Long Term Disability Law Blog
Tips To Help You Avoid a Denial of Your Disability Benefit by Lincoln Financial
Lincoln Financial is notorious for finding ways to deny disability insurance benefit claims. Even if Lincoln Financial initially approves your claim, the company continues to monitor your medical condition and seizes on any opportunity to deny your claim and decide you are ready to go back to work. At Dell & Schaefer, we provide a claim handling service. We take over every aspect of your claim and work diligently to keep your file updated. Our experience has taught us what information we need to periodically provide Lincoln Financial so that you can stay on claim. We do everything possible to be sure your claim won’t get denied and your benefits will not be terminated.
GREGORY DELL: Hi, I’m am attorney Gregory Dell. And I’m here today with attorney Alexander Palamara. And we’re going to discuss an interesting topic, Alex. This is one of the most popular videos that we do, which is basically how to protect your disability insurance benefits with the Lincoln Financial insurance company.
And also, that goes along the lines with tips for basically how to avoid a Lincoln Financial disability claim denial. And the reason this type of video is so popular is because anyone who is on claim is always nervous constantly about the fact that they’re going to be denied. And as you know, one of the unique services that our law firm offers is this monthly claim handling service, where we get involved and take over every aspect of the claim.
So we’ll talk about these tips for how to protect claims and how we work with the claimants to help them prevent the benefits from being denied. So let’s start first with what I think would be the first tip, which is what comes to your mind when dealing with Lincoln Financial as the single most important thing for a claimant to make sure their claim won’t get denied?
ALEXANDER PALAMARA: It’s proof. I mean, it’s your duty as a claimant to prove your claim. And you constantly have to keep on proving your claim to the insurance company. I mean, congratulations on getting approved, but the insurance company– no matter what their commercials say, they don’t want to pay you benefits.
Each time they’re paying you benefits, they’re paying you thousands upon thousands of dollars that’s leaving their pockets going into your pocket. So they kind of want to deny your claim. But the way to prevent a denial is proof. And proof is in the form of medical documentation, medical support from your treating providers.
And your policy provides that it’s your duty to provide the proof. You can’t rely upon the insurance company to gather the documentation and prove it to themselves that they have to pay you thousands of dollars per month. It’s your duty to prove it to them. And never forget that. So always submit as much proof as possible.
Lincoln Financial Requires Strong Medical Documentation and You Must be Treating with Appropriate Doctors
GREGORY DELL: OK, so let’s start with the first thing, which you talked about was medical proof. And medical proof of disability comes about I think, in two different forms. There’s one that people kind of sit back and wait for the doc, for the insurance company to ask for a attending physician statement claim form that has to be submitted.
But you and I both know that that form is just one document. That really what’s going on is the medical records behind the scene. So talk about the importance of medical records being properly documented, as well as treating with the appropriate medical specialists.
ALEXANDER PALAMARA: So doctors– they write their reports not to prove to a disability insurance company that somebody is disabled. They write their reports to treat the patient. And sometimes the reports are bare bones just so they can go back next time you come to their office, see what happened last time, you know.
But they need to be more clear. And sometimes you have to talk to your doctor and explain to him what you’re actually going through, that you actually are on a disability insurance claim. And you might want to educate your doctor– what it means to be disabled under the terms of the policy.
More often than not for the first 24 months, you have to prove to the Lincoln that you are disabled from your own occupation. And after 24 months, you have to prove that you’re disabled from any occupation. It’s important that your doctor knows what your occupation is, what the requirements of your job is, so that when your doctor writes those reports he or she is writing restrictions and limitations that prove that you aren’t able to perform the duties of your own occupation or any occupation, and can point to objective evidence of why your doctor feels that way.
So like you said, you have to go beyond intending physician statement. And half the time, I don’t believe they even review the attending physician statements, unless it’s something detrimental to your claim. But for the most part, the most important proof is your medical documentation. It’s great to have your doctor’s support in filling out the APS or writing a letter of support, but the most important thing is the medical documentation and the objective evidence behind it.
GREGORY DELL: I think that the other thing that’s important is making sure everything’s in those records. You know now that medical records are required to all be digital, which means that they’re electronically typed. We don’t have the days anymore of the handwritten records. But with that comes some downsides, because the medical records in front of the doctor pulls up on the system. And a lot of it form fills from the last visit.
And very often we see that the same– if it’s something that is not favorable for a claimant is carrying forward to the next time. Like for example, you know, someone who has back pain. And then it will say like, musculoskeletal limitations. And it might say possible limited range of motion but no soreness, no spasm.
ALEXANDER PALAMARA: And it says that for three months in a row. And they use it against you for sure.
GREGORY DELL: When the claimant’s like, what do you mean? Every time I’m going in there my back is in spasm and it’s hurting me. But the doctor, not intentionally, is forgetting to update the record. So I think that’s essential. And the claimants need to be aware of that so much so that I think claimants should be saying to the doctor, can I take a look at the medical records like, right after the visit or within a day or two to get them, review your records, and make sure everything that you want as a claimant is in there.
Increase Your Chances of Having Lincoln Financial Approve Your Claim by Keeping a Symptom Log and Documenting Your Daily Limitations
The other thing that we do with our claimants when we’re representing them is to say keep a log of your symptoms. And so much so that if it’s a daily log– and we provide a free one on our website, kind of what we call daily pain log that you can download and keep that. But it’s also just as simple as taking a calendar and writing down how you’re feeling, if you have a flare during the day, what parts of your body are bothering you, if you’re fatigued, any of your symptoms.
And then taking that log and giving it to the doctor. I mean, how often do you have clients that you say, go ahead take this log and make the doctor include it in the medical records?
ALEXANDER PALAMARA: It’s very helpful.
GREGORY DELL: Because what happens is, is that means the doctor, even if the doctor doesn’t document it appropriately, at least the symptoms of the claimant are in the records. Because what do you get in denial letters about symptoms versus the medical records? What do you commonly see?
ALEXANDER PALAMARA: Well, they take a little thing in the medical records and they run with it. And it says, oh, today he felt– he felt a little bit stronger today. He felt a little bit better. The pain was not so bad.
And like you said, the doctor leaves those same records and repeats them for three months in a row. And it says, oh, each time you’re reporting, your pain’s getting better. And they end up using that against you and denying your claim.
So what Greg is explaining is very important, that you’re symptomology is in there. Because sometimes, you’re symptomology– there’s no objective evidence to prove a level of pain that you’re suffering from. But if it’s in there and you’re reporting on a consistent basis each time you bring with you one of these pain logs and telling your doctor exactly how bad you are feeling or what you are feeling and it’s in those records, the insurance company– it’s one less thing they can harp on for trying to deny the claim.
GREGORY DELL: The other thing is doctors don’t want to be like always writing negative. And they want to put in the positive things that a claimant tells them. So the claimant you know, someone who’s sick going to see their doctor would love to say yeah, I felt a little better.
From my experience, if they have any improvement whatsoever, then the disability carrier is like well, you’re getting better. So maybe you’re ready to go to work. So it’s like this double-edged sword.
You want to go and you want to have better, and you have some good days and you have some bad days. And the doctor doesn’t always want to document the negative. He wants to try to show the improvements.
ALEXANDER PALAMARA: He’s treating. I mean, he’s getting paid to treat you.
GREGORY DELL: Right, and so the doctors tend to lean towards putting in the positive-type findings and not necessarily the negative. And unfortunately, the companies know that. And Lincoln Financial takes advantage of that and uses the positive finding of the doctor to say, you’re better. Let’s start talking about you going back to work.
How important is it when you’re treating– when the doctor suggests that you go for some additional testing of some sort, diagnostic, and the claimant doesn’t do it? Do you see that that could have a negative effect on remaining on claim?
ALEXANDER PALAMARA: Of course. They want to use everything they possibly can against you. If they’re asking you to go do a functional capacity evaluation, or maybe not even forcing you to do one, but recommending that you do one, or any other objective testing, you should do it.
Because they’re going to use it against you and say, you know, we brought up this, that, and the other. And you decided not to do it. And based on our review of the medical records, which might be weak, they deny your claims. So it’s best to do as much as possible.
You know, I always recommend if you’re suffering from a physical condition, to do a functional capacity evaluation to show your occupational abilities and inabilities. You know, if your job is a light duty job or heavy duty job, you want to prove that you can’t do that level of strenuous work. If it’s a sedentary job, you want to prove you can’t do a sedentary job.
And it’s always good to have those records in your file. You don’t even have to submit it the day you receive the report. You always want to have a backlog of medical records ready to go as soon as the insurance company starts inquiring about such.
You Must Prepare for the Change of Disability Definition to Avoid a Lincoln Financial Denial at the Time of the Change
GREGORY DELL: OK, so you brought up– when you were talking, it made me think about another situation that commonly leads to a denial with Lincoln Financial, which is the change of definition. And you mention that I think, in the beginning of the video how it goes from an own occupation to an any occupation. When should a claim and start to be preparing– making sure that their file is in good shape so that they get through that transition period?
ALEXANDER PALAMARA: Well, you need to start 12 to 9 months before that change in definition of disability. I’ve seen insurance companies deny people claims due to the changing definition of disability, which is the most likely time they’re going to deny your claim once you’re approved. But I’ve seen them deny it six to nine months ahead of that change in definition of disability, which kind of makes no sense to me whatsoever, because how can they predict that you’re still going to be disabled– that you’re not going to get worse in the next six months?
It kind of messes with my head whenever I see a denial that way. But at the very least, it gives you time. If they deny you six months in advance, at least they know they’re going to pay you for those final six months. And it gives you time to strengthen your file.
If they don’t deny you six months in advance, you have to know that a denial might be coming. And it’s your duty to use that time period to strengthen your file as much as possible. You can’t just sit by the wayside, wait for them to ask for updated records. You really have to go out to your doctors, get updated medical records, updated treatment, updated testing to prove this new definition of disability.
Because again, this is when they’re going to deny your claim. If they’re going to deny your claim, I’d have to say 90% chance this is the time period they’re going to do it.
GREGORY DELL: And what’s challenging about that with Lincoln Financial in particular, is that you know they require two appeals. Now, what we’re going to see in the transition is since Lincoln acquired Liberty, Liberty policies don’t require two appeals. But the Lincoln policies do.
On the newer policies that are going to come out over the next couple of years, I don’t know if they will. But with two appeals, it’s that much longer potentially that you have to wait–
ALEXANDER PALAMARA: And you’re without benefits for a long period of time.
GREGORY DELL: So that that’s if you get denied. The other topic I want to talk about is when we’re handling a claim for a client, all communications come to our office and Lincoln can’t call the claimant at all, can’t show up at their door to interview them. Nothing is done outside of our presence. Every letter sent to us.
Claimant never has to worry about do they want something? Why didn’t I hear from them? Because if they don’t call us, then the claimant doesn’t have to do anything. So that’s a piece of mind that a lot of claimants really like when we’re involved with the claim.
But if a claimant is on their own and they get a phone call from Liberty Lincoln. Lincoln wants to send somebody to interview them. How cautious should they be for that type of interview or in-person examination?
ALEXANDER PALAMARA: Very cautious. I mean, they’re allowed to have you seen by a medical provider or investigator or a person they hire of their choosing as long as it’s over a reasonable time period. They can’t do it once a week for 52 weeks. But every few months or every couple of years, they can certainly do it.
They’re not doing this investigation to you know, just make sure everything’s all rosy. Any information they’re getting out of this, they want to utilize it to deny your claim. So you have to be very, very, not scared, but obviously, very prepared, understand what the purpose of this interview is.
I mean, always call us if you have any questions. We’ll obviously give a free consultation, maybe walking through what to expect. Or you could actually hire us, and we can either be there in person or the very least, if it’s a last second thing, be there on the phone to make sure anything they’re– asking any questions or what they might be doing is on the up and up.
GREGORY DELL: You know, and the other thing is, you know before they do these interviews, they’ve done extensive background checks. They’ve likely run video surveillance. So they’re going to start asking you questions about specific things going on in your life that you had no idea they even knew about.
They’re running your credit history, depending upon how you completed the authorization for them. So you really, really need to be prepared. And you don’t want to get stuck misrepresenting something, exaggerating something, or not answering appropriately. Because you can avoid these denials by doing things the right way and not even having to be nervous about whether or not you’re answering something or not.
And we always prepare our clients extensively for these interviews. And often if we’re involved, they won’t even speak to the claimant. They’ll just speak to us, and we’ll relay whatever information it is that they need.
Lincoln Financial Allows You to File an Addendum to the Standard Claim Form
The last area I want to talk about is on the claim forms, and not the attending physician statements, but the regular claim forms that come. I find that they’re wholly inadequate for the information that’s needed. Talk about why you always do an addendum on these claimant statements, whether they’re requested monthly, quarterly, or semi-annual by Lincoln?
ALEXANDER PALAMARA: I mean, these forms– they’re not written specifically for your claim. They’re just essentially the same forms that are shipped out to thousands of people across the country. And not everyone fits in a square box.
So when they ask certain questions, you may have to expand on it. You may have to write your own explanation of what’s going on in your life, or what’s going on with your various conditions. Because again, nothing fits in a perfect box. Every single claim is at least a little bit different, if not a lot different.
So you will have to expand and essentially prove to them continually why you’re disabled and go above and beyond what they’re asking. If you just answer yes or no and check some boxes and fill out you know, I can’t work because, pain, you know, they’re going to deny your claim. You really have to go above and beyond what they’re asking and give them more information than they possibly will want to know. Give them all your medical records, all your medication list, all your treating providers. You have to get as much proof to them as you possibly can.
GREGORY DELL: And I think also important the manner in which we answer the questions for like, what activities are you doing. Because a lot of people get nervous with that question. You know, they want to say oh, I’m home and I’m in bed.
Well, if you are really home and in bed all day, that’s not the common situation for someone on disability, because you’re allowed to have a normal life and do normal things. But you have to know how to portray that in such a manner so that you don’t have to worry.
And that’s the pressure that we want to take off the claimant is live your normal life within reason. Have a disclosure that’s appropriate with Lincoln so that you don’t have to always be looking over your shoulder and saying, oh, my gosh, am I doing something that’s going to result in a denial. And that’s the kind of foundation that we want to set up for a Lincoln claimant and maintain for them, and at the same time, work with their treating doctors to support these other activities they’re doing.
I’m not saying they’re going to be able to go and do every single thing they want to do within reason. But you have to know that delicate balance so that you can protect yourself, enjoy your life, at the same time, not be completely paranoid that your benefit’s going to be denied.
ALEXANDER PALAMARA: Right, I understand why people are paranoid and want to describe their restrictions and limitations worse than they are, or say that on a daily basis, I maybe leave my house for one hour a day. But they’re going to catch you on surveillance you know, being at the mall for two hours. And there’s nothing illegal, there’s nothing improper about you know, like Greg was saying, going out and living your life and going shopping or you know, going to the supermarket.
You have to be able to do those things. That doesn’t mean that you can work 40 hours a week, whatever your prior job was. Just because you know, today you went out to the supermarket for two hours and did all your grocery shopping for the month doesn’t mean that tomorrow you’re not down for the count, because you strained the heck out of yourself the day before.
So sometimes it’s better to be honest. You know obviously, we have to figure out– there’s a certain level of communication. We don’t want to give them too much information that they’re not asking. But there’s a level that you can give them and safely feel that you can give this information. Sometimes it’s worse to get caught in a– I’m not saying that you’re lying, but you know, something that could look like a lie, or you’re being misleading.
GREGORY DELL: So in summary, what we do for when we help someone with a claim is we offer basically a flat fee type arrangement that’s very affordable based upon the amount of your monthly benefit, the amount of time you have left on your claim. A lot of claimants love that arrangement that we have, because we basically become vested in your claim. And we don’t get paid unless you get paid.
So we have a strong vested interest to make sure your benefits continue so that you can keep continue doing what you’re doing. And we take the pressure of dealing with the claim. All of our clients are spread all over the country. We’re available to offer you a free consultation at any time.
We’ll simply ask for a copy of your disability policy. Whether you call Alex, myself, or any of our other disability attorneys, we’re always going to provide you with an immediate free consultation. And we look forward to the opportunity to speak with you.
At Dell & Schaefer, we offer a monthly claim handling service. We take the pressure off you. You will no longer need to deal with phone calls or interviews from Lincoln Financial on your own. For information about how we can help you, no matter where you are in your claim process, we offer a free consultation. Contact us at 888-699-9438.