Michigan Court Orders Lincoln to Pay Long-Term Disability Benefits to Former Nurse Suffering From Narcolepsy

A trial federal court in Michigan ruled that Lincoln National Life Insurance Company (“Lincoln ”) was wrong to terminate the former nurse’s long-term disability benefits and ordered Lincoln to pay past due benefits.

Background

Ms. Cheryl Bombassei stopped working as a nurse in September of 2018 because of a disability caused by narcolepsy, rheumatoid arthritis, and a shoulder injury. Unable to work as a nurse, Ms. Bombassei filed a claim for long-term disability (“LTD”) benefits with Lincoln. Her claim was approved by Lincoln with benefits payable in March of 2019. In March of 2020, Ms. Bombassei was also approved for Social Security Disability benefits.

Lincoln paid long-term disability benefits for 24 months recognizing Ms. Bombassei’s medical conditions made it impossible for her to work as a nurse. After 24 months of benefits, Ms. Bombassei was required to prove that she could not work in any occupation for which she was qualified based on training, education, or experience.

Lincoln terminated Ms. Bombassei’s benefits effective March 5, 2021, based on its suggestion that she could work in some other occupation.

Lawsuit

After Ms. Bombassei’s appeal was denied, she filed a lawsuit in federal court. Lincoln argued that its termination of benefits was correct because:

1. The approval of SSDI benefits was based on older medical records;
2. Ms. Bombassei’s disability was based upon her self-report and reports from her family and co-workers
3. Some of Ms. Bombassei’s doctors failed to complete attending physician statements when requested;
4. There was no proof narcolepsy impacted her ability to work in 2022; and
5. The records show Ms. Bombassei’s arthritis and narcolepsy were improved.

Ms. Bombassei argued that the termination of benefits was wrong because:

1. Lincoln unreasonably ignored her self-reports;
2. She requires regular naps which would preclude her from working in any job; and
3. Her diagnosis was confirmed by testing.

After a review of the medical evidence, the court ultimately ruled in favor of Ms. Bombassei based on the following:

1. Ms. Bombassei has demonstrated she suffers from narcolepsy precluding work of any kind;
2. The reports of Ms. Bombassei and her family members that she regularly falls asleep is unrebutted;
3. Lincoln did not have Ms. Bombassei examined;
4. Lincoln’s reviewing doctor ignored the narcolepsy diagnosis;
5. The doctors who did not complete attending physician statements did not treat Ms. Bombassei for narcolepsy;
6. There is no proof that narcolepsy is curable.

Disability insurance claims are often denied despite sufficient proof of disability. It is important to have someone on your side who knows how insurance companies deny claims and how to push back on them.

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