After suffering complications from bilateral knee surgery, a former core equipment operator in the fracking industry in Aubrey, Texas filed a long-term disability (LTD) claim with Lincoln National Life Insurance Company. Although the man could not perform the duties of his occupation and could barely walk, Lincoln denied his claim for LTD benefits under the pre-existing condition exclusion.
Puzzled that his surgical complications could somehow be “pre-existing,” the oil field worker called Dabdoub Law Firm.
Lincoln Makes Up a Diagnosis for Our Client
Instead of acknowledging our client’s disability, Lincoln took advantage of his policy’s lookback window and all but invented a pre-existing condition for him. Lincoln said our client received treatment for arthritis in his left elbow and both knees, but our client had never been diagnosed with arthritis.
In reality, before joining his employer’s group disability policy, our client saw a doctor for an infected injury on his big toe, which resolved with no other complications. He was not diagnosed with arthritis nor prescribed any medications during the time frame for pre-existing conditions.
Further, our client’s disabling condition is complications from bilateral knee surgery, which can in no way be pre-existing, as our client did not have the surgery during the lookback window.
Emphasizing Legal Precedents
Because Lincoln did not dispute our client’s inability to work, Dabdoub Law Firm simply proved how the insurance company’s behavior was wrong. The Eleventh Circuit Court of Appeals dismissed a similar interpretation of the pre-existing condition clause to be unreasonable and against the Employee Retirement Income Security Act of 1974 (ERISA) in a case involving Reliance Standard Life Insurance Company.
Similarly, in Fought v. Unum Life Ins. Co. of Am., 379 F.3d 997, 1011 (10th Cir. 2004), the Tenth Circuit Court of Appeals explained:
“[t]he exclusion cannot merely require that the pre-existing condition be one in a series of factors that contributes to the disabling condition; the disabling condition must be substantially or directly attributable to the pre-existing condition.”
Essentially, neither an infection on our client’s toe nor a previous bout with arthritis would be enough to dismiss our client’s LTD claim for complications from bilateral knee surgery. Further, our client’s doctor has even stated that his current disability has nothing to do with the issue he was receiving treatment for during the lookback window.
When presented with the facts of the case, Lincoln reversed its denial and awarded our client’s LTD benefits.
Help from a Lawyer with Expertise in Disability Insurance
Dabdoub Law Firm was built to be a disability insurance law firm.
That focus means:
- All of our lawyers specialize in disability insurance claims.
- We have experience with every major disability insurance company.
- We have won important long-term disability lawsuits and improved the law for claimants like you.
Our disability lawyers can help you 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.
Hiring an experienced disability attorney is important. Because federal law applies to most disability insurance claims, our lawyers can help you from any state.
Call us at (800) 969-0488 or contact us online for a free consultation with an experienced disability attorney. Pay no fees or costs unless you get paid.