What to Know:
- A former health professional in San Diego, CA with post-concussive syndrome and chronic tachycardia was suddenly cut off from her long-term disability (LTD) benefits.
- Lincoln’s decision relied on limited, outdated records and ignored clear documentation of lingering symptoms and functional limitations.
- The insurer dismissed the impact of photosensitivity, dizziness, and neurologically based restrictions, even after multiple treating doctors validated her condition.
- Dabdoub Law Firm submitted a comprehensive appeal supported by recent evidence, enforcing the claimant’s right to a full and fair review under ERISA.
Background: A Life Changed by a Sudden Injury
In 2021, a routine drive turned into a life-altering event when a healthcare professional in San Diego experienced a sudden stop on the highway that caused a whiplash injury. The trauma triggered a cascade of symptoms including post-concussive syndrome, photosensitivity, chronic sinus tachycardia, dizziness, and cognitive dysfunction.
Despite aggressive treatment, physical therapy, occupational therapy, neurology consults, and behavioral health support, her symptoms persisted. She made every effort to return to work in a reduced capacity, even managing 20-hour remote work weeks with special accommodations. But her recovery plateaued, and eventually, her employer terminated her due to an inability to return full-time.
In the face of worsening symptoms and a disrupted life, she filed a claim for long-term disability benefits under her employer-sponsored policy administered by Lincoln Financial.
Lincoln Terminates Benefits Without Just Cause
After approving benefits for a time, Lincoln conducted an internal review and issued a denial letter cutting off her LTD benefits moving forward. The decision cited a lack of “medically necessary restrictions or limitations” and leaned on the opinions of paper-review physicians who never examined her.
Specifically, Lincoln claimed:
- There were “no supported limitations” from internal medicine or neurology.
- Her photosensitivity was “inconsistent” and could be managed with simple accommodations.
- There was no objective evidence of neurocognitive impairment.
- Her ability to use a stationary bike and attend Pilates class months earlier indicated functional improvement.
These conclusions contradicted years of treatment records, documented work accommodations, and her treating doctors' assessments.
The Medical Evidence Tells a Different Story
We submitted a detailed appeal on behalf of our San Diego client showing Lincoln had mischaracterized and minimized her conditions. Her medical history includes:
- Post-Concussive Syndrome with ongoing symptoms of visual sensitivity, dizziness, and cognitive challenges
- Chronic Sinus Tachycardia, documented by cardiology specialists
- Photosensitivity, requiring workplace accommodations such as tinted eyewear, screen filters, and adjusted lighting
- Orthostatic Symptoms, with documented episodes of dizziness upon standing and abnormal heart rate patterns
- Mental Health Diagnoses, including PTSD, ADHD, and generalized anxiety disorder
Multiple treating physicians, across neurology, internal medicine, and primary care, documented:
- Restrictions on visual exposure, screen use, and tasks requiring sudden head movements
- Cognitive and physical fatigue impacting sustained work activity
- Clear medical necessity for continued work restrictions and flexible accommodations
Lincoln had not gathered or reviewed updated records from many of these providers before making its determination. A clear violation of its fiduciary duties under ERISA.
Vocational Missteps and Flawed Assumptions
As part of its denial, Lincoln relied on a vocational review to suggest the claimant could perform alternative jobs such as:
- Nurse Consultant (Sedentary)
- Utilization Review Nurse
- Reproduction Order Processor
However, these roles failed to consider the unique challenges posed by her neurological symptoms, cognitive fatigue, and sensitivity to screens and lighting. More importantly, they ignored the nuanced restrictions outlined by treating physicians, including:
- No rapid head movements
- Limited screen exposure
- Need for flexible work arrangements
- Avoidance of safety-sensitive environments
In effect, Lincoln attempted to sidestep medical reality in favor of a generalized skill assessment.
Upholding Her Rights Under ERISA
Dabdoub Law Firm stepped in to prepare a robust appeal, arguing that Lincoln violated its fiduciary duty under ERISA by:
- Relying exclusively on non-examining consultants
- Ignoring up-to-date medical records
- Failing to communicate effectively with treating providers
- Dismissing her functional and neurological impairments without valid justification
The appeal afforded Lincoln an opportunity to conduct a full and fair review, and emphasized that any further failure to do so could expose the insurer to litigation in federal court.
A Claim Denial Doesn’t Have to Be the Final Word
Too often, insurers like Lincoln Financial cut off long term disability benefits based on incomplete evidence or flawed reasoning. In this case, the claimant was fortunate to have legal representation focused solely on disability insurance claims.
With medical records, treating physician letters, and detailed legal arguments, the appeal put Lincoln on notice: ignoring legitimate disability evidence is not an option.
How Dabdoub Law Firm Can Help
At Dabdoub Law Firm, disability law is all we do. We represent clients nationwide in long-term disability claims, appeals, and litigation, and we’ve taken on every major insurance company, including Lincoln Financial.
Our team has a proven track record of success:
- We know how to hold insurers accountable under ERISA and private policy law
- We litigate in federal court and win
- We represent healthcare professionals, executives, and workers across all fields
- We do not charge any fees unless we recover benefits for you
If your disability benefits have been denied, let’s talk.
Call (800) 969-0488 or contact us online to speak with an experienced disability attorney. Pay no fees or costs unless you get paid.