With practically $20 billion in annual income (and a web revenue of $1.4 billion in 2021), Lincoln Monetary Group is definitely one of many largest monetary providers and insurance coverage corporations in the US. And when it acquired Liberty Life Assurance Firm of Boston in 2018, it grew to become America’s largest supplier of totally insured incapacity insurance policies within the nation. you probably have a bunch long-term disability or short-term disability coverage, there’s a respectable likelihood Lincoln Monetary issued it.
In fact, insurance coverage corporations typically don’t develop to the dimensions of Lincoln Monetary by all the time paying out full incapacity advantages to each claimant. Denying and delaying claims is sweet for the underside line—and Lincoln Monetary has an extended historical past of doing each.
When you’ve got been on the flawed finish of an unfairly denied incapacity declare, you understand how devastating it may well really feel. However an preliminary denial doesn’t must be the tip of the story. At Bryant Authorized Group, we’ve intensive expertise dealing with Lincoln Monetary incapacity insurance coverage claims. We will help you perceive why your declare was denied, clarify your authorized rights, and deal with your enchantment.
Denied, Delayed, and Even Misplaced Claims Are Nothing New for Lincoln Monetary Group
Like different massive monetary and insurance coverage establishments, Lincoln Monetary has an extended historical past of defending itself—not all the time efficiently—towards authorized claims of wrongdoing. The corporate has paid thousands and thousands to settle circumstances the place claimants’ rightful incapacity advantages or life insurance coverage advantages have been unfairly withheld.
In one of the excessive examples of the final 20 years, Lincoln Monetary really misplaced at the very least 4,000 insurance coverage claims after a merger. Though Lincoln found the error in 2008, it didn’t do something about it till after a 2015 investigation by the New York Division of Monetary Providers—greater than six years later.
Our personal private expertise paints the same image. We deal with loads of Lincoln Monetary incapacity denial circumstances, and we incessantly discover enormous gaps and lacking medical data through the administrative evaluation course of. You might need signed a notice authorizing a incapacity insurance coverage to evaluation your medical data, however that doesn’t imply they’ll really have a look at them. They don’t seem to be going to go digging for data that damage their very own case.
The easy conclusion: the insurance coverage firm just isn’t in your aspect. Income come first. If they will assemble an excuse to keep away from paying advantages to guard their backside line, they’ll. Lincoln Monetary is actually not distinctive on this regard, however they’re additionally not an exception.
Widespread Causes Incapacity Claims Are Denied
In fact, an insurance coverage firm can not merely refuse to pay out promised advantages simply because they don’t really feel prefer it. They wouldn’t keep in enterprise. They should present some justification.
However that doesn’t imply each denial is legit. Some are, but when there’s any ambiguity over the interpretation of the very fact or of a coverage, the insurance coverage firm is probably going to provide themselves the good thing about the doubt.
Under, we take a more in-depth have a look at among the commonest causes that Lincoln Monetary incapacity claims are denied—together with denials for each short-term disability benefits and long-term disability benefits.
Denied Quick-Time period Incapacity Claims
Typically, short-term incapacity insurance coverage claimants are much less prone to contest a denied declare than long-term incapacity claimants. It might not appear well worth the hassle for individuals who plan to be again to work in a couple of weeks or months.
Insurance coverage corporations know this and should use it to their benefit when denying claims.
A few of the commonest causes for denial embrace:
- Inconsistent statements or behaviors. The insurance coverage firm will fastidiously evaluation all supplies you submit, and would possibly even observe your social media posts or rent a personal investigator, to search for proof that you just misrepresented your damage.
- Lack of medical proof. You will want to supply medical proof outlining your prognosis and signs. Nevertheless, the insurance coverage firm could attempt to declare that what you supplied isn’t ample proof.
- Claiming you aren’t disabled or solely partially disabled. Your Lincoln Monetary incapacity insurance coverage coverage would possibly solely pay advantages if you happen to’re “completely” disabled. The insurance coverage firm would possibly declare that their analysis signifies you’re nonetheless able to performing a few of your duties or might delegate a few of your duties briefly.
- Points along with your preliminary software. If there are any inaccuracies or misrepresentations in your unique software for short-term incapacity insurance coverage—for instance, you didn’t establish a related pre-existing situation—the insurance coverage firm could use this as grounds to disclaim your declare or query your credibility.
- Particular exclusions. Your coverage would possibly particularly exclude sure circumstances, resembling pre-existing circumstances, self-inflicted accidents, or accidents that outcome from high-risk hobbies or actions.
Denied Lengthy-Time period Incapacity Claims
Corporations like Lincoln Monetary reject long-term incapacity insurance coverage claims for most of the identical causes they deny short-term advantages, together with all those described above: like inadequate proof, paperwork errors, inconsistent statements and surveillance.
One added hurdle frequent to long-term incapacity claims is the definition of incapacity. Most employer-provided group long-term incapacity insurance policies use an “any occupation” definition, that means that you’re solely eligible for long-term advantages if you happen to can not work any job. So, even if you happen to can not proceed in your chosen profession, your declare should be denied if the insurance coverage firm believes you might be succesful and certified to deal with different full-time work—even low paying and unfulfilling occupations.
This may increasingly catch claimants without warning in the event that they anticipate to have the ability to transition immediately from short-term incapacity to long-term incapacity. Quick-term incapacity insurance policies nearly all the time use an “own occupation” definition of incapacity, that means you solely want to point out you can’t work your present job. In case you at the moment carry out high-wage or high-skill work, we strongly suggest you buy a long-term incapacity plan that additionally makes use of an personal occupation definition every time potential.
Bear in mind: simply because your short-term advantages have been accredited doesn’t assure your long-term advantages can be.
What to Do If Lincoln Monetary Denies Your Incapacity Insurance coverage Declare: The Enchantment Course of
If the insurance coverage firm denied your incapacity declare, you will have a proper to enchantment that call.
Most Lincoln Monetary incapacity insurance coverage are ruled by ERISA, a legislation that applies to all employer-provided insurance coverage with few exceptions. This implies that you will want to undergo an administrative enchantment course of immediately with Lincoln Monetary earlier than you’ll be able to file a lawsuit. (In reality, most Lincoln Monetary group insurance policies require two administrative appeals.)
It’s critically essential to take these appeals critically and make sure you embrace all of the paperwork and proof you want. In case your enchantment goes to court docket, the choice can be made primarily based on the identical data out of your administrative enchantment. In different phrases, you often can not add any new proof that wasn’t already supplied in your declare file.
Right here’s a fast appeals course of guidelines, however make sure you click on the hyperlink under for extra particulars:
- Overview your denial letter to establish the rationale the insurance coverage firm denied your declare. (Below ERISA, you need to obtain an preliminary resolution inside 45 days of submitting your declare.)
- Overview your insurance coverage coverage’s enchantment procedures and deadlines. Mark the submitting deadlines in your calendar.
- Seek the advice of a incapacity insurance coverage lawyer who can educate you about your enchantment choices.
- Request a replica of your declare file from the insurance coverage firm or third-party administrator to your employer’s incapacity profit plan.
- Decide whether or not the declare file is lacking details about your medical circumstances and incapacity declare.
- Order the related data and supply them to the insurance coverage firm.
- Write an in depth enchantment letter and ship it earlier than your enchantment deadline.
- Overview the insurance coverage firm’s remaining resolution and assess your authorized choices.
How Bryant Authorized Group Can Assist With Your Lincoln Monetary Incapacity Enchantment
Since you solely have a restricted time to file an enchantment, and in lots of circumstances, you solely get one likelihood so as to add new proof to the report, dealing with your enchantment by yourself is a dangerous selection. Even easy errors might value you your likelihood at successful your enchantment. And Lincoln Monetary’s insurance coverage adjusters can be all too blissful to allow you to make them. They’re searching for his or her earnings, not you.
At Bryant Authorized Group, our attorneys have intensive expertise coping with Lincoln Monetary Group incapacity circumstances. We’re aware of their coverage language, the methods they use to keep away from paying advantages, and in lots of circumstances even the attorneys that they use to defend towards authorized claims.
Our staff can evaluation your coverage and declare file with you and provide you with an neutral, life like evaluation of your authorized choices. In case you rent us to deal with your enchantment, we’ll deal with the paperwork, keep on prime of deadlines, and do the digging essential to ensure you’ve gathered and submitted all of the proof you could show your incapacity. And in case your administrative enchantment continues to be denied, our skilled trial attorneys can defend your rights in court docket when needed.
Chicago’s Premier Incapacity Attorneys
Don’t let an insurance coverage firm like Lincoln Monetary deny you the incapacity insurance coverage advantages you deserve. Bryant Authorized Group has earned a repute as considered one of Chicago and Illinois’ premier incapacity insurance coverage legislation companies, and we’d love the chance to evaluation your case and aid you discover a resolution.
To request your free authorized session with considered one of our skilled incapacity insurance coverage legal professionals, please name 312-586-9650 immediately or complete this brief online form.
