A Massachusetts district court found that Lincoln Life Assurance Company of Boston (“Lincoln”) abused its discretion because it failed to properly explain that Mr. Taylor was not cognitively impaired.
Mr. Taylor, a cardiothoracic surgical physician’s assistant, submitted a claim for long-term disability (“LTD”) benefits to Liberty Life Assurance Company of Boston n/k/a Lincoln Life Assurance Company. Lincoln paid Mr. Taylor LTD benefits under the “own occupation” provision of the policy. Meaning Lincoln found that Mr. Taylor was disabled from his own occupation as a physician’s assistant due to small fiber neuropathy and cognitive impairment.
But Lincoln denied Mr. Taylor’s LTD benefits under the “any occupation” provision of the policy. It found that he was not disabled from performing the duties of any occupation. After submitting an appeal with additional medical evidence, Lincoln still denied his claim.
Mr. Taylor then filed a lawsuit in the district court of Massachusetts.
ERISA requires plan administrators to give specific reasons for its denial of benefits that are written in a way that is understood by the participants. This also means that Lincoln must explain in detail why it chose to discredit relevant evidence.
In this case, Lincoln’s denial letter states that there were no exam findings, diagnostic test results or other forms of medical documentation supporting symptoms or impairments of such severity to render Mr. Taylor unable to work in any occupation.
The Court disagreed. In fact, Mr. Taylor had provided medical documentation that supports his disability from three of his treating providers: an occupational therapist, a neuropsychologist and a primary care physician. The medical documentation included letters of support from his treating doctors, a functional capacity evaluation and a neuropsychological evaluation that all supported Mr. Taylor’s disability.
The Court also noted that Lincoln’s denial letter did not adequately explain why Mr. Taylor is not cognitively impaired but rather just quotes a peer review report from a doctor hired through a third party, paid for by Lincoln.
Although the Court ruled that Mr. Taylor’s evidence was not overwhelming enough to win on summary judgment, it found that Lincoln abused its discretion by disregarding the evidence Mr. Taylor has presented. The Court remanded the case back to Lincoln to review Mr. Taylor’s claim properly.
Help from a Lawyer with Expertise in Disability Insurance
Disability insurance law is complex. Hiring an experienced disability attorney is important. Because all disability lawyers at this law firm focus on disability insurance claims, we have expertise in disability insurance law.
That means we have:
- Experience with every major disability insurance company;
- A proven track record of success by winning major disability lawsuits;
- Recovered millions of dollars in disability benefits for clients;
And, we never charge fees or costs unless our clients get paid.
The firm can help at any stage of your disability insurance claim, including:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- Negotiating a lump-sum settlement; or
- Filing a lawsuit against your disability insurance company.
Because federal law applies to most disability insurance claims, our lawyers are able to represent clients across the country.
Contact Dabdoub Law Firm today at (800) 969-0488 for a free consultation with an experienced disability attorney.
