Our client worked as an Outside Sales Representative for a metals company. His job was not a desk job in any real-world sense. His responsibilities included prospecting for jobs and companies, preparing for sales calls, making sales calls, visiting offices and job sites, driving a truck, completing sales reports, making deliveries, and following up with architects. To do the job reliably, he needed to drive, walk job sites, interact with customers and colleagues, concentrate on details, prepare reports, and follow through on sales activity.
Then Meniere’s disease and ocular migraines changed his life. He began suffering major balance problems, frequent vertigo, constant pressure and ringing in both ears, and visual disturbances. Simple movements, such as turning or tilting his head, could worsen his symptoms. He described dizziness and vertigo episodes several times per week, with each episode lasting about 45 minutes and requiring roughly two hours of recovery lying down. During those recovery periods, he could not sit, concentrate, focus, or perform mental tasks.
He also experienced ocular migraines at least once a week. Those episodes were severe enough that he had to lie down in a dark room for the rest of the day or risk the migraine returning. He could sit only about 10 minutes before needing to change position or lie down. He could stand about 15 minutes. He could walk only about 50 feet while using a wall or something nearby for support. He could drive only very short distances before symptoms impaired his ability.
This was not a person who could reliably perform outside sales. And, as his symptoms progressed, it was not a person who could reliably perform any full-time job requiring reasonable continuity, attendance, focus, screens, sitting, or interaction with others.
Lincoln Initially Paid LTD Benefits, Then Denied the Claim under the Any-Occupation Standard
Lincoln agreed that our client was unable to perform the material and substantial duties of his own occupation as an Outside Sales Representative.Â
But when the policy changed from the own-occupation definition to the any-occupation definition, Lincoln terminated benefits. It concluded that, although the medical records supported restrictions and limitations that would preclude the Outside Sales Representative job, those restrictions would not preclude all work. Lincoln relied on its own vocational expert’s review that identified three sedentary occupations: Automobile Locator, Information Clerk, and Telephone Solicitor.
The Denial Did Not Fairly Account for Real-World Function
That conclusion missed the point. The question was not whether Lincoln could locate sedentary job titles in a vocational database. The question was whether our client could perform the material and substantial duties of an occupation with reasonable continuity, given his actual symptoms, functional limitations, and need to lie down unpredictably after vertigo and migraine episodes.
 That is a common problem in LTD claims. Insurance companies often treat “sedentary” as if it requires someone to sit mindlessly. It does not. Full-time sedentary work still requires reliable attendance, concentration, persistence, pace, screen tolerance, communication, and the ability to sit and function for sustained periods.
Our client could not do those things reliably. He had near falls throughout the day. He needed support from walls, grab bars, a cane, or sudden sitting to keep from falling. He had difficulty showering, cooking, driving, grocery shopping, cleaning, managing appointments, and completing ordinary activities of daily living. He relied heavily on his wife for support.
Almost every day, his symptoms caused him to need to lie down for at least two hours during a workday period. That limitation alone destroys the ability to perform competitive work with reasonable continuity, even if the job is physically sedentary.
Building the Appeal Around the Full Story
We helped our client build a stronger appeal record than Lincoln had before its denial. We added a detailed sworn statement of our client explaining his work duties, symptoms, medication use, vertigo episodes, ocular migraines, balance problems, near falls, limited sitting, standing, walking, and driving, and his need to lie down during the day.
His wife also signed a statement confirming that his description was consistent with what she observed. Additional evidence was submitted from treating providers as well, including much more detailed physician notes and recommended restrictions. These addressed the disabling nature of his medical condition much more directly than the medical chart notes did.
This evidence mattered because LTD claims are not decided by diagnosis alone. A diagnosis explains the medical condition. But disability is about function. The appeal needed to show how Meniere’s disease, vertigo, tinnitus, and migraines affected his ability to perform work activity on a reliable and continuous basis.
We also emphasized that the administrative record is critical in ERISA claims. In most ERISA LTD cases, a court later reviews the insurer’s decision based only on the evidence submitted to the insurance company before suit. That makes the appeal stage one of the most important parts of the entire case. Our appeal placed more accurate and detailed evidence of disability facts into the administrative record.Â
The Insurer Denied the Appeal Relying on Paper Reviews and Vocational Job Titles
Lincoln obtained additional medical record reviews by their own hand-picked physicians who had never even seen our client in person, and another vocational analysis during the appeal process. The reviewers accepted some restrictions, including no balancing, no climbing ladders, no working at heights, no operating motor vehicles, no operating or being around heavy machinery, and no movement involving constant turning of the head. Yet Lincoln still maintained that those restrictions would not prevent the previously identified sedentary occupations.
Lincoln denied the appeal, further delaying payment of benefits, which forced us to file suit. But now with a strong administrative record for the Court to consider, we felt that our client had a compelling case there. As trial approached, Lincoln and our client reached a settlement for a confidential sum.Â
Why This Kind of LTD Denial is So Harmful
Meniere’s disease and vestibular disorders can be difficult for insurance companies to evaluate because symptoms may not always appear neatly on imaging or routine physical examination. But that does not make the condition non-disabling. Vertigo, tinnitus, balance loss, ocular migraines, and unpredictable symptom flares can make ordinary daily life difficult and work impossible. A person may look normal during a short office visit and still be unable to drive, sit at a computer, speak with customers, complete reports, or stay upright and focused for a workday.
That is why the claimant’s detailed statement, family observations, treating physicians’ direct input, and specific functional restrictions are so important. The insurer needs to understand not just the medical label, but what the condition does to the person hour by hour and day by day.
Victims of Disability Should Not Give Up After an Unfair LTD Denial
Lincoln’s denial was not the final word. Our client continued to fight and presented stronger evidence on appeal. The lesson for other disabled workers is simple: do not assume a denial letter means the insurance company is right. LTD insurers deny legitimate claims every day, often by focusing too narrowly on selected medical notes, generic job titles, or theoretical sedentary work.
A strong ERISA appeal should tell the whole story. It should explain the claimant’s actual occupation, the medical condition, the functional limitations, the need to lie down or miss work, medication effects, safety problems, and why the claimant cannot perform work with reasonable continuity.
We were honored to help our client challenge Lincoln’s denial and present the full evidence of his disabling Meniere’s disease, vertigo, tinnitus, balance impairment, and ocular migraines.
Results may vary. Every case is different, and no outcome can be guaranteed.
