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 USA. And when it acquired Liberty Life Assurance Firm of Boston in 2018, it turned America’s largest supplier of totally insured incapacity insurance policies within the nation. when you have a bunch long-term incapacity or short-term incapacity coverage, there’s a first rate likelihood Lincoln Monetary issued it.
After all, insurance coverage corporations typically don’t develop to the scale 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.
If in case you have been on the mistaken finish of an unfairly denied incapacity declare, you know the way devastating it could possibly really feel. However an preliminary denial doesn’t must be the tip of the story. At Bryant Authorized Group, we’ve got 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 attraction.
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—in opposition to authorized claims of wrongdoing. The corporate has paid tens of millions to settle instances the place claimants’ rightful incapacity advantages or life insurance coverage advantages had been unfairly withheld.
In one of the crucial excessive examples of the final 20 years, Lincoln Monetary truly misplaced not less than 4,000 insurance coverage claims after a merger. Though Lincoln found the error in 2008, it did not do something about it till after a 2015 investigation by the New York Division of Monetary Companies—greater than six years later.
Our personal private expertise paints an analogous image. We deal with plenty of Lincoln Monetary incapacity denial instances, and we steadily discover enormous gaps and lacking medical data through the administrative assessment course of. You may need signed a understand authorizing a incapacity insurance coverage to assessment your medical data, however that doesn’t imply they are going to truly have a look at them. They aren’t going to go digging for data that damage their very own case.
The straightforward conclusion: the insurance coverage firm just isn’t in your aspect. Earnings come first. If they’ll assemble an excuse to keep away from paying advantages to guard their backside line, they are going to. Lincoln Monetary is actually not distinctive on this regard, however they’re additionally not an exception.
Widespread Causes Incapacity Claims Are Denied
After all, an insurance coverage firm can’t 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 professional. Some are, but when there may be any ambiguity over the interpretation of the actual fact or of a coverage, the insurance coverage firm is probably going to provide themselves the advantage of the doubt.
Under, we take a more in-depth have a look at a number of the most typical causes that Lincoln Monetary incapacity claims are denied—together with denials for each short-term incapacity advantages and long-term incapacity advantages.
Denied Brief-Time period Incapacity Claims
Typically, short-term incapacity insurance coverage claimants are much less more likely to contest a denied declare than long-term incapacity claimants. It could not appear definitely worth the bother for many who plan to be again to work in a couple of weeks or months.
Insurance coverage corporations know this and will use it to their benefit when denying claims.
A number of the most typical causes for denial embody:
- Inconsistent statements or behaviors. The insurance coverage firm will rigorously assessment all supplies you submit, and would possibly even observe your social media posts or rent a non-public investigator, to search for proof that you simply misrepresented your harm.
- Lack of medical proof. You’ll need to supply medical proof outlining your analysis and signs. Nonetheless, the insurance coverage firm could attempt to declare that what you supplied isn’t adequate 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 quickly.
- Points along with your preliminary utility. If there are any inaccuracies or misrepresentations in your unique utility for short-term incapacity insurance coverage—for instance, you did not 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 situations, corresponding to pre-existing situations, 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 similar causes they deny short-term advantages, together with all those described above: like inadequate proof, paperwork errors, inconsistent statements and surveillance.
One added hurdle widespread to long-term incapacity claims is the definition of incapacity. Most employer-provided group long-term incapacity insurance policies use an “any occupation” definition, which means that you’re solely eligible for long-term advantages if you happen to can’t work any job. So, even if you happen to can now 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 occasionally catch claimants without warning in the event that they count on to have the ability to transition straight from short-term incapacity to long-term incapacity. Brief-term incapacity insurance policies nearly all the time use an “personal occupation” definition of incapacity, which means you solely want to indicate you can not work your present job. When you presently 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 attainable.
Bear in mind: simply because your short-term advantages had been permitted doesn’t assure your long-term advantages will probably be.
What to Do If Lincoln Monetary Denies Your Incapacity Insurance coverage Declare: The Attraction Course of
If the insurance coverage firm denied your incapacity declare, you’ve got a proper to attraction that call.
Most Lincoln Monetary incapacity insurance coverage are ruled by ERISA, a regulation that applies to all employer-provided insurance coverage with few exceptions. This implies that you will want to undergo an administrative attraction course of straight with Lincoln Monetary earlier than you may file a lawsuit. (In actual fact, most Lincoln Monetary group insurance policies require two administrative appeals.)
It’s critically vital to take these appeals severely and you’ll want to embody all of the paperwork and proof you want. In case your attraction goes to courtroom, the choice will probably be made based mostly on the identical data out of your administrative attraction. In different phrases, you normally can’t add any new proof that wasn’t already supplied in your declare file.
Right here’s a fast appeals course of guidelines, however you’ll want to click on the hyperlink beneath for extra particulars:
- Overview your denial letter to establish the explanation the insurance coverage firm denied your declare. (Below ERISA, it is best to obtain an preliminary determination inside 45 days of submitting your declare.)
- Overview your insurance coverage coverage’s attraction 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 attraction choices.
- Request a duplicate 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 situations and incapacity declare.
- Order the related data and supply them to the insurance coverage firm.
- Write an in depth attraction letter and ship it earlier than your attraction deadline.
- Overview the insurance coverage firm’s ultimate determination and assess your authorized choices.
How Bryant Authorized Group Can Assist With Your Lincoln Monetary Incapacity Attraction
Since you solely have a restricted time to file an attraction, and in lots of instances, you solely get one likelihood so as to add new proof to the report, dealing with your attraction by yourself is a dangerous alternative. Even easy errors might price you your likelihood at successful your attraction. And Lincoln Monetary’s insurance coverage adjusters will probably be all too comfortable to allow you to make them. They’re looking for his or her earnings, not you.
At Bryant Authorized Group, our attorneys have intensive expertise coping with Lincoln Monetary Group incapacity instances. We’re conversant in their coverage language, the methods they use to keep away from paying advantages, and in lots of instances even the attorneys that they use to defend in opposition to authorized claims.
Our crew can assessment your coverage and declare file with you and provide you with an neutral, real looking evaluation of your authorized choices. When you rent us to deal with your attraction, we’ll deal with the paperwork, keep on prime of deadlines, and do the digging essential to be sure you’ve gathered and submitted all of the proof it’s worthwhile to show your incapacity. And in case your administrative attraction continues to be denied, our skilled trial attorneys can defend your rights in courtroom when essential.
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 one in every of Chicago and Illinois’ premier incapacity insurance coverage regulation corporations, and we’d love the chance to assessment your case and provide help to discover a resolution.
To request your free authorized session with one in every of our skilled incapacity insurance coverage attorneys, please name 312-586-9650 as we speak or full this temporary on-line kind.
