Long Term Disability Law Blog
Overview of Lincoln, Merger with Liberty Mutual
Having handled hundreds of claims from Lincoln Financial Disability, the law firm of Dell & Schaefer knows what to expect. Overall, Lincoln recently purchased and underwent a merger with Liberty Mutual. This has moved Lincoln from a large to a massive insurance company. This has lead to speculation that Lincoln does not currently have the bandwidth to process all claims promptly from Liberty (due to the merger). Overall this seems to have lead to deadlines being missed and some claims slipping through the cracks. With this in mind, Lincoln is expected to eventually smooth out this transition and get to full speed soon.
In terms of fairness in dealing with claims, Lincoln is a “middle of the road type” company compared to others. Lincoln is historically on time with evaluating claims, but can also be very stringent in their evaluations. Roughly 99% of claims through Lincoln are also ERISA-governed disability policies. For people who meet the requirements, you’ll need to get the policy from your employer, which also means your claim will be governed by ERISA. There are a lot of ERISA regulations you’ll need to comply with as well.
Time Frames
The time it takes for a claim to be made, evaluated, and decided upon will vary depending on the complexity of the claim. Supporting evidence such as medical records, tax returns, and financial documents could speed up or slow down the process. Overall, it just depends on how much documentation Lincoln requires for the specific claim under the circumstances of that claim. However, a general rule of thumb is that there should be some form of a decision made within 45 days. If a decision is not made, then often times Lincoln will request more information like additional documentation of medical notes and so on.
Standard Definitions for Longterm Disability Insurance
Lincoln generally decides what a disability is with a core question, “can you do your occupation?”, this is the initial core definition which will define your long term disability insurance claim. However, further definitions become more nuanced, given the numerous different types of occupations. Lincoln also defines your occupation according to how it’s defined in the national economy. So, it’s not actually what your day to day occupation is per se, but rather the definition of how O*NET or the dictionary of occupational titles will define your occupation. Definitions also change after roughly 24 months to ask whether you can do the substantial duties of any gainful occupation. They essentially define that as “Can you do a job while sitting at a desk for 40 hours a week?”. In some other cases, there will also be an income component to the definition as well. They’ll see if you can make 60% or 80% of your salary. Yet, that income component isn’t always included. That’s why it’s so critical to the claims process to understand what the disability claims policies are since they can vary from person to person.
Mental Health Claims And Limitations
There is, oftentimes, a limitation of the policy for “mental” conditions. There’s a 24-month mental nervous limitation, which means that you have only 24 months in the lifetime of the entire policy to collect disability. So, if you suffer from something like depression, bipolar, anxiety, or even schizophrenia, the company will only pay you for 24 months. The only case in which that could be extended is if you have a disability on top of the mental one. For example, having a handicap on top of having anxiety, depression, or so on. It’s also worth noting that in some policies, schizophrenia is counted as an exclusion to the 24-month limitation policy.
Appeals Process
Unlike Liberty Mutual and most other companies, Lincoln requires two administrative appeals for a denied claim before you can take them to court. The overall claim amount will also determine whether or not Lincoln will try to use their own in-house physicians for evaluations or third-parties. Typically with lower amounts, Lincoln will refer in-house doctors while larger claims will be referred to outside help and to undergo a functional capacity evaluation.
Common Reasons for a Denial
One of the most common reasons for a disability insurance claim denial is a mismatch in subject complaints and psychical problems. This means a subjective complaint often lacks something concrete, such as an MRI, X-ray, or blood work, which objectively supports the subject complaints. However, this is also a common private disability denial that Attorneys Dell & Schaefer deal with. Lincoln’s policies almost never include objective evidence requirements because there isn’t a proven measure of pain. In other words, the level of pain you may be experiencing won’t also be evident from an objective test like an X-ray. Some common conditions for this type of example are fibromyalgia or chronic fatigue syndrome. Although these are well known and documented in the medical community, there is also no objective test for them or for the severity of pain felt from them.
Perhaps the second most common reason for a denied disability claim is when Lincoln runs video surveillance on the claimant. Often times, someone making a claim without the help of a disability attorney doesn’t understand what should and should not be written in the claim. Something simple like stating, “I cannot lift for than 20 pounds due to pain” can be discredited. Say for example you don’t have someone around to help and need to lift something which is 20 lbs if Lincoln has a video of just that one instance, then they can deny your claim. They’ll also claim your exaggerating and use that video as the basis.
That’s why it’s so important to work with a disability insurance attorney during the entire claims process. Attorneys Dell & Schaefer have been through these types of claims hundreds of times and know exactly what to expect and how to make the best possible case for you. There will be caveats and rules that only someone experienced in this matter will know about, so, give us a call, shoot us an email or stop in to discuss your options. You won’t pay a dime if your claim or appeal fails, you only pay us if you get paid.