An Oklahoma court found that Lincoln was wrong in terminating a woman’s long-term disability benefits. Before her disability, Ms. Sharon Clark worked as a radiologic technologist. Osteoarthritis forced her to cease working. She then submitted a claim for LTD benefits with Lincoln.
Lincoln first denied her claim. It then reversed its position finding she was physically unable to work in her occupation. Lincoln continued paying Ms. Clark for 36 months. However, after 36 months the LTD policy required that Ms. Clark prove she could not work in any job, not just her own. After 36 months of paying Ms. Clark’s LTD benefits, Lincoln terminated her claim.
This is very typical behavior of insurance companies. This law firm focuses on ERISA and disability insurance claims. We have helped numerous people whose benefits were wrongfully terminated by the insurance company.
Lincoln’s Denial of Ms. Clark’s Appeals
In terminating Ms. Clark’s benefits, Lincoln relied on the review of a physician who had never treated Ms. Clark. This paid consultant concluded she could work in a desk job. Accordingly, Ms. Clark appealed this decision and supplied new medical information supporting her disability.
In reviewing Ms. Clark’s appeal, Lincoln again relied on a consulting doctor. This doctor also found Ms. Clark could work in some capacity. Again, Ms. Clark appealed Lincoln’s decision. This time she included a functional capacity assessment, and MRI of her spine, and visit notes showing her disability. Still, Lincoln upheld its decision to terminate benefits.
Accordingly, Ms. Clark filed a lawsuit against Lincoln for the wrongful termination of her benefits.
The Court’s De Novo Review
The Oklahoma court reviewed Ms. Clark’s case de novo, meaning it did not have to give deference to Lincoln’s decision. Under ERISA when the policy contains discretionary language, the court can only rule against the insurance company if acted entirely unreasonable in terminating benefits. Lincoln’s policy did not contain this discretionary language. Thus, Ms. Clark only needed to prove to the court that she was disabled.
In reviewing Ms. Clark’s case, the court emphasized that Lincoln ignored the fact that Ms. Clark applied for and received Social Security Disability (SSDI) Benefits. The court acknowledges that an award of SSDI benefits does not result in an automatic approval of LTD benefits. However, the court ruled that the approval of SSDI benefits is persuasive evidence that Ms. Clark could not work. Because the court felt that Lincoln unreasonably ignored the approval of SSDI benefits, the court instructed Lincoln to reconsider its denial and take into account the approval of SSDI benefits.
Having an Experienced Disability Attorney Matters
Disability insurance law is complicated. If your claim for long term disability benefits was denied or being delayed by an insurance company, it is important to get legal help from a lawyer who focuses on disability law.
As a law firm built to focus disability insurance, all our long term disability lawyers spend every day working to get our clients disability benefits from insurance companies.
Because federal law applies to most disability insurance claims, we do not have to be located in your state to help.
Dabdoub Law Firm represents clients nationwide with:
- submitting a disability insurance claim;
- appealing a long-term disability denial;
- negotiating a lump-sum settlement; or
- filing a lawsuit against your disability insurance company.