Long-Term Disability Benefits Won on Appeal for Dentist with Spine Disorder After Lincoln Financial Denied Her “Any Occupation” Claim
Our client was a dentist who had undergone lumbar fusion surgery and sacroiliac joint fusion. She was receiving long-term disability benefits because chronic back and joint pain prevented her from performing clinical dentistry. When her policy shifted from an “own occupation” definition of disability to a stricter “any gainful occupation” definition, Lincoln Financial terminated her benefits.
Lincoln’s position was that, even though she could no longer practice as a dentist, she could work full-time in a sedentary position as a Director of Dental Services.
The problem was that this conclusion did not match her medical condition, her actual work history, or the earnings requirement in her policy.
After two administrative appeals, detailed additional medical and vocational evidence, and a direct challenge to the insurer’s assumptions, Lincoln reversed its denial and determined that long-term disability benefits were appropriate.
A Career in Dentistry Interrupted by Serious Back Problems
Our client’s job was not a desk job. She examined and treated patients, performed restorations and other dental procedures, supervised hygienists, and regularly had to bend forward, remain in fixed positions, use fine motor skills, and work at an appropriate clinical pace. Her back condition eventually made that work impossible.
She underwent an L5-S1 lumbar fusion and later, a right sacroiliac joint fusion. Despite treatment, she continued to suffer from significant low-back and sacroiliac pain, radicular symptoms, post-laminectomy symptoms, and inflammatory arthritis.
Her pain was not limited to dental work. She reported difficulty sitting, standing, or walking for extended periods. On many days, she had to lie down every two or three hours to relieve her discomfort. Her medications, including gabapentin and methocarbamol, also caused dizziness, drowsiness, forgetfulness, and mental fog.
Lincoln initially approved long-term disability benefits under the policy’s “own occupation” definition, recognizing that she could no longer perform the duties of her profession.
But the policy definition of disability changed after 24 months, and she had to prove that she was unable to perform the main duties of “any gainful occupation” for which she was reasonably qualified and that would satisfy the policy’s earnings requirement.
Lincoln Terminates Benefits Based on a Sedentary Dental Director Position
Lincoln advised our client that it would stop paying benefits under the “any gainful occupation” policy definition of disability.
Lincoln acknowledged her history of lumbar degenerative disc disease, sacroiliitis, lumbar fusion, SI fusion, persistent pain, and post-laminectomy symptoms. It also acknowledged that restrictions were appropriate, including limitations on standing, walking, lifting, carrying, pushing, pulling, bending, kneeling, crouching, stair climbing, and working around heavy machinery. Nevertheless, Lincoln concluded that she retained the capacity for full-time sedentary work.
For its vocational analysis, Lincoln identified one occupation: Director of Dental Services, classified as a sedentary occupation. Lincoln stated that this occupation paid approximately $9,200 per month and was consistent with her education, training, and experience.
Based on that single occupational alternative, Lincoln determined that she would no longer qualify for disability benefits once the “any occupation” period began.
The First Appeal: Explaining Why the Paper Review Did Not Reflect Real Life
Our office appealed Lincoln’s termination decision and submitted additional evidence showing why our client could not reliably perform full-time work. That evidence included a detailed, sworn written statement from the client, corroborating statements from family members and others who regularly observed her condition, medical records from her treating providers, and a work-capacity assessment from her treating physician.
Our client explained, in practical terms, what her condition meant from day to day. She could not sit, stand, or walk for 30 to 45 minutes without increased pain. She could lift only limited weight and could not predict when an activity would trigger a flare lasting days or even weeks. She frequently needed to lie down. She also described how her medication side effects interfered with focus, pace, and accuracy.
Those limitations mattered. Sedentary work is not simply a job performed while sitting. It requires the ability to remain reliably productive through a normal workday, day after day. Her treating physician concluded that she could not sustain full-time employment, even in sedentary work. He limited her to approximately four hours of work per day and estimated that her condition would cause numerous absences each month.
Lincoln Obtains Another Medical Review
During the first appeal, Lincoln obtained a review from another physician specializing in physical medicine and rehabilitation. Lincoln provided that to us for a response as ERISA regulations require.Â
The reviewer agreed that our client had impairing medical diagnoses, including lumbar spondylosis, lumbar radiculopathy, chronic pain syndrome, and psoriatic arthritis. However, he concluded that she could perform work with restrictions, including sitting for up to 45 minutes at a time for a total of six hours per day, and walking or standing for limited periods.
We requested additional time to respond and asked Lincoln not to make a final decision until our submission was complete. Lincoln responded that it would not grant the full extension requested, but it would allow continued development of the appeal and would send newly received treating-physician information back to its reviewer for an addendum.
We also requested copies of materials submitted directly by the treating physician so that the client and our office could review and address everything Lincoln was considering. Despite our comprehensive response, Lincoln issued a first-level appeal denial on June 24, 2025.
Lincoln maintained that our client had sedentary work capacity and again relied on the occupation of Director of Dental Services. According to Lincoln, she could perform that position and earn enough to satisfy the policy’s “gainful occupation” requirement.
The Second Appeal: Challenging Both the Medical and Vocational Assumptions
The second appeal directly addressed what we saw as weak points in Lincoln’s analysis.
We submitted updated medical evidence, including additional physician support, diagnostic imaging, and a functional capacity evaluation.
Our client’s treating physician confirmed that her symptoms, pain complaints, and functional limitations were credible and consistent with her condition and objective medical findings. He concluded that she could not reliably sustain any full-time gainful employment, including sedentary work.
The functional capacity evaluation also documented meaningful limitations. Although the evaluator stated that she might be capable of some form of employment within restrictions, he concluded that she could not return to work as a dentist because of her limitations with forward bending. Importantly, the evaluation found that she gave maximal effort, demonstrated consistent performance, and tested negative for non-organic pain behavior. When she reported increased pain, the evaluator observed objective physical correlations.
We also retained a highly-qualified vocational rehabilitation expert and submitted his assessment addressing Lincoln’s proposed occupation of Director of Dental Services. Lincoln’s vocational expert depended on the assumption that our client had experience in a dental management position. But her actual professional history was clinical dentistry, not the administration of a dental department. Although she had occasionally covered limited duties when another dentist was absent, she had not performed the core management functions associated with directing dental services, such as budgeting, hiring, developing policy, setting staffing levels, managing schedules, or overseeing operations.
The vocational evidence also addressed the salary issue. Under the policy, our client needed to be capable of earning at least 60 percent of her pre-disability income, approximately $7,800 per month, within 12 months of returning to work. Lincoln had used a wage figure of more than $9,200 per month for the proposed director position. But the vocational consultant explained that this figure reflected a median wage for people already working in that occupation. It did not establish that someone without meaningful management experience could reasonably be expected to earn that amount upon entering the field.
Using lower wage percentiles more consistent with an entry-level transition into the position, the proposed earnings fell below the policy’s required threshold. In other words, even apart from the medical limitations, Lincoln had not identified a gainful occupation that reasonably fit our client’s actual experience and the policy’s earnings requirement.
Lincoln Reverses Its Decision and Restores Benefits
We submitted the final administrative appeal with the updated medical, functional, employment, and vocational evidence. We informed Lincoln that, unless the denial was reversed, our client intended to pursue court review.
After reviewing the claim again in its entirety and analyzing the additional evidence, Lincoln advised that it had determined long-term disability benefits were appropriate, and our client’s benefits were restored without the need to file a lawsuit.
Why This Case Matters
Long-term disability claims are often terminated when a policy changes from “own occupation” to “any occupation.” At that stage, an insurer may acknowledge that a professional cannot return to her former career but still contend that she can perform another occupation.
That conclusion must be tested carefully. In this case, the insurer’s initial decision rested on two central assumptions: that the client could sustain full-time sedentary work and that her background qualified her for a sufficiently paying dental director position. The appeal evidence addressed both assumptions with specifics: the client’s daily functional limitations, the treating physicians’ opinions, objective functional testing, her actual job duties, and a vocational analysis of the proposed occupation and expected earnings.
A successful disability appeal is rarely about submitting one more medical record. It is about identifying the insurer’s reasoning, finding the unsupported assumptions, and building the evidence needed to answer them. That is what changed the result here.
Results may vary. Every case is different, and no outcome can be guaranteed.
