Long-term disability insurance is intended to help provide you financial protection should you have to miss an extended period of work due to an accident or illness. According to Lincoln’s website, long-term disability insurance from Lincoln Financial Group, also known as Lincoln National Corporation, may include “Employees can earn up to 100% of pre-disability income through partial-disability employment”.
According to some estimates, the average employee with a long term disability misses as much as two and one-half (2.5) years of work. Unfortunately, and like many other disability insurance companies, Lincoln does not always pay disability insurance claims as it should.
The Ortiz Law Firm primarily gets involved in a claim once it has been denied or terminated, so this article and the video below will focus on Lincoln Financial long term disability denial letters and how to submit an appeal. If you still need to apply for benefits, we’ve also included information relating to the application process to help you get started.
Submitting an Application for Disability Insurance Benefits
Lincoln’s website indicates that you can submit claims by completing a claim form. Claim forms can be downloaded by going to www.Lincoln4Benefits.com. Directions for submission of the claim forms are included on the forms.
If you’ve already submitted a claim, you can log in 24/7 to check the status of your claim. Registration is required to check the status of your claim online.
The rest of this article will discuss Lincoln’s denial letters and the appeal process, but we encourage you to keep reading if you have recently filed a claim with Lincoln or if you plan to submit a claim in the near future. If you are already aware of the top reasons that Lincoln denies disability insurance claims you can avoid some common mistakes from the very start of your claim.
Lincoln Financial Long Term Disability Denial Letters
Lincoln will typically begin its denial letters with the definition of “Total Disability” under the policy. Here is a typical Lincoln disability definition:
“TOTAL DISABILITY or TOTALLY DISABLED will be defined as follows:
1. During the Elimination Period and Own Occupation Period, it means that due to an Injury or Sickness the Insured Employee is unable to perform each of the Main Duties of his or her Own Occupation.
2. After the Own Occupation Period, it means that due to an Injury or Sickness the Insured Employee is unable to perform each of the Main Duties of any occupation which his or her training, education or experience will reasonably allow.
The loss of a professional license, an occupational license or certification, or a driver’s license for any reason does not, by itself, constitute Total Disability.”
Even if a claim was previously approved during the “Own Occupation”, it is common for Lincoln to issue a claim denial when the definition changes to the “Any Occupation” period in paragraph number two. Here is the typical language used by the insurance company:
“The Own Occupation Period for this claim will end on 1/1/2014. Your own occupation was identified at the time benefits were approved and listed as a Physician or Medical Doctor. After a thorough review of the information currently contained in your claim file, we have determined you are capable of performing work in other occupations. Outlined below is the information reviewed which led to our determination.”
There are plenty of other reasons why Lincoln Financial may deny a claim for long term disability benefits, which are outlined in the video below:
Lincoln will also summarize your medical records received during claim processing before concluding the letter:
“In summary, it is our determination that based upon your age, education, training, past work experience and your current abilities, that you are not prevented from performing work in other occupations, even if you can no longer perform your Own Occupation. Therefore, you no longer meet the definition of disability in this policy and benefits will be denied as of 1/1/2014.”
Your payments for benefits will then cease as of that date.
Your Right to Appeal a Lincoln Financial Long Term Disability Denial Letter
Lincoln will explain your right to appeal:
As a reminder, on 8/16/2014, your Own Occupation Period of the policy ends. This means, to qualify for ongoing Total Disability benefits, you must have restrictions and limitations beyond 8/16/2014 that render you unable to work in any gainful occupation (sedentary or otherwise) that your past training, education and experience will reasonably allow. If you believe that your condition prevents you from working in any occupation, please submit medical records, not previously submitted, that will help us evaluate your capacity to work as of 8/16/2014.
As set forth below, you should contact an experienced long term disability attorney to assist you in filing the appeal.
Contact Information for Lincoln Financial Group / Lincoln National Corporation
You may send documentation supporting an ongoing disability to the address listed on the letterhead of your denial letter. As of March 2020, the mailing address and fax for Lincoln were:
The Lincoln National Life Insurance Company
8801 Indian Hills Drive
Omaha, NE 68114-4066
Toll-free phone: (800) 423·2765
Fax: (877) 843-3950
Where to Send Your Appeal
Lincoln explicitly sets forth what you should do to file an appeal:
“You, your attorney or a person legally authorized as your representative may request a review of your denied claim. Such request must be made in writing and submitted to us at the address below within 180 days after you receive this denial notice.
The Lincoln National Life Insurance Company
PO Box 2337
Omaha, NE 68103
Your request for an appeal needs to include the following:
• A letter of appeal outlining the reasons for your appeal. This letter needs to include your policy number and claim number.
• Medical records to support your appeal such as office and treatment notes, laboratory results, x-rays and testing results.”
You should not simply send a letter saying, “I appeal”. You should be including updating medical records and opinion evidence from your treating medical providers to support your appeal. Disability lawyers can assist you in obtaining this evidence.
Hiring an Attorney to Assist You in Your Long Term Disability Claim
Too many claimants seek assistance from an attorney after all of their appeals with the disability insurance company have been “exhausted” or used up. This is a huge mistake. After your appeals are used up the next step is to file a lawsuit, and you do not have the right to introduce any new evidence in an ERISA lawsuit. If an attorney had been involved in the appeals process, he or she could have filled the record with evidence that could be used in a federal lawsuit, such as a mental or physical capacity evaluation from your treating doctor.
An experienced attorney will help you prepare the best evidence for your claim and help you file the appeal in a way that will maximize the chance for you to be put back on claim.
Mr. Ortiz is an experienced long term disability attorney. He has handled numerous claims against Lincoln and offers free consultations in claims where you have been wrongfully denied (or terminated) LTD benefits. Contact us today at (888) 321-8131 to see what we can do to help you or your loved one.