, both the insurance company and the person representing the policyholder will spend considerable time on this. The goal of both sides is to prove whether the person bringing the claim has restrictions or limitations in performing his “own occupation” or even “any occupation.”
The insurance company tends to oversimplify the person’s occupation. They look at the official Dictionary of Occupational Titles (DOT) and try to fit the policyholder into a category that shows them as being able to perform certain types of work, such as sedentary, light duty, medium duty or similar. They try to narrow the focus to the physical requirements of an occupation, whereas an attorney knows to break it down and point out the “material and substantial duties” of the claimant’s actual position.
Then there is what’s called a vocational assessment. This is a comprehensive report that paints a picture of the claimant’s specific job and what it consists of on a daily basis. The Dell & Schaefer law disability law firm has resources throughout the entire country and will hire a professional vocational consultant to create this report for the client.
“We work with an expert who will take all the medical records, do a market labor analysis, look at jobs that are available, look at the skills required of a job, and write a pretty intensive report comparing the responsibilities for a particular job (or any occupation),” states Greg Dell, “and then compare the restrictions and limitations that the doctor has proffered forward, and the medical evidence that we’ve helped to gather, and then render an opinion on whether or not there’s any job that the claimant can do.”
Greg Dell notes that this kind of report can cost up to $2,000, but since his firm handles these kinds of claims on a contingency basis, the claimant is not responsible for that cost unless they win the appeal. He also points out that the insurance company’s in-house vocational consultant will definitely have reviewed the case, so the claimant is at a disadvantage if he doesn’t have a similar report in his own favor when making an appeal.
Lincoln’s Second Appeal Requirement
There are many important things to know when dealing with a Lincoln Financial appeal, including the fact that their policies typically require two levels of appeals. If they deny you the first one, you have to submit a second appeal in order to preserve your right to any legal remedies, such as filing an ERISA lawsuit to fight for your well-deserved disability benefits. Those second appeals must be strategically organized, as they are there for a reason: to benefit Lincoln Financial and to justify your denied disability claim.
Anyone who has a claim with Lincoln Financial or what was formerly Liberty Mutual can reach out to Greg Dell or any other disability attorney at the Dell & Schaefer law firm. They handle claims anywhere in the country, and the initial consultation is always free. They’ll let you know right away if they can help, so give them a call or make contact through the company email form.