Long-Term Disability Insurance Denial by Lincoln National for Nurse with Osteoarthritis Reversed on Appeal
This was a first, and is a true story from late 2023…
Lincoln: Your Wife is Dead. She Owed Us Money. Pay Us Now.
We were in the middle of appealing a denied long-term disability insurance claim for our client “Jane”, A Hospice Nurse, when her husband “Tim” received this letter…
“Dear [Husband Tim]: Please accept our sincerest condolences regarding the death of [Jane]. We received notification that they passed away… This letter is regarding his/her outstanding overpayment with Lincoln National Life, in the amount of $2,576.64… Please remit payment of $2,576.64, payable to Lincoln National Life.”
To which we replied…
“This is to advise that [Jane] is NOT DECEASED. Accordingly, we ask that any and all communications regarding this claim continue to be directed through our office. Additionally, we would ask that you please provide the source of the erroneous death notice as well as confirmation that Ms. Knight’s appeal review has not been interrupted.”
Lincoln never gave us an explanation. We continued building her appeal.
No, Jane Wasn’t Dead, but She was Severely Disabled from the Work She Loved
Jane worked with horrible pain for years until her fibromyalgia, type 2 diabetes, osteoarthritis, and other ailments, requiring medical marijuana and other strong narcotic pain medications, made it impossible to continue. She loved her work helping terminal patients and their families, and hated to give it up.
Long-Term Disability Claim Denials for Seizures- Shocking, but Also Common
Jane’s treating physicians told her that she was unable to continue working. Yet Lincoln ignored their opinions and denied her claim for disability benefits, claiming that Jane could still perform his job duties and was therefore not disabled, nor entitled to benefits under the policy. Lincoln further claimed that the evidence she presented was insufficient to prove her case, despite her treating physicians’ unwavering opinions.
Being accustomed to a steady (and high) wage, Jane was also distraught from losing her livelihood. She never imagined having to fight Lincoln for the benefits she purchased to protect herself, all while coping with a difficult medical condition.
Learning Jane’s Whole Story to Help Appeal the Bogus Claim Denial
We worked closely with Jane to help her build her claim carefully and systematically with new, undeniable evidence far beyond what he had presented to Lincoln before they denied his claim. Jane simply needed to tell her story more vividly and effectively to the insurance company in her appeal.
How Jane Won Her Case: Obtaining Medical Support and Presenting Her Story Effectively to Appeal the Claim Denial
With Jane’s help, we were able to work with her treating physician to create a more detailed expert opinion far beyond what he had in the medical chart. These were made into formal signed statements.
We were also able to create a much more vivid detailed statement for Jane’s own signature, describing her symptoms and how they affected her work in more detail.
Jane’s husband also completed a sworn affidavit of his observations of Jane’s difficulties.
We presented this and other new evidence that was not part of Jane’s initially denied application to Lincoln.
Jane’s new description of how many ways her symptoms affected her life was compelling. She described how some of the medications she had to take caused her to experience dizziness and brain fog, affecting the quality of her work.
A Just Outcome
Thankfully, presented with undeniable new evidence in Jane’s appeal, along with copies of court opinions our case law research found, where judges had awarded benefits under fact scenarios similar to our client’s case, Lincoln finally did the right thing. They paid her for all past due benefits and reinstated her benefits under the policy going forward.
Victims Of Disability Should Always Appeal Unfair Claim Denials
In the end, because she continued to fight, appealing the insurance company’s denial of her disability claim rather than just accepting it as the final word, Jane was able to maintain her financial security while she took some much-needed time to focus on her own well-being.
Unfortunately, disability insurance companies unfairly deny legitimate claims every day, but anyone faced with an unfair claim denial should continue to fight and appeal the denial. These unfair denials can be overturned with stronger evidence, properly presented.
James deserved the benefits he had paid a premium for over the years, and it was an honor to help such a wonderful physician and person overturn such an unfair claim denial.
Results may vary. Every case is different, and no outcome can be guaranteed.
