Lincoln - Exploring and Dissecting Lincoln Financial's History and Handling of Claims

Welcome to Season 4, Episode 16 of Winning Isn't Easy.  In this episode, we'll dive into the complicated topic of "Lincoln." 

Host Nancy L. Cavey, a seasoned attorney with extensive experience in disability claims, discusses Lincoln, also known as Lincoln Financial, one of the oldest and largest insurance companies in the United States. While Lincoln is well known for boasting about their fundamentals of integrity, just like other insurance companies, they are out to protect their bottom dollar, not to give disabled policyholders the benefits they paid for, and deserve. In this episode of Winning Isn't Easy, host Nancy L. Cavey provides an overview of Lincoln's history, as well as a deep dive into various different Lincoln claims, so you can get firsthand knowledge regarding their claims handling process.

In this episode, we'll cover the following topics:

1 - The “You Can’t Apply for Long-Term Disability Benefits Because We Denied Your Claim Game” That Lincoln Plays, and How to Fight Back

2 - Federal Judge Calls Out Lincoln on Its ERISA Regulation Violating Conduct By  Improperly Rejecting Neuropsychological Testing in a Chronic Fatigue Syndrome Case

3 - Lincoln Ehlers Danlos Long-Term Claims Denial Remanded Because of Lincoln’s Failure to Provide a Full and Fair Review

4 - Lincoln’s Seeming Inability to Perform a Full and Fair Review of ERISA Disability Claims

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Resources Mentioned In This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Transcript

Speaker A [00:00:11]:
 Hey, I'm Nancy Cavey, national ERISA and individual disability attorney. Welcome to winning isn't easy before we get started, I've got to give you a legal disclaimer. This podcast is not legal advice. So I've done what the Florida Bar association told me I had to do, but nothing will ever prevent me from giving you an easy to understand overview of the disability insurance world, the games that carriers play, and what you need to know to get the disability benefits you deserve. So off we go. Today I'm going to be discussing Lincoln Financial. It was founded in 1905 and it boasts that the basis of its company lies in fundamentals of integrity, claiming that it defines how we do business and how we interact with our customers, our colleagues, and our communities. In this episode of winning isn't easy, we'll walk through some of Lincoln's history and handling of claims that really put those ideas of integrity to the test.
 
 Speaker A [00:01:17]:
 Now I'm going to be talking about four things. Number one, you can't apply for long term disability benefits because we denied your claim game that Lincoln plays and how to fight back. Number two, a federal judge calls out Lincoln on its ERISA regulations violating conduct by improperly rejecting neuropsychological testing in a chronic fatigue syndrome case. Lincoln Eller Stanlow's long term disability claim denial remanded because of Lincoln's failure to provide a full and fair review and Lincoln's seemingly inability to perform a full and fair review of ERISA disability claims. Now, this is not unique to Lincoln, so you may be thinking, well, I don't have a Lincoln claim. Why should I listen to this? You should listen to this because these are the disability games that carriers and plans will play. Lincoln just happens to have perfected some of these denial tools and techniques a little better than other disability carriers or plans. Let's take a break for a moment before we get into this episode.
 
 Speaker B [00:02:25]:
 Have you been robbed of your peace of mind by your disability insurance carrier? You owe it to yourself to get a copy of robbed of your peace of mind, which provides you with everything you need to know about the long term disability claims process. Request your free copy of the book@kvlaw.com. today.
 
 Speaker A [00:02:49]:
 Welcome back to winning isn't easy. Ready to get started? Let's talk about that. You can't apply for long term disability benefits because we denied your claim game that Lincoln plays and how to fight back. Now, disability carriers or plans will go to great lengths, including lying to prevent disabled policyholders or plan participants from filing a claim for long term disability benefits the typical scenario is that the employer offers its employees a short term disability plan either through a carrier or through a self insured plan. Because the employer and the carrier of the plan don't want to deal with an application for long term disability benefits, they'll deny the short term disability claim at some point, and then they'll say, look, you're not eligible for long term disability benefits because you didn't complete getting your short term disability benefits. Now, you would think that the employer would know better, and unfortunately, that's not often the case. Often they're complicit with this game. What you can and cannot do is really based on the language in the long term disability policy or plan.
 
 Speaker A [00:04:00]:
 Now, some long term disability policies or plans will require that you do, in fact, receive the full payment of your short term disability benefits before you can apply for long term disability benefits, while others don't. The truth, quite frankly, is that many long term disability policies or plans don't require that you be paid short term disability benefits at all or be paid out all of the short term disability benefits. Now, what you'll probably find is that there are two separate policies or plans, two separate standards of disability, two separate premiums being paid, and a long term disability policy or plan that doesn't require that you be paid short term disability benefits as a prerequisite to filing the long term disability claim. So you can see that games are already being paid played, and it's gonna come down to the language in the short term disability policy or plan and the long term disability policy or plan. So when you're calling a lawyer such as myself to ask about these types of issues, they're going to ask for this kind of documentation. Now, I'm often asked, well, how do I fight back if the disability carrier plan says, too bad, so sad, we're not going to let you apply for your long term disability benefits. You should, in my view, number one, get a copy of the short term disability claim claims file and appeal the denial of that short term disability benefits. You should submit, certified mail, return receipt requested, a generic long term disability application, because many times they won't give you the application.
 
 Speaker A [00:05:33]:
 So you can get online and find a generic keep the green card that you get documenting that they have received it. Why? Well, if the disability carrier of the plan does not timely respond to the application, you should be retaining counsel, obviously, to file a lawsuit not only on the short term disability claim, but on the long term disability claim. So what I really try to do is to file a lawsuit on both now, if the short term disability plan is self insured or through a disability carrier, you probably are going to have to file two different lawsuits, one for the short term disability benefits and a second for the long term disability benefits of themselves. Again, you can see a lot of strategy goes into this. It really depends, in my view, in large measure, what the short term disability policy or plan says, who is providing those benefits, whether it's an employer, self insured fund, or a disability carrier, whether or not that disability carrier is the same carrier for the long term disability benefits. So you can see a lot of thought needs to go into this. But the point is, we don't want you to let a disability carrier or plan or employer's refusal to pay out the short term disability benefits or to give you a long term disability application or to tell you that you can't apply. You know, we don't want them to play those games and interfere with your rights to get not only your short term disability benefits, but your long term disability benefits.
 
 Speaker A [00:07:10]:
 We, as all Arista disability attorneys are here to protect you from the games that disability carriers and plans play and the games that disability. I'm sorry that employers can play either individually or in concert with the disability plan or the policy. Again, interactions are important and they can impact the strategy here. Got it? Let's take a break. Welcome back to winning isn't easy. Federal judge calls out Lincoln on its ERISA regulation violating conduct by improperly rejecting neuropsychological testing in a chronic fatigue syndrome case. Now, CFS can be very hard to diagnose. There's no gold standard tool.
 
 Speaker A [00:08:32]:
 It's often accompanied, however, by cognitive dysfunction. Disability carriers and plans hate these types of complaints, even in view of positive neuropsychological testing. I think that the testing can make a difference, particularly whether you're going to be able to win in federal court. Let me tell you the story of Lincoln's improper conduct and how that conduct was highly criticized by a federal judge. There was a person by the name of Turkloy who was a highly paid global account manager for Docusign, and she made over $400,000 a year. She became disabled from autoimmune and mental health issues. She applied for her benefits, her own occupation benefits, through Lincoln national, and they paid for ten months. And then, guess what? Lincoln decided that she could do her own occupation and terminated her benefits.
 
 Speaker A [00:09:32]:
 Now, she appealed as expected, the appeal was unsuccessful. She then filed a lawsuit in federal court asking for the balance of her 24 month own occupation benefits. This is where policies or plans become important. Her occupation, as defined by the disability policy, was based on the dictionary of occupational titles, and it required significant interaction and work with coworkers, customers, and vendors in a fast paced, high stressed environment, including influencing their opinions, changing tasks frequently, directing and coordinating activities to sell products and services, monitoring customer usage, making course corrections as needed for fast and efficient customer service, training the customer, providing accurate account information, forecasting and activity consistent with maintaining the product and the customer's use of the product. She unfortunately developed flu like symptoms, and she recovered in a month. But she then began treatment with a psychiatrist for depression, anxiety, and panic attacks. She reported to her doctors that her position was being eliminated, but that she could stay by taking an unchallenging job or working under a manager in a challenging position. Now, while she and her family lived in Portland, she would have to travel extensively and live part time in the state of Washington.
 
 Speaker A [00:11:12]:
 Because of her psychological issues, her psychiatrist placed her on short term disability benefits, and subsequently she decided to go a more natural way of treating her medical problems. So she started treating with a naturopathic because she was having issues with ongoing brain fog. When she filed her claim, she claimed both the physical manifestations of her symptoms and then the psychological basis of a claim, together with the cognitive issues. We know that disability carriers like Lincoln don't like these kinds of claims, so what they did is they slow walked the claim, but ultimately they approved it on the psychological issues, which was subject to a 24 month mental nervous limitation. Now, all through this, she's continuing to report to her doctors fatigue, joint pain, and memory problems. She was variously diagnosed with Lyme disease, chronic fatigue, fibromyalgia, cognitive impairment. Now, a lot of this, of course, isn't necessarily objectively based in terms of objective testing. These diseases are real.
 
 Speaker A [00:12:26]:
 But disability carriers always look for a gold standard test that says, you have fibromyalgia, you have Lyme disease, you have cognitive impairment, even if testing is positive. For example, in the case of Lyme disease, they may even argue that the testing was the result, basically a false result. So they'll attack the testing. Even if there's testing, they'll complain that there is no objective testing when you don't expect to have objective testing. So you can see how this game goes. But in Lincoln's case, they piled on. Lincoln questioned her claim, and as always, they conducted surveillance. Now, it showed her attending her son's basketball game for 72 minutes, walking six minutes to a piece of pizza parlor where she ate for 60 minutes.
 
 Speaker A [00:13:17]:
 The next day, the surveillance showed that she drove to Starbucks. She walked three minutes to a nail salon and spent 60 minutes having a manicure and a pedicure. In response to questions from Lincoln, her psychiatrist said, look, she can't work because of her psychiatric impairments and they are related to, and they're exacerbated by her medical issues. The psychologist psychiatrist noted that there wasn't any need for any more frequent treatment. She had only had a partial response to increased psychotropic medication, but the doctor didn't recommend any increase in her medication. Now, this would be important because ultimately Lincoln would argue through their peer review doctors that her psychological conditions were not severe enough to render her disabled. But they also had peer review providers who concluded that she had had an inadequate evaluation to rule out rheumatological causes of her symptoms. Noting that nobody had referred her to a rheumatologist in the face of the CFS diagnosis, they scratched their head and said, look, we think this is really the manifestation of depression and anxiety.
 
 Speaker A [00:14:32]:
 Now, this typical of disability insurance carriers or plans. Obviously, they're doing this to set up a claims denial, and that's exactly what they do. She said, look, I'm calling your bluff. And she underwent a extensive four day neuropsychological evaluation. And the neuropsychologist concluded that there was a significant impairment of her memory, including executive functioning, which was a key aspect of her occupation. Now, of course, Lincoln's neuropsychologist reviewed it and Pooh poohed it. They discounted the test results. They criticized the level of mental health treatment as being inconsistent with the neurocognitive test results.
 
 Speaker A [00:15:18]:
 They also had her medical records reviewed by an occupational medicine doctor who concluded that she had a plethora of, of subjective complaints and many diagnoses, many of which were not supported by actual clinical findings. And, of course, that's a common comment that we see from liar for hire doctors looking for reasons to deny a claim. Now, her medical providers wrote reports addressing each one of the objections raised by Lincoln's peer reviewed doctors, which were, in turn, once again rejected by Lincoln's peer reviewed providers. Again, this is typical. Now, while this whole peer review process ping pong game was going on, she had a Social Security claim that she was found to be disabled. Yet, of course, Lincoln prepared a 14 page denial letter disputing her entitlement to benefits and upholding their original denial. You can see that this was a case ripe for litigation, and ultimately the federal judge found that the key medical opinion in this case was the neuropsychological evaluation. And the test results they rejected.
 
 Speaker A [00:16:27]:
 The judge rejected Lincoln's arguments regarding the validity of the testing. Now that was important because Lincoln didn't make that argument until they were in court. They never made that argument in the denial process in any of the denial letters. And it only came about when Lincoln's defense attorneys realized they had a crappy case, if you will, and decided to come up with reasons to bolster the denial. Now, this was in violation of ERISA regulations because the denial letter had made it clear that it was based on the lack of objective cognitive testing and not the lack of validity markers or providing any criteria for objective testing that it found lacking. The judge noted that Lincoln had even been criticized for this MO and this type of denial letter in a similar case involving neuropsychological testing. So what the judge realized was that Lincoln had a pattern of doing this. Let's talk a second about discounting evidence on grounds Lincoln never disclosed because this is very important and it's a game that disability carriers and plans play.
 
 Speaker A [00:17:41]:
 ERISA regulations require that if benefits are denied in whole or part, that the reason for the denial has to be stated in reasonably clear language with specific reference to plan provisions or policy language that form the basis of the denial. If the plan administrator believes that there's more information that's needed to make a reasoned decision, they have to ask for it. Now in this case, the court noted that there was objective screening to confirm her cognitive impairments that precluded her from performing her own occupation. The court found that Lincoln had played games with the basis of the denial, then trying to create secondary reasons to justify that claims denial after they are called to task by her filing a lawsuit in federal court. Ultimately, the judge says, look, she's entitled to her own occupation benefits and remands the case back to Lincoln to determine whether she's entitled to any occupation benefits. This is a great win for her, but it's also a lesson for policyholders and plan participants about the games that carriers and plans will play in violating the ERISA rules and regulations and creating new reasons after the fact to justify a wrongful claim denial or termination. Got it? Let's take a break.
 
 Speaker C [00:19:08]:
 Are you a professional with questions about your individual disability policy? You need the disability insurance claim survival guide for professionals. This book gives you a comprehensive understanding of your disability policy with tips and to DOS regarding your disability application that will assist you in submitting a winning disability disability application. This is one you won't want to miss. For the next 24 hours, we are giving away free copies of the disability insurance claims survival guide for professionals order yours Today@disabilityclaimsforprofessionals.com.
 
 Speaker A [00:20:05]:
 Welcome back to winning isn't easy Lincoln Ehlers Danlos long term disability claim denial remanded because of Lincoln's failure to provide a full and fair review Ehlers Danlos syndrome EDS affects connective tissue like your skin, joints and blood vessel walls. There are different types of EDS, like hypermobile EDS or vascular EDS, but the most common signs and symptoms of EDS include over flexible joints, stretchy skin, fragile skin and other symptoms that can vary from person to person. There are also complications from EDS that can impact a person's entitlement to their disability benefits. I will tell you that disability carriers or plans rarely appreciate the symptoms, severity of the symptoms and complications of EDS. They take a cookie cutter approach, one size fits alls, to the analysis of an EDS claim, and this often leads to a claims denial or termination. I want to give you an example. This is the case of Rebecca Pfeiffer, who was a dental analyst for Blue Cross Blue Shield of North Carolina, and she became disabled because of Ehlers Danlos and osteoarthritis of the cervical spine, right shoulder, hands and feet. Lincoln paid her benefits for ten years, from 2010 to 2020.
 
 Speaker A [00:21:30]:
 But as usual, they pulled out their surveillance camera. Let's talk about symptoms and surveillance in an EDS case. Now this is a game that's played in cases, regardless of whether it's elder Stanlos, but it's the game that they will play to try to justify a claims denial or termination. So here's how the game goes. They'll ask you to complete activities of daily living form and they will call you. The claims examiner will call you for an update, notwithstanding the fact that you just filled out a form. And in this case, Pfeiffer advised that she had lots of joint pain with pain in her hands, her neck and her shoulder. She reported that she had trouble walking, used a cane as needed.
 
 Speaker A [00:22:24]:
 She didn't do any hobbies anymore. She didn't really travel because walking was tough. Now, guess what the surveillance showed? It showed that there were, and by the way, this was 16 hours of surveillance. It showed her walking normally without a cane and driving a vehicle. So obviously there's a question here. She tells us one thing on the ADL forms, and she tells us something in the statement to us, which is somewhat cooperative, but the surveillance film contradicts what she has said. So what do disability carriers do at this point? Well, they'll either use their rights to a not so independent medical evaluation or a not so objective functional capacity evaluation. Now, during the course of the FCE, which is a testing, it can be four to 8 hours that tests your ability to walk, sit, stand, stoop, lift.
 
 Speaker A [00:23:24]:
 She reported elevated pain and as a result of that elevated pain, she didn't perform a lot of the testing. She didn't do the push pull test, the carrying test, and she didn't lift weights because she reported pain. Now, the physical therapist concluded that she could do sedentary work, but did not discuss any functional limitations involving her hands and her feet. And as expected, based on the finding that she could do sedentary work, Lincoln said, too bad, so sad, we're terminating your benefits. She filed an appeal that was denied and of course we're now in federal court. So the question is, what did the federal court do? Pfeiffer kept a symptoms journal which contained numerous entries regarding the pain in her hands, feet and ankle. Lincoln never gave the peer reviewed doctors this journal and as a result, the peer reviewed doctor was only reviewing medical records and not discussing her symptoms. Additionally, Lincoln ignored the subjective manifestation of her pain, which is consistent with Ehlers Danlos syndrome.
 
 Speaker A [00:24:29]:
 The court noted that when a claimant suffers pain and fatigue because of the disease, these subjective complaints will serve to pinpoint the precise intensity of the symptoms and her inability to endure them over the course of a workweek. Now, fortunately for her, the court concluded that the termination was not the result of a reasoned and principled decision making process, notwithstanding the surveillance. But instead of awarding benefits, the court remanded the case back to Lincoln to get the termination right. So, in my view, what Pfeiffer should be doing, because the case is getting remanded, is to continue, obviously to get medical treatment, to be compliant with that medical treatment, to continue to keep a diary that documents the problems she has with her joints and in particular hands. As appropriate, take pictures if there's any swelling of the hands or some video documenting the difficulty she has using her hands. She should undergo her own functional capacity evaluation that concentrates on the issue of bilateral manual dexterity and the ability to do sustained repetitive motion with her hands. Why you can't do full time sustained sedentary work if you have problems doing repetitive tasks with your hands. She should also consider going undergoing a PCE test, a scan test that will measure their fatigue level and their impact on their ability to do sustained sedentary employment.
 
 Speaker A [00:26:01]:
 This involves measurement of your heart rate, measurement of your oxygen exchange, and helps address the issues of fatigue. She should also hire a vocational evaluator to address her ability to do sedentary work in view of the totality of her medical condition. Those are the things I think she should do. But in the meantime, do you have any idea of what Lincoln is probably going to do with this claim? We all know what they're going to do. They're going to deny the claim again. So hopefully, she will have someone giving her this kind of advice, and she will have her claim ready to file yet another appeal and potentially another lawsuit against Lincoln. Got it? Let's take a break. Welcome back to winning isn't easy.
 
 Speaker A [00:27:25]:
 Lincoln's seemingly inability to perform a full and fair review of an ERISA disability claims. Now, ERISA regulations require that a disability carrier provide a policyholder or plan beneficiary with a full and fair review before denying and terminating benefits. Lincoln seems to have a hard time doing that. As you read the case law, you will see that that is a criticism of them. Now, the ERISA regulations require that any document, record, or other information considered by them relevant to the claim be produced if it was relied on in making the benefit determination or was submitted, considered or generated in the course of making the benefit determination. In other words, they have to ask and they have to give. That doesn't always happen, and unfortunately, that doesn't always make a difference to some courts. I'm going to tell you the story found in Hughes versus Lincoln national life.
 
 Speaker A [00:28:20]:
 Hughes was a principal systems engineer and actually worked for Liberty Mutual Insurance company, which was purchased by Lincoln, the defendant. This is a case of eating your own, if you will. His position was sedentary online, but he was on call 24/7 now, he was, like all policyholders or plan beneficiaries, has the burden to prove that they were disabled, as that term is defined by the policy or the plan. He claimed that he was disabled as a result of chronic diarrhea, waxing and waning, abdominal pain, and bouts of nauseousness and vomiting. Lincoln initially approved his benefits for a period of time until they pulled out their denial playbook. So let's talk about Lincoln's denial playbook tools. It's a toolbox of denial rationales, if you will, and it kind of starts with an investigation of the policyholder. They'll do a background search and they will use investigative companies, and in this case, they use Covenant Bridge, which allegedly is an independent full service investigation company.
 
 Speaker A [00:29:36]:
 They scoured, uses social media accounts and found a photograph of him knee deep in snow next to a shovel during a period of time in which he claimed to have uncontrolled diarrhea. Now, he claimed that this was curated reality. In other words, it was staged, and he denied doing any shoveling. Now, of course, Covenant kept on digging, and they found photos of him fishing and kayaking. More digging discovered that he was involved in a newly incorporated business called virtual on site, a property caretaking service. And, of course, you know what happens next. The claim was denied, and it ends up in federal court. What did Hughes argue about Lincoln's denial? Well, Hughes argued that Lincoln denied him a full and fair review because it failed to provide him with a copy of the vocational analysis that.
 
 Speaker A [00:30:29]:
 That had concluded that because he could do sedentary work, that there was other work, and he was not entitled to his any occupation benefits. Lincoln, on the other hand, argued that under the first circuit case law, he had to show both procedural irregularities in the course of the review and that he was prejudiced by these procedural irregularities. In other words, there had to be some connection between the plans administrators procedural failure and. And the inability to receive a full and fair review. Now, you would think that this is a common sense analysis. In other words, if you don't give it to me, how can I respond to it? But in this case, the court said, look, you didn't identify or submit any evidence that you would have provided to Lincoln to develop the record if you had been given an opportunity to respond to the vocational evaluator. To me, that's like gobbledygook. How can you respond to a vocational evaluator's opinion that's only summarized in a denial letter without seeing the report? As a practical matter, I think the court was trying to say that Hughes should have taken the information in the denial letter and challenged it by getting his own ve report.
 
 Speaker A [00:31:42]:
 But I think that's stupid. How can a ve write a meaningful report without having the very report that was the basis of the denial? I think, with all due respect to the first circuit, that this approach to addressing the failure to provide a full and fair review by producing evidence just encourages carriers to hide the ball that the regulations are designed to prevent. The regulations, I think, are really clear. If you considered it, if it was a factor in your decision, it was the basis of your denial. You got to produce it. How hard is that? Well, I guess in the first circuit, it's pretty tough. What do you think? I hope you've enjoyed this week's episode of winning isn't easy. I hope that you have liked our page.
 
 Speaker A [00:32:30]:
 Please leave a review, please share it. And I would love it if you would subscribe, please tune in to next week's episode of winning isn't easy to learn more about the games the disability carriers and plans play to deny or terminate benefits. See you then.