Why Was My Lincoln Financial Disability Claim Denied?
With nearly $20 billion in annual revenue (and a net profit of $1.4 billion in 2021), Lincoln Financial Group is easily one of the largest financial services and insurance companies in the United States. And when it acquired Liberty Life Assurance Company of Boston in 2018, it became America’s largest provider of fully insured disability policies in the country. if you have a group long-term disability or short-term disability policy, there is a decent chance Lincoln Financial issued it.
Of course, insurance companies generally don’t grow to the size of Lincoln Financial by always paying out full disability benefits to every claimant. Denying and delaying claims is good for the bottom line—and Lincoln Financial has a long history of doing both.
If you have been on the wrong end of an unfairly denied disability claim, you know how devastating it can feel. But an initial denial does not have to be the end of the story. At Bryant Legal Group, we have extensive experience handling Lincoln Financial disability insurance claims. We can help you understand why your claim was denied, explain your legal rights, and handle your appeal.
Denied, Delayed, and Even Lost Claims Are Nothing New for Lincoln Financial Group
Like other large financial and insurance institutions, Lincoln Financial has a long history of defending itself—not always successfully—against legal claims of wrongdoing. The company has paid millions to settle cases where claimants’ rightful disability benefits or life insurance benefits were unfairly withheld.
In one of the most extreme examples of the last 20 years, Lincoln Financial actually lost at least 4,000 insurance claims after a merger. Although Lincoln discovered the error in 2008, it failed to do anything about it until after a 2015 investigation by the New York Department of Financial Services—more than six years later.
Our own personal experience paints a similar picture. We handle a lot of Lincoln Financial disability denial cases, and we frequently find huge gaps and missing medical records during the administrative review process. You might have signed a realize authorizing a disability insurance to review your medical records, but that does not mean they will actually look at them. They are not going to go digging for records that hurt their own case.
The simple conclusion: the insurance company is not on your side. Profits come first. If they can construct an excuse to avoid paying benefits to protect their bottom line, they will. Lincoln Financial is certainly not unique in this regard, but they are also not an exception.
Common Reasons Disability Claims Are Denied
Of course, an insurance company cannot simply refuse to pay out promised benefits just because they don’t feel like it. They wouldn’t stay in business. They need to provide some justification.
But that doesn’t mean every denial is legitimate. Some are, but if there is any ambiguity over the interpretation of the fact or of a policy, the insurance company is likely to give themselves the benefit of the doubt.
Below, we take a closer look at some of the most common reasons that Lincoln Financial disability claims are denied—including denials for both short-term disability benefits and long-term disability benefits.
Denied Short-Term Disability Claims
In general, short-term disability insurance claimants are less likely to contest a denied claim than long-term disability claimants. It may not seem worth the trouble for those who plan to be back to work in a few weeks or months.
Insurance companies know this and may use it to their advantage when denying claims.
Some of the most common reasons for denial include:
- Inconsistent statements or behaviors. The insurance company will carefully review all materials you submit, and might even follow your social media posts or hire a private investigator, to look for evidence that you misrepresented your injury.
- Lack of medical evidence. You will need to provide medical evidence outlining your diagnosis and symptoms. However, the insurance company may try to claim that what you provided isn’t sufficient proof.
- Claiming you are not disabled or only partially disabled. Your Lincoln Financial disability insurance policy might only pay benefits if you’re “totally” disabled. The insurance company might claim that their evaluation indicates you’re still capable of performing some of your duties or could delegate some of your duties temporarily.
- Issues with your initial application. If there are any inaccuracies or misrepresentations on your original application for short-term disability insurance—for example, you failed to identify a relevant pre-existing condition—the insurance company may use this as grounds to deny your claim or question your credibility.
- Specific exclusions. Your policy might specifically exclude certain conditions, such as pre-existing conditions, self-inflicted injuries, or injuries that result from high-risk hobbies or activities.
Denied Long-Term Disability Claims
Companies like Lincoln Financial reject long-term disability insurance claims for many of the same reasons they deny short-term benefits, including all the ones described above: like insufficient evidence, paperwork mistakes, inconsistent statements and surveillance.
One added hurdle common to long-term disability claims is the definition of disability. Most employer-provided group long-term disability policies use an “any occupation” definition, meaning that you are only eligible for long-term benefits if you cannot work any job. So, even if you can no longer continue in your chosen career, your claim may still be denied if the insurance company believes you are capable and qualified to handle other full-time work—even low paying and unfulfilling occupations.
This may catch claimants by surprise if they expect to be able to transition directly from short-term disability to long-term disability. Short-term disability policies almost always use an “own occupation” definition of disability, meaning you only need to show you cannot work your current job. If you currently perform high-wage or high-skill work, we strongly recommend you purchase a long-term disability plan that also uses an own occupation definition whenever possible.
Remember: just because your short-term benefits were approved does not guarantee your long-term benefits will be.
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What to Do If Lincoln Financial Denies Your Disability Insurance Claim: The Appeal Process
If the insurance company denied your disability claim, you have a right to appeal that decision.
Most Lincoln Financial disability insurance plans are governed by ERISA, a law that applies to all employer-provided insurance plans with few exceptions. This means that you will need to go through an administrative appeal process directly with Lincoln Financial before you can file a lawsuit. (In fact, most Lincoln Financial group policies require two administrative appeals.)
It’s critically important to take these appeals seriously and be sure to include all the paperwork and evidence you need. If your appeal goes to court, the decision will be made based on the same records from your administrative appeal. In other words, you usually cannot add any new evidence that wasn’t already provided in your claim file.
Here’s a quick appeals process checklist, but be sure to click the link below for more details:
- Review your denial letter to identify the reason the insurance company denied your claim. (Under ERISA, you should receive an initial decision within 45 days of filing your claim.)
- Review your insurance policy’s appeal procedures and deadlines. Mark the filing deadlines in your calendar.
- Consult a disability insurance lawyer who can educate you about your appeal options.
- Request a copy of your claim file from the insurance company or third-party administrator for your employer’s disability benefit plan.
- Determine whether the claim file is missing information about your medical conditions and disability claim.
- Order the relevant records and provide them to the insurance company.
- Write a detailed appeal letter and send it before your appeal deadline.
- Review the insurance company’s final decision and assess your legal options.
How Bryant Legal Group Can Help With Your Lincoln Financial Disability Appeal
Because you only have a limited time to file an appeal, and in many cases, you only get one chance to add new evidence to the record, handling your appeal on your own is a risky choice. Even simple mistakes could cost you your chance at winning your appeal. And Lincoln Financial’s insurance adjusters will be all too happy to let you make them. They are looking out for their profits, not you.
At Bryant Legal Group, our attorneys have extensive experience dealing with Lincoln Financial Group disability cases. We are familiar with their policy language, the tricks they use to avoid paying benefits, and in many cases even the attorneys that they use to defend against legal claims.
Our team can review your policy and claim file with you and give you an impartial, realistic assessment of your legal options. If you hire us to handle your appeal, we’ll handle the paperwork, stay on top of deadlines, and do the digging necessary to make sure you’ve gathered and submitted all the evidence you need to prove your disability. And if your administrative appeal is still denied, our experienced trial attorneys can defend your rights in court when necessary.
Chicago’s Premier Disability Attorneys
Don’t let an insurance company like Lincoln Financial deny you the disability insurance benefits you deserve. Bryant Legal Group has earned a reputation as one of Chicago and Illinois’ premier disability insurance law firms, and we’d love the opportunity to review your case and help you find a solution.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.