Will My Insurer Pay My Claim if I Demonstrate that I Worked for as Long as I Could Before I Filed My Disability Claim?
Unfortunately, if a disability insurer has identified an argument that allows them to deny a claim, the insurer will generally not be swayed by the fact that the policyholder demonstrated a willingness to work for as long as possible before filing.
Take the case of Lim v. Lincoln.[1] The Plaintiff in this case, Dr. Kellie Lim, suffered from meningococcal disease when she was a child. Due to complications of the infection, her legs below the knees were amputated, along with her right arm below the elbow and all but her thumb and the fourth finger on her left hand. She learned to use prosthetics and was able to complete medical school and began practicing. However, she suffered from debilitating pain throughout her time practicing.
She was able to manage this pain through the use of opioid prescriptions. However, in 2020, new regulatory restrictions led her doctors to reduce Dr. Lim’s dosage, causing her pain to increase. Then, on February 24, 2022, Dr. Lim’s right prosthetic limb broke. She was able to return to work part-time from April through June while using an old prosthesis but the pain became too much and she filed a claim for long term benefits. Dr. Lim’s primary disabling complaints were back pain, trigger finger pain, and pain associated with learning to reuse her prosthesis.
Lincoln referred the claim to a peer review provider and their doctor both reviewed Dr. Lim’s records and interviewed her pain management specialist, Dr. Shah. According to the reviewing doctor, Dr. Shah indicated that Dr. Lim’s chronic pain was controlled with medications and opined that she was functionally able to sustain physical activity. However, during the course of the lawsuit, Dr. Shah disputed that he had said these things.
The reviewing doctor’s initial report also found that Dr. Lim was capable of physical activity, but did not even address Dr. Lim’s finger pain that she had reported as a disabling condition. Later on, the Lincoln analyst sent the claim back to the reviewing doctor, who provided a supplemental opinion stating that Dr. Lim was able to perform her typing duties for up to 15 minutes at a time followed by a 3-minute break throughout an 8-hour day. After reviewing this report, the analyst denied Dr. Lim’s total disability claim in spite of Dr. Lim’s serious medical conditions and the remarkable fortitude she demonstrated to practice medicine and maintain that practice for as long as it was realistically possible to do so.
This case demonstrates that disability insurance companies are willing to deny claims and force litigation even in instances where you might feel you have a clear-cut disability claim. If you feel that your insurance company has unfairly denied your claim, it is a good idea to at least speak with an experienced disability attorney.
Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If you are concerned that your insurer is not evaluating your claim under the proper standard, an experienced disability insurance attorney can help you assess the situation and determine what options, if any, are available.
[1]Lim v. Lincoln Nat’l Life Ins. Co., No. 22-CV-07493-RS (N.D. Cal. Jan. 9, 2025)
