Lincoln Financial Disability Claim Tips for Physicians
Our law firm has extensive experience handling disability claims for physicians. Our attorneys understand how Lincoln Financial operates and what it takes to file a successful Lincoln Financial disability claim, and are happy to set up a free consultation to discuss your particular Lincoln Financial claim.
Below are some answers to the most common questions our attorneys receive from physicians about the disability claim process, generally, and their Lincoln Financial disability benefits, specifically.
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3. Is there a limit to the amount I can earn as a physician on partial disability?
9. When should I contact an attorney about my Lincoln Financial physician disability claim?
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1. Do Lincoln Financial disability policies for physicians have “true” own occupation disability definitions?
Lincoln Financial’s disability definitions can vary depending on when the policy was issued and the coverage selected by your employer, if you have an employer-sponsored plan.
Many employer-plans define disability as “any occupation” rather than “own occupation,” or change from “own occupation” to “any occupation” after a certain number of months/years (e.g. 24 months/2 years). However, there are Lincoln Financial policies that offer own occupation coverage.
For example, a Lincoln Financial policy may recognize that an insured is Totally Disabled for an Own Occupation period as long as they are unable to work in their own occupation (but they can be working in another, unrelated field).
After the Own Occupation period, the insured would then have to prove that they are not able to “engage with reasonable continuity in any occupation in which the Insured Employee could reasonably be expected to perform satisfactorily in light of the Insured Employee’s age, education, training, experience, station in life, and physical and mental capacity.” In some instances, the Own Occupation period may last for the entire life of the policy, in essence making it a true own occupation policy.
Additionally, many disability insurance policies define occupation as the occupation, or occupations if more than one, that the insured was engaged with at the time the disability started. However, in some Lincoln Financial policies, occupation is defined as:
the occupation, trade or profession:
1. in which the Insured Employee was employed with the Employer prior to Disability; and
2. which was his or her main source of earned income prior to Disability.
This definition is beneficial to the insured, especially if they have multiple income sources. With a dual definition policy, an insurer may argue, for example, that you have multiple occupations; however, under this policy language, it is clear that your “main source” of income is your occupation. However, not all Lincoln Financial policies have this same language, so it is important to review your coverage carefully. Policy language and terms can vary greatly depending on what employers negotiate for a specific contract. Your policy may or may not have the language discussed above and below, and could change as the policy is replaced with updated versions over time.
2. I’m a physician with an infectious disease that prevents me from working in a clinical environment. Will Lincoln Financial recognize this as disabling condition?
The threat of infectious diseases can impact one’s ability to practice, even if the symptoms are not in and of themselves disabling enough to prevent an individual from practicing. Because of this, some Lincoln Financial policies sold to employers of medical professionals can include what is called an infectious disease rider.
In order to be considered either totally or partially disabled under the terms of this rider, the insured must be a medical professional, test positive for an infectious disease, have been restricted from performing duties if his or her Own Occupation by a state licensing board, governing body, or Employer because the performance of the duties of his or her Own Occupation includes procedures that “reasonably could pose a risk of transmitting the infectious disease.”
The rider names examples of infectious diseases, including Hepatitis and HIV. In this rider, medical professional is defined, in part, as a person “whose Main Duties of his or her Own Occupation include invasive procedures on a routine basis.” Whether or not your Lincoln Financial policy has this specific rider will depend on whether your employer negotiated for it to be included as part of the disability insurance contract.
3. Is there a limit to the amount I can earn as a physician on partial disability?
Partial disability is a way for those who can still work, but not at full capacity, to earn money but also collect a portion of their disability benefits.
Many ERISA policies, including Lincoln Financial policies, set limits on how much you can earn, in comparison to your prior income, before the claim terminates under the contract. Additionally, some Lincoln Financial policies have different rules depending on how long you have been receiving partial disability benefits.
For example, under certain policies, the claim will terminate if, during the first 24 months, you make more than 99% of your pre-disability income. Then, after 24 months, this threshold income that terminates the claim drops to 85% of your pre-disability earnings.
4. I see my doctor periodically. Is that enough to satisfy Lincoln Financial’s requirement that I undergo treatment?
Most disability policies have a care requirement that must be satisfied in order to qualify for disability benefits. Some Lincoln Financial policies have a fairly lengthy and strict regular care requirement, in comparison to other companies:
Regular Care of a Physician or Regular Attendance of a Physician means the Insured Employee:
- personally visits a Physician, whose license and any specialty qualify him or her to provide Medically Appropriate Treatment for the Insured Employee’s disabling condition;
- is treated as often as medically required, according to the standard medical practice, to effectively manage and treat the disabling condition and when that care would serve to improve the Insured Employee’s condition; and
- receives Medically Appropriate Treatment. Such treatment must be consistent with the disabling condition; and it must be rendered according to generally accepted, professionally recognized standards of medical practice.
“Medically Appropriate Treatment” is then defined as:
Medically Appropriate Treatment means diagnostic services, consultation, care or services that are consistent with the symptoms or diagnosis causing the Insured Employee’s Disability. Such treatment must be rendered:
- by a Physician whose license an any specialty are consistent with the disabling condition; and
- according to generally accepted, professionally recognized standards for medical practice.
Of note here are several things, including that the treatment must be in person—which can be difficult, given the new prevalence of tele-medicine, especially since the COVID-19 pandemic.
Further, treatment is not just considered doctor visits but can include diagnostic measures and refills of medications—even if you and your doctor feel that these are not necessarily needed. Lincoln Financial may push back with their own experts stating that a course of treatment is medically appropriate.
Regardless, as you can see, care requirements can be lengthy and complex, and should not be overlooked by physicians filing a disability insurance claim.
5. My doctor says I am unable to work in any capacity as a physician but Lincoln Financial wants to deny my claim anyway. Can they do that?
As part of a disability insurance claim, Lincoln Financial will usually require periodic statements and information from your treating provider(s) to verify your disabling condition. But will they always listen to your treating provider when it comes to your ability to return to work?
In Whitfield v. Lincoln National Life Ins. Co., No. 10-CV-096-JHP-FHM (N.D. Okla. Sept. 30, 2011), the plaintiff, Mr. Gregg Whitfield, worked as a case manager/therapist until he became unable to work as a result of symptoms related to cervical radiculopathy (and after undergoing anterior cervical discectomy fusion), degenerative disc disease and a herniated disc in his neck.
After an evaluation of his claim, including a review of medical records by a nurse, Lincoln Financial denied Whitfield’s claim, indicating that it found him able to perform his occupation (which they classified as light duty). Whitfield filed an appeal and submitted a statement by his treating provider which stated that Whitfield was unable to work full time due to chronic pain, headaches, difficulty with movement, as well as problems with the sedative side effects of his medication. Lincoln obtained a physician to conduct an independent medical evaluation/peer review. This physician indicated that the work restrictions placed on Whitfield by his treating physicians were not “reasonable and consistent with medical findings” and there were no objective medical findings. This reviewing doctor found that Whitfield was capable of light duty work. After this, Lincoln Financial upheld its denial.
On his appeal, Whitfield indicated that his job was actually “medium to heavy duty.” However, Lincoln Financial pointed to the terms of his policy, which indicated that “Own Occupation” was defined how the occupation was performed in the “national workforce” versus how it was performed for a specific employer.
Whitfield filed another appeal, again including a statement from his treating provider indicating that he was unable to work due to his conditions, and pointing to objective evidence including reduced range of motion, reduced grip strength, sensory and reflex changes, impaired sleep, weight change, tenderness, trigger points, swelling, muscle spasm, and muscle weakness. Lincoln Financial then performed a second independent medical evaluation and an occupational analysis. Findings again stated that there was no objective documentation to support the restrictions or limitations, and that there was no relationship to cervical impairment and the restrictions placed upon Whitfield.
The Court agreed with Lincoln Financial, finding that its decision was “wholly supported by the administrative record.” They cited case law that courts have no obligation to give special weight to a claimant’s physician. They further pointed out that Lincoln Financial had though taken into account the treating physician’s reports, and given him a chance to respond to the reviewing doctor’s report.
Finally, Whitfield argued that Lincoln National should have ordered a functional capacity evaluation (FCE) to determine whether he was able to perform his work duties. However, the Court stated that “under the terms of the Policy the claimant bears the burden of submitting proof of continuing disability” and that Whitfield could have submitted an FCE, but Lincoln Financial was not required to order one.
This case shows how Lincoln Financial may seek to discredit a treating provider’s opinion, and how it can be difficult to successfully secure your disability benefits if your claim is not proactively handled from the outset.
6. How far back will Lincoln Financial look in my medical history when determining whether I am eligible for benefits?
It is not uncommon for insurance companies, including Lincoln Financial, to pour through medical records—even ones long prior to the onset of a disabling condition—in order to determine whether they can get out of paying benefits, whether this be through rescission or by misclassifying a disability. This may mean trying to argue that an insured’s condition is due to sickness versus injury, as this may impact the length of a claim.
For example, in Uberti v. Lincoln National Life Ins. Co., 144 F. Supp. 2d 90 (D. Conn. 2001), Lincoln argued that Uberti was disabled due to a sickness (and therefore only eligible for 60 months of benefits) versus an injury (which would make him eligible for lifetime benefits).
Uberti severely injured his left knee when he slipped on some ice in 1994. Uberti was diagnosed with torn lateral and medial menisci and, despite undergoing two surgeries and continuous physical therapy, his condition generally remained unchanged. Lincoln Financial approved benefits; however, after 60 months they indicated that they had classified his disabling condition as a sickness and were going to end benefits.
The rationale behind this classification was that Uberti was struck by a car when he was seven years old (in 1952) and required several surgeries for a shattered left femur, which resulted in significant leg shortening, left patella malalignment and chronic low back pain. However, for the majority of his life, Uberti was very physically active, participating in numerous sports and working construction.
Lincoln Financial honed in on this record and stated that Ubertis’ disabling condition was sickness as “total disability is not resulting from accidental bodily injury directly and independently of all other causes.” In the course of the investigation, Lincoln’s analyst submitted several questions to a consulting physician (who was a family medicine doctor, with no certification in orthopedics), who answered only some of the questions and indicated that there were deficiencies in the medical records and that an independent medical examination (IME) may be helpful. However, Lincoln Financial’s analyst did not have an IME performed, did not try to update the medical records, and failed to get all her questions to the reviewing physician answered.
The Court found that the analyst had taken records out of context and relied on records that had misstated Uberti’s injuries, had rendered medical opinions without training, and otherwise acted egregiously. The Court concluded that “Lincoln National’s determination that plaintiff’s disability was the result of ‘sickness’ was an arbitrary medical determination made by an unqualified claims examiner whose opinion was unsupported by the medical record, and directly contradicted by the opinions of Mr. Uberti’s treating physician in the pertinent specialty.” Because of Lincoln Financial’s actions, Uberti was awarded reinstatement of benefits and compensatory damages.
While Uberti was successful in proving that his condition was truly an injury stemming from a 1994 accident, we’ve seen cases go the other way—where Lincoln is successful in combing through old medical records to aggressively find evidence of a pre-existing condition(s) that could either be a basis for rescinding a policy, or used to deny or limit benefits. An experienced disability insurance attorney can help ensure that a disabling condition is correctly classified in a claim.
7. What will Lincoln Financial use when determining post-disability income, whether I am working as a physician or in another occupation?
In many Lincoln Financial policies, benefits may be terminated if an insured has post-disability income that exceeds a certain percentage of prior income. But what is considered “current income” is not always clear-cut, and may not be spelled out in policy language.
One such example is the case of Hanson v. Lincoln National Life Ins. Co., No. CV 19-551-MWF (JEMX) (C.D. Cal. Aug. 3, 2021). In this case, the plaintiff, Ms. Holly Hanson, was a financial advisor who owned her own financial advising company that acted as an independent contractor for a large investment management entity.
Hanson filed a claim for benefits after she became partially disabled due to synovitis and tenosynovitis and was prevented from performing all of her job duties (including using a keyboard). Lincoln initially began paying benefits. However, they later terminated benefits, claiming that benefits were no longer due because her current monthly income exceeded 100% of her Predisability Income. Here, the parties disagreed on how Hanson’s post-disability income should be calculated.
Hanson argued that this calculation should not include “residual income” that she received as largely passive fees from client accounts that were established before the onset of her disability. The policy did not expressly define “current earnings,” but Hansen pointed to Lincoln’s marketing materials and statements that Lincoln’s employees had made, which indicated that residual income was exempt from the calculation of current earnings.
Lincoln Financial argued several things including that extrinsic evidence should not be considered, it had not prepared the marketing material, and that it’s representative made “honest misstatement[s]” but that these opinion statements were “irrelevant” to the interpretation of an insurance contract.
The Court did not find these arguments persuasive and found for Hanson, indicating “it was objectively reasonable for Plaintiff to expect the Policy to exclude residual income . . . [g]iven the unique business model of fee-based financial advisors like Plaintiff, the Policy would hold little value if residual income impacted eligibility for benefits.”
While this case is specific to a financial advisor, in certain instances, physicians may also have residual income that comes after their last day of work (if they are paid based on collections), so it is possible that Lincoln Financial could make similar claims when determining eligibility for benefits based on current earnings. An experienced disability insurance attorney can help determine the specific terms of your policy.
8. Do I need to hire an experienced Lincoln Financial disability attorney to file my physician disability claim to help ensure that I get paid benefits?
While there are certainly claims that may not require attorney involvement—for example, a disability claim due to the loss of a limb or something very serious, such as paralysis—in our experience physician claims are not that straightforward.
Many of our clients have more nuanced conditions, such as slowly progressive musculoskeletal conditions due to degenerative disc disease. Others have conditions like a tremor, that may not prevent them from working in other jobs, but have a significant impact on their ability to work as a physician. Others have mental health conditions (anxiety disorder, panic attacks, PTSD) that cannot be verified by a single, definitive objective test.
Obviously, if your claim is denied or you have a dispute over policy interpretation, you may need an attorney to become involved to resolve the matter. That being said, lawsuits with insurance companies are often costly, stressful, and, in some instances, can drag out over several years, all to the insurance company’s advantage. Even if you prevail, it can be an exhausting process, and companies typically appeal, which can take at least another year or more, all the while you are not getting paid benefits.
In our view, it is more prudent to approach your claim carefully from the outset and have your disability attorney address any concerns that the Lincoln Financial may have over the course of the investigation itself, so that you are not placed in a position where disability benefits have been cut off/denied, you are not working and your only option is a lawsuit.
In our law firm’s experience, the most common areas where complexities can arise in physician’s disability claims include:
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- The timing of the claim (particularly in situations where a disabling condition is slowly progressive);
- Claims made by physicians who own their practice and need to decide whether to sell, bring on new associates, or keep working in a limited capacity;
- Claims where the underlying condition is difficult to diagnose or is diagnosed by exclusion;
- Claims involving pain/musculoskeletal conditions;
- Claims involving mental health conditions.
- Claims involving multiple co-morbid conditions; and
- Claims involving recommendations for or against certain treatments or surgery.
9. When should I contact an attorney about my Lincoln Financial physician disability claim?
Physicians who are considering filing a claim for disability insurance benefits should meet with a disability attorney well-before submitting a claim.
Each disability policy has different, complex language that insurance companies may manipulate to circumscribe and restrict coverage. Before filing, physicians should make a coordinated effort, with an attorney’s assistance, to determine whether their particular claim is covered, and if so, how that claim is best presented to ensure payment.
The information provided above is offered purely for informational purposes. It is not intended to create or promote an attorney-client relationship, and does not constitute and should not be relied upon as legal advice.
Every claim is unique and the discussion above is only a limited summary of information that may be relevant to your claim. If you are concerned that Lincoln Financial is not handling your claim fairly, an experienced disability insurance attorney can help you assess the situation and determine what options are available to you.
Notable Lincoln Financial Disability Insurance Cases
Parks v. Lincoln Nat’l Life Ins. Co., No. 22-12814 (E.D. Mich. Mar. 21, 2024)
Learn v. Lincoln Nat’l Life Ins. Co., No. 6:20-CV-00060 (W.D. Va. Mar. 19, 2024).
Hanson v. Lincoln Nat’l Life Ins. Co., No. CV 19-551-MWF (JEMX) (C.D. Cal. Aug. 3, 2021).
Whitfield v. Lincoln Nat. Life Ins. Co., No. 10-CV-096-JHP-FHM (N.D. Okla. Sept. 30, 2011).
Uberti v. Lincoln Nat. Life Ins. Co., 144 F. Supp. 2d 90 (D. Conn. 2001).
Pifer v. Lincoln Life Assurance Co. of Bos., No. 1:22-CV-186 (M.D.N.C. Aug. 14, 2023)
Lincoln Financial Disability Insurance Blog Posts
Employee Retirement Income Security Act of 1974 (ERISA)
Disability Insurance: What Every Physician Needs to Know about ERISA
Case Study: Abuse of Discretion Under ERISA
