Articles Posted in Lincoln Financial

O’Ryan Law Firm, on behalf of the Plaintiff, Dr. B, recently settled a lawsuit against Lincoln National Life Insurance Company (“Lincoln National”) for the denial of Dr. B’s claim for long term disability insurance benefits.

Dr. B was a radiologist at a regional hospital, where he worked approximately 10-14 hour days which consisted primarily of interpreting diagnostic images on a computer monitor. The position demanded absolute accuracy in reading diagnostic images, as even a single mistake or omission could be the difference between life and death for a patient. He also performed interventional procedures (e.g. percutaneous biopsies of various organs, joint injections, and fluoroscopy) and consulted with physicians and patients to review his findings. His position also involved a substantial amount of physical activity, including assisting techs with moving or positioning larger patients, and wearing lead aprons to shield himself from radiation associated with imaging equipment.

Several years ago, Dr. B began to suffer from keratoconjunctivitis sicca (dry eye syndrome), a condition that commonly affects radiologists.[1] Over the next several years, his condition progressively worsened, to the point that he often had to pull over on the drive to or from work to rest his eyes because his vision had become too blurry to drive. While his vision is good when his eyes are well-rested, even a small amount of computer usage causes his eyes to become sore, dry, and itchy, blurring his vision and requiring him to blink excessively and use eye drops to the fullest extent possible.

Amy was employed as a Special Education teacher by Elkhart Community Schools until she became disabled in 2015 due to the disabling effects of orthostatic hypotension, syncope and collapse. By definition, orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that happens when you stand up from sitting or lying down. Orthostatic hypotension can make you feel dizzy or lightheaded, and maybe even faint.  Amy was also treated for autonomic dysfunction, had bradycardia in 2010 with pacer implant with improvement until she was head-butted by a student resulting in subsequent dizziness and syncope (fainting)

Amy’s primary care physician recommended disability for autonomic problems with syncope episodes.  A treating physician at the Cleveland Clinic placed Amy at a class 4 physical impairment, and class 3 mental with a diagnosis of Orthostatic hypotension, syncope, fatigue, dizziness, and memory loss and stated that Amy is disabled from all work and would never return to work.

When Amy was forced to stop working she submitted a claim to Lincoln National Life Insurance Company who is her disability insurer.  Lincoln National approved her disability benefits on February 5, 2016 and paid benefits through November 2, 2017, when Lincoln abruptly terminated with little notice.  To terminate the claim, Lincoln relied on two of their hired record reviewers. One neurologist reviewer was aware of Amy’s abnormal head tilt testing with induction of symptomatic orthostatic hypotension. At baseline her blood pressure was 113/70. Her heart rate was 63.  After three minutes blood pressure was not found and the heart rate was 63. The test was ultimately aborted.  The reviewer also spoke with Amy’s treating physician, who advised him that she has syncopal episodes.

O’Ryan Law Firm, on behalf of Plaintiff, William M., recently filed a federal lawsuit against Lincoln National Life Insurance Agency (“Lincoln”).   Lincoln is an Indiana corporation with its main headquarters in Omaha, Nebraska.  William M. was employed by Olon Industries, which made him eligible for Olon Industries’ employee benefit plan.  Part of the employee benefit plan included long term disability coverage which pays 60% of an employee’s salary if an employee becomes unable to work due to sickness or injury.  Lincoln National agreed to insure the long term disability benefits and provided this coverage to the Olon Industries employees.

William M. was employed by Olon Industries until he became disabled in May 2012.  He became unable to work due to a severe stroke, intracerebral hemorrhage, hypertension, permanent vertigo, and partial blindness in his right eye.  His treating physicians provided objective medical proof that he was unable to continue working due to these medical conditions.

Lincoln paid Plaintiff’s claim for disability benefits for 24 months, then they abruptly terminated the benefits with little notice.  Plaintiff internally appealed Lincoln’s decision and in November 2016, Lincoln upheld their decision to deny Plaintiff’s long term disability benefits.  William M.’s doctors never returned him to work even though he was 4 years past his stroke.  As proof that he remained disabled, the Social Security Administration recently reviewed Plaintiff’s claim, and after sending him for a medical exam, concluded that he remains disabled.

One of the most disabling symptoms for our disability clients at the O’Ryan Law Firm is chronic, severe pain. The type of pain that keeps you awake most of the night or forces you to lay down most of the day in order to alleviate the pain just a little bit. The pain that results from degenerative disc disease, fibromyalgia, neuropathy and failed back surgeries among other medical conditions. Disability insurance companies are loath to pay disability benefits when the most significant symptom is disabling pain. Oftentimes, the insurance company will discount considerable evidence that the chronic pain is a significant factor in the disability claim because many of the objective medical testing is “normal.” There are no x-rays, MRIs or CT scans that are able to document chronic, severe pain. However, many courts have held that a disability claimant can prove the severity of their pain by showing, with their medical records, repeated attempts to treat the pain including steroid injections, prescription medications, surgery, physical therapy and acupuncture. These treatment methods can show that a claimant is suffering from severe pain.

In this area, when there is an absence of testing to establish the source of pain, a claimant can show that they are disabled by chronic pain by proving that the claimant has diligently sought out treatment for the pain. The Seventh Circuit Court of Appeals has held that “medical science confirms that pain can be severe and disabling even in the absence of ‘objective’ medical findings, that is, test results that demonstrate a physical condition that normally causes pain of the severity claimed by the [plaintiff].” Carradine v. Barnhart, 360 F.3d 751, 753 (7th Cir.2004). Thus, while objective medical evidence must support a finding of an underlying impairment, subjective evidence can be used to demonstrate that the pain associated with that condition is disabling. Carradine, 360 F.3d 753; see also Hawkins v. First Union Disability Plan, 326 F.3d 914, 919 (7th Cir.2003) “Taken in the light most favorable to the plaintiff, the evidence of [plaintiff’s] repeated attempts to seek treatment for his condition supports an inference that his pain, though hard to explain by reference to physical symptoms, was disabling.” Diaz v. Prudential Ins. Co., 499 F.3d 640, 645 (7th Cir. 2007). In Sandell v. Prudential Ins. Co., 2007 WL 4404487, *7 (S.D. Ind. Dec. 13, 2007), the court found that a record review commissioned by the plan administrator was not persuasive, in large part because the reviewing physician failed to consider the claimant’s subjective pain symptoms or address whether the claimant’s pain made it impossible for the plaintiff to hold full-time gainful employment. Similarly in Gessling v. Group Long Term Disability Plan for Employees of Sprint/United Management, 693 F. Supp.2d 856, 866 the Court held:

The record here also shows that Gessling aggressively pursued for several years a range of therapies for his pain, including the rhizotomies, acupuncture, epidural injections, and even hypnosis. Those efforts are hard to reconcile with a theory that Gessling was exaggerating or lying about his pain. See Diaz v. Prudential Ins. Co. of America, 499 F.3d 640, 646 (7th Cir.2007) (reversing summary judgment for plan under de novo review; efforts at therapy supported credibility of claimant’s complaints of pain); Carradine v. Barnhart, 360 F.3d 751, 755 (7th Cir.2004) (remanding denial of Social Security disability benefits based on subjective pain complaints where claimant had undergone extensive, varied, and intrusive pain therapies).

If your short term or long term disability benefits have been denied or terminated chances are high that the insurance company has utilized a record reviewing physician to review your medical records and conclude that you are not disabled, without having ever examined you in person. The utilization of record reviewing physicians has become the favorite tactic to deny claims by many of the disability insurance companies such as Cigna, Prudential, Hartford, Sedgwick, Liberty Mutual, Unum and Lincoln Financial. For many of our clients, there are significant medical records and reports from their treating physicians supporting their disability claim yet the insurance company denies the claim because a doctor, who never spoke to or examined the client, says that the client is not disabled and can return to work.

Over the past few several years, the courts have become less tolerant of claims administrators utilizing a bunch of record reviews to deny legitimate claims. Two recent cases from the Southern District of Indiana followed this trend and rejected the opinions of several record reviewing physicians while reversing the denial of benefits. In Gessling v. Group Long Term Disability Plan for Employees of Sprint/United Management, 693 F. Supp.2d 856 (S.D. Ind. 2010), Judge Hamilton held that three paper reviews were insufficient to overcome the medical records and reports from the plaintiff’s treating physician. Specifically, Judge Hamilton found:

At the very least, a mere record review is not sufficient to provide a reasonable basis for discounting Dr. Walker’s and Gessling’s accounts of his pain and resulting limitations. The court does not mean to suggest that it is reviving any requirement of special deference to a treating physician. Far from it. See Nord, 538 U.S. at 825, 123 S.Ct. 1965 (holding that ERISA does not require plans to provide such deference). But to disagree with an apparently sound opinion of a treating physician, a plan administrator needs something much more solid than the consulting physicians provided in this case. See id. at 834, 123 S.Ct. 1965 (reminding courts that plan administrators may not arbitrarily refuse to credit a claimant’s reliable evidence, including opinions of a treating physicians). The medical records did not show that Dr. Walker and Gessling must have been correct–the problems of subjective pain and resulting limitations are difficult to evaluate based on records alone. But after reviewing the records, the reviewing physicians failed to come to grips with the real problem, the whole person, and the history that corroborated his complaints of pain. For these reasons, the records reviews in this case did not provide a reasonable basis for denying the disability insurance benefits for which Gessling and his employer paid substantial premiums to Hartford Life.

We have represented numerous clients in short term disability and long term disability claims after Lincoln Financial, also known as Lincoln National, has denied or prematurely terminated the client’s disability benefits claim. Lincoln traces its origin to June 12, 1905, in Fort Wayne, Indiana, as the Lincoln National Life Insurance Company. Perry Randall, a Fort Wayne attorney and entrepreneur, suggested the name “Lincoln,” arguing that the name of Abraham Lincoln would powerfully convey a spirit of integrity. In August, 1905 Robert Todd Lincoln provided a photograph of his father, along with a letter authorizing the use of his father’s likeness and name for company stationery and advertising.Lincoln 3.jpg

Lincoln National Corporation is a Fortune 250 American holding company, which operates multiple insurance and investment management businesses through subsidiary companies. Lincoln Financial Group is the marketing name for LNC and its subsidiary companies. LNC was organized under the laws of the state of Indiana in 1968, and maintains its principal executive offices in Radnor, Pennsylvania In 1928, LNC president Arthur Hall hired Dr. Louis A. Warren, a Lincoln scholar, and in 1929, LNC acquired one of the largest collections of books about Abraham Lincoln in the United States. The Lincoln Museum in Fort Wayne was the second largest Lincoln museum in the country. The Abraham Lincoln Presidential Library and Museum in Springfield, Illinois is now the world’s largest museum dedicated to the life and times of Abraham Lincoln, after the closing of the Fort Wayne Lincoln Museum June 30, 2008.

Lincoln National issues group disability policies, and individual disability policies, to provide income replacement benefits to residents of the State of Indiana who are forced to stop working due to injury or illness. At O’Ryan Law Firm, we have received numerous calls from individuals who were promised disability benefits under a Lincoln National policy yet those benefits were denied by Lincoln despite medical proof establishing that the definition of “Disabled” had been met under the terms of the policy. Several of our clients who are insured by Lincoln National were teachers who had taught for many years until reaching the point where they were no longer able to keep teaching because of medical conditions.