Lincoln Financial Disability Claim Denied

26% of all Americans have some type of disability. In some cases, these disabilities are severe enough that a person is unable to work.  Short and long-term disability insurance and Social Security disability benefits can provide financial stability in the event you cannot work because of an injury or illness.

Being approved for long-term disability (LTD) benefits can be complicated, particularly with certain insurance companies like Lincoln Financial Group. If your long-term disability claim with Lincoln Financial has been denied, you may be able to file an appeal with the help of an experienced long-term disability attorney. Your lawyer can put together additional medical evidence and other proof to show that you do qualify for disability benefits under the terms of your policy.

At Bross & Frankel, we are dedicated to advocating for people with disabilities. We have handled thousands of disability benefits claims, including initial applications and administrative appeals involving Lincoln Financial Group. Reach out to our law office today to schedule a free claim review with a member of our team.

Common Reasons for Denial of Lincoln Financial Disability Claims

Many people have long-term disability coverage through Lincoln Financial Group. These policies are often offered as part of a group insurance plan through an employer. When your LTD policy is provided by your employer, it is covered by the Employee Retirement Income Security Act (ERISA). This is important when it comes to procedural safeguards and your right to appeal a denial.

When you apply for long-term disability, you may assume that getting approved is a straightforward matter. After all, if you cannot work because of a disability, then you should be covered – right? Unfortunately, that is not always the case. Insurance companies like Lincoln Financial use a variety of tactics to deny legitimate disability claims.

There are many reasons why a long-term disability claim may be denied. Some of the more common rationales include:

• Insufficient medical evidence
• Pre-existing medical conditions
• Changed definition of disability after 24 months
• Failure to meet the definition of disability under the plan
• Missed deadlines
• Paperwork errors
• Other evidence that conflicts with your claim (which may come from an investigation into you or even your own social media posts)
• Conflicting medical assessments

For example, Lincoln Financial may require you to undergo an independent medical examination (IME) and/or a functional capacity evaluation (FCE). These assessments are performed by doctors who are hired and paid for by the insurance company. If the IME and/or FCE state that you are not disabled under Lincoln Financial’s definition, then your claim could be denied.

Under ERISA, you have the right to know why your claim was denied. The notice of denial must include:

• What standards were used to deny the claim;
• Why the claim adjudicator disagreed with your doctor or Social Security Administrator’s determination of disability;
• What rules, guidelines, and standards are used to decide long-term claims;
• The scientific basis for any denials based on medical necessity, experimental treatment, or other policy exclusion

Based on this information, you may decide to appeal the LTD denial. An experienced New Jersey disability benefits attorney can help you with the appeals process.

The Appeal Process

As noted above, most long-term disability claims are covered by ERISA. As such, the appeals process is governed by ERISA. However, if you bought a Lincoln Financial plan on your own, then you will likely need to pursue an appeal by filing a lawsuit in state court.

Under ERISA, you generally file one or two administrative appeals before filing a lawsuit against Lincoln Financial Group in federal court. When you file an administrative appeal, you will be able to submit additional medical records and other documentation to strengthen your claim. The exact type of evidence that you submit may be different based on the reason for the denial. In many situations, submitting additional evidence through an administrative appeal is sufficient to overturn the denial and be approved for benefits.

The appeals process can be complicated. It requires more than simply telling the insurance company that you want to appeal and including a letter from your treating physician that states that you are disabled. Importantly, the evidence that you submit through these administrative appeals is often the only evidence that will be considered in a lawsuit. In other words, you have to make sure that your case file is as complete as possible to protect your interests.

After an initial denial, you have 180 days to file the first level of appeal. The company then has 45 days to respond to your appeal. If Lincoln Financial denies this first appeal, then you will need to file a second and final administrative appeal. It is only if this second appeal is denied that you will have the right to pursue a federal lawsuit against Lincoln Financial Group.

This two-level appeals process is designed to wear claimants down. Many people get frustrated by their inability to get approved for disability benefits, and may simply stop trying. The confusing rules may also result in people making errors or mistakes – such as missing a deadline – that can ultimately lead to a denial of benefits.

Because the appeals process is complicated, it is often a good idea to work with a seasoned New Jersey disability benefits lawyer. With legal representation, you can make sure that you submit the right medical records to support your claim – which may be sufficient to overturn a denial. Alternatively, these medical records can be used to support a lawsuit against Lincoln Financial.

How a Disability Benefits Attorney Can Help

There are many pitfalls in the long-term disability claim process. The paperwork can be confusing, and many people don’t understand the level of proof required to get approval. Insurance policies can also be hard to comprehend, particularly when the insurance company has different definitions of disability.

A disability benefits lawyer can assist with the initial application, putting together medical evidence that supports your claim. Even if you don’t hire an attorney to help you file a claim, they can still assist you with administrative appeals and a lawsuit, if necessary. Working with an attorney is the best way to increase the likelihood that your Lincoln Financial LTD claim will be approved.

A lawyer will thoroughly examine the denial notice sent by the insurer. They will also analyze the policy as well as the medical records and other documentation that you submitted. In this way, they can put together the strongest possible case. They will also keep the court’s “abuse of discretion” standard in mind so that they can show a judge that Lincoln Financial abused its discretion when it denied your claim for LTD benefits.

When you pay for long-term disability insurance, you expect to be covered in the event that you cannot work due to a disability. Don’t let Lincoln Financial Group get away with wrongfully denying your LTD claim. Reach out to Bross & Frankel to consult with an experienced New Jersey Disability benefits attorney about your claim.

How Our Law Firm Can Help

Too often, getting approved for LTD benefits is much harder than it should be. Insurers like Lincoln Financial Group may use minor errors and other technicalities as a way to deny legitimate claims. We can help you appeal a disability denial.

Based in Cherry Hill, Bross & Frankel represents individuals throughout Pennsylvania and New Jersey who are seeking disability benefits. We have substantial experience in all aspects of disability benefits law, which we put to work to help our clients achieve the best possible outcome for their cases. To learn more or to schedule a free initial consultation with a member of our legal team, give us a call at 866-708-3985 or fill out our online contact form.

How Does Lincoln Financial Decide If You Qualify for Long-Term Disability?

Many insurance companies, including Lincoln Financial Group, often rely on “paper only” reviews of your medical records. In other words, they hire doctors to review your claim file without ever scheduling an assessment or examination. This can often lead to denials, particularly if your claim did not include sufficient proof that you are disabled and unable to work because of your disability.

A skilled New Jersey disability benefits lawyer can often help you overcome unfair LTD claim denials based on paper reviews. They will put together evidence to document your disability and how it affects your ability to work. Reach out to Bross & Frankel to schedule a free claim review.

Can I Be Denied LTD Benefits If I Have a Pre-Existing Condition?

It depends. Many of Lincoln Financial’s disability policies contain an exclusion for pre-existing conditions that occur during the first year of coverage. If your insurance policy has this exclusion, then your claim could be denied if the insurer decides that your disability arose from a pre-existing condition.

A skilled disability benefits lawyer can carefully examine your plan’s exclusions and limitations before you submit a claim for disability insurance benefits. If your disability claim is denied, then your attorney can put together an appeal that demonstrates that your current disability is not related to a pre-existing condition. Call Bross & Frankel to schedule a confidential consultation about your claim.