Dabdoub Law Firm recently secured a favorable outcome for our Baltimore client in a long-term disability (“LTD”) appeal to Lincoln Financial Group (“LFG”). Our client had been denied her LTD claim, and we believed this denial was unjust. The disability in question was chronic, intractable migraines - a debilitating condition that should have been covered based on criteria effectively presented by our legal team.
Responding to Lincoln Financial Group’s Denial of Long-Term Disability Benefits
Our disability attorneys began by specifically responding to LFG’s physician consultants’ opinions, which had resulted in the denial of LTD benefits for our client. Under the Employee Retirement Income Security Act (ERISA), an insurance carrier must act as a fiduciary, operating “solely in the interest of the participants and beneficiaries.”
As a plan administrator and fiduciary with discretionary authority, LFG holds the power to interpret and apply the terms of the LTD policy. However, due to this power, LFG is held to a “higher than marketplace” standard. We argued that LFG abandoned its fiduciary duties owed to our client by ignoring the medical evidence before them, including the unanimous conclusions of treating physicians supporting disability, and instead relied on its own paper-based medical reviewers’ opinions.
Chronic Migraines: A Debilitating Condition
According to the International Headache Society (“IHS”), a “migraine” is defined as a headache occurring on 15 or more days/month for more than three months, which, on at least eight days per month, has the features of a migraine headache.” Our client’s medical history and reports are the hallmark symptoms of the above-referenced diagnostic criteria for chronic migraines, and her condition is disabling.
Johns Hopkins Medicine (“Johns Hopkins”) further supports this, stating that treatments are approved for select people aged 18 and older who experience 15 or more migraine days per month.
Our client's condition met the following criteria:
- Headache (migraine-like or tension-type like), on ≥15 days/month or > three months, and fulfilling criteria B and C;
- Occurring in a patient who has had at least five attacks fulfilling criteria B-D for 1.1. Migraine without aura and/or criteria B and C for 1.2 Migraine with aura; On ≥8 days/month for >3 months, fulfilling any of the following:
- Criteria C and D for 1.1 Migraine without aura;
- Criteria B and C for 1.2. Migraine with aura;
- Believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative;
- Not better accounted for by another ICHD-3 diagnosis.
Through our diligent efforts and thorough presentation of the facts, we were able to secure a positive outcome for our client, reaffirming our commitment to fighting for those who suffer from chronic conditions and need support the most.
Help from a Lawyer with Expertise in Disability Insurance
Disability insurance law is complex. Hiring an experienced disability attorney is important. Because all disability lawyers at this law firm focus on disability insurance claims, we proudly offer significant expertise in disability insurance law.
The Dabdoub Law Firm has:
- Experience with every major disability insurance company;
- A proven track record of success by winning major disability lawsuits; and
- Recovered millions of dollars in disability benefits for clients.
We never charge fees or costs unless our clients get paid. Our firm can help at any stage of your disability insurance claim, including:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- Negotiating a lump-sum settlement; and/or
- Filing a lawsuit against your disability insurance company.
Because federal law applies to most disability insurance claims, our lawyers are able to represent clients across the country.
Call (800) 969-0488 or contact us online to speak with an experienced disability attorney. Consultations are free.