Missouri Court Finds Lincoln Financial's Decision to Terminate Benefits for Nurse Practitioner Unreasonable
Mr. Flanagan, the claimant in this case, was a nurse practitioner when she became disabled. Her condition included spondylolisthesis, failed lumbar fusion and nerve root scarring. Her treating physicians fully supported her disability. His attending physician statements indicated she could not work in any capacity. None of this seemed to matter to Lincoln.
As part of its review, Lincoln had a medical review done by its own paid doctor. He concluded she was disabled from her own occupation. Lincoln, thus paid her benefits for two years. After two years, it conducted another review to determine if she could work in any occupation. It determined she could perform sedentary work and terminated her benefits.
Ms. Flanagan timely appealed and provided even more evidence of her disability. During the appeal review, Lincoln had another one of its paid doctors review her claim.
Notably, Lincoln's own doctor agreed with Ms. Flanagan’s treating physician that she could not work in any capacity. Lincoln ignored it. Instead it relied on the original review and its vocational reviews and denied her appeal.
The medical evidence in support of disability is overwhelming. Her treating physicians, medical records, and a functional capacity evaluation (“FCE”) all support her inability to work in even a sedentary job. Nonetheless, Lincoln ignored anything that favored disability and instead plucked lines supporting it goal of denying benefits.
The Court considered all this and the internal conflict the insurance company carries as the reviewer and the funder of benefits. The court determined Lincoln was unreasonable in its determination to terminate benefits. Ms. Flanagan’s benefits were reinstated and paid to the date of termination.
It is so important to review everything your insurance carrier used to make its determination on your claim. This kind of “cherry-picking” of the records and reviews happens often. An experienced know to look for this and other tactics used by insurance carriers to meet their ultimate goal of denying benefits.
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