Richard Bone and his Florida disability attorney have a proverbial bone to pick with Lincoln National Life Insurance Company (Lincoln). Lincoln denied Mr. Bone’s claim for long-term disability benefits under a group plan governed by ERISA that Mr. Bone had with his employer. Mr. Bone and his Florida disability lawyer were left with no choice but to file a civil complaint in United States District Court in the Middle District of Florida in the Orlando Division in order to seek relief from Lincoln regarding Lincoln’s refusal to pay long-term disability benefits that are due.
Mr. Bone and his disability attorney allege that Lincoln denied Mr. Bone’s claim based on a structural conflict of interest since Lincoln served as the underwriter, administrator, and fiduciary to Mr. Bone’s long-term disability plan. Mr. Bone further alleges that the disability plan set forth by Lincoln failed to comply with the ERISA statute, claiming Lincoln did not give Mr. Bone’s claim a “full and fair review” when they denied his claim. This, in turn, goes back to the original allegation that Lincoln has a structural conflict of interest in place that essentially works in favor of the company and against disability claimants.
As plan administrator, Lincoln has a responsibility of reviewing disability claims submitted by claimants in determining whether or not there is enough evidence to substantiate a claim and whether or not to make payments. However as the plan’s fiduciary, Lincoln has a responsibility to work on behalf of the claimant to ensure a full and fair review is conducted by the plan administrator. With Lincoln serving as both administrator and fiduciary, it appears that Lincoln might not be acting in the best interest of Mr. Bone, rather it appears they are acting in the best interest of their shareholders.
With that said, it is up to the court to decide whether or not Lincoln acted unreasonably in denying benefits due to a structural conflict of interest. In most disability cases the structural conflict of interest exist and the courts will consider it as one factor in reviewing a disability claim denial.
Mr. Bone also alleges that Lincoln failed to provide a copy of the guidelines and criteria used to deny Mr. Bones long-term disability benefits claim. Apparently, Lincoln acted in an arbitrary and capricious manner when deciding to deny Mr. Bone’s plan and not provide him with any specifics regarding the reason(s) why his claims denied. Mr. Bone and his disability attorney also assert that the claims process through which Mr. Bone has experienced is unreasonable in nature. This, according to Mr. Bone’s attorney, constitutes yet another failure on the part of Lincoln to comply with the ERISA statute.
Since Mr. Bone has exhausted all of his administrative remedies with Lincoln, Mr. Bone is asking the court to find in his favor and award him long-term disability benefits that are due to him under the ERISA governed policy he has with Lincoln. Additionally, Mr. Bone seeks to have his rights under the ERISA plan clarified so that he can have his plan reinstated by Lincoln in order to receive future long-term disability benefits. In addition to being awarded long-term disability benefit payments from Lincoln, Mr. Bone seeks attorneys’ fees and court fees as part of the settlement.