If you’re overwhelmed (like I was) with your long-term disability appeal, you might be encouraged to know that I won my appeal of Lincoln Financial Group. I’m not an attorney, but I’m willing to share with you what I’ve learned during this year-long process from a patient’s perspective. Maybe it will help.
The first step, I think, is to provide a timeline of events, starting with my brain cancer diagnosis in 2017 and hitting all the major points along the way from my policy cancellation to the final decision in March 2020. Appealing is a long, tedious process, especially when you’re sick or injured, and it’s no accident: it’s that way by design.
So, I guess what I’m saying is…brace yourself and know I’m rooting for you.
Hang in there,
NOTE: I will continue to update resources on this website as I’m able, but if you have a specific question or just need moral support from someone who’s been through it, please email me using my contact form.
Long-Term Disability Appeal Timeline
February 2017: Diagnosed with brain cancer. Underwent brain surgery. Started chemotherapy and radiation at Washington University (Siteman Cancer Center) in St. Louis Missouri.
Related Post: February 4, 2017, 9:41 PM
May 2017: Continued chemotherapy. Submitted initial long term disability claim with Lincoln Financial Group (LFG). Job terminated with my employer.
August 8, 2017: LFG disability claim approved. Received backpay for benefits earned between my official date of disability (February 2017) and the date my initial claim was approved (August 2017).
September 1, 2017: Received first routine monthly long term disability benefit from Lincoln Financial Group.
September 2017 – March 2019: Provided periodic updates to Lincoln Financial Group representatives about my health, sometimes in writing and sometimes by phone. Signed additional forms giving them permission to receive my medical records. Forced to apply for SSDI according to the terms of the long term disability policy. SSDI approved. LFG benefits reduced.
March 2019: Informed by LFG representative my claim was going under review. After two years, the policy stipulated a change in what qualified me for benefits. This is when a policy goes from the “own occupation” period to the “any occupation” period. During the “own occupation” you can receive benefits if you are unable to perform the type of work you were doing when you became disabled. During the “any occupation” you can only receive benefits if you are unable to perform ANY type of work.
March 20,2019: Lincoln Financial Group’s review team claimed I could perform gainful work and cancelled my claim. Their “team” was actually just a hired gun named Dr. Brian L. Samuels whose side gig was selling blind reports to LFG and other disability insurance carriers via a third-party company. LFG used the report Samuels wrote while contracted with Professional Disability Associates to justify cancelling my policy.
Related Post: Open Letter to Dr. Brian Samuels, Oncologist
April 1, 2019: I notified Lincoln Financial Group of my intent to appeal and requested my entire file, which by law they had to provide. (My policy, like many, is covered by ERISA.) I also demanded LFG send the curriculum vitae and medical license number of Dr. Samuels. LFG started the clock on my appeal.
April 11, 2019: LFG still had not mailed my file, intentionally burning up my appeal time. Without seeing their file, I had no way of knowing what was missing from my file or what misinformation to dispute. In an email, I demanded their claims specialist overnight my file and provide the name of the courier service they were using and a tracking number for the shipment.
April 12, 2019: I received a disc with a PDF version of my 700-page claim file via FedEx. The claims specialist claimed she sent the first file via standard mail on April 4. It was never received. (I am confident the claims specialist lied about mailing it, but if she did it means there’s still a 700-page PDF floating around out there somewhere connecting my Social Security Number to my HIPAA-protected medical history.
April 18, 2019: I refused to speak with any employee of Lincoln Financial Group by phone for any reason. I insisted all correspondence be done in writing.
April 19, 2019: I sought the advice of a disability attorney based in Florida. I learned my policy required two administrative appeals with LFG before I could sue them. For financial reasons, I decided to submit the first appeal myself, and hire an attorney if a second appeal was required.
July 9, 2019: After submitting additional medical records and a statement from my primary physician with my appeal, LFG denied my appeal. They hired a new doctor, Penn Medicine oncologist Lee P. Hartner, to write a new report supporting their denial In exchange for payment. Hartner claimed I was in remission despite having access to my full claim file and half a dozen MRIs showing the unchanged, malignant astrocytoma on my brain stem. Hartner’s third-party handler was a company called Reliable Review Services.
Related Post: Open Letter to Dr. Lee Hartner, Oncologist
July 11, 2019: I called the attorney I had spoken to in April, intending to hire her for the second appeal. She quoted me higher contingency fees than she had in April. I made more phone calls and looked for a better lawyer.
August 15, 2019: I hired a firm based in Tennessee to handle my appeal.
Related Post: Lincoln Financial Group Appeal Update
January 2020: My primary physician switched jobs, making it impossible for my attorney to get a sworn statement from her. My attorney tried to get a sworn statement from my neuro-oncologist at Washington University instead. He refused unless paid $500 for the 30-minute phone call. My attorney, much to her credit, decided to move forward without letting my doctor extort me. I found a new oncologist.
March 18, 2020: I won. Lincoln Financial Group provided verification of their decision to reinstate my claim in writing, and my attorney called me with the news.
March 23, 2020: My attorney called to tell me she received the first check from LFG. She now manages my claim. All communications from LFG must go through her, and LFG claims representatives cannot call me.
Additional Lincoln Financial Group Long-Term Disability Appeal Posts
My Favorite Phone Call 12/5/2018
Appealing Lincoln Financial Group, an Update 4/3/2019
When Checking the Mailbox is Terrifying 4/7/2019
Lincoln Financial Group Policies Are Shit 4/15/2019
Next Steps: Appealing Lincoln Financial Group 4/29/2019
Lincoln Financial Group Denied Disability Benefits to Brain Cancer Patient 6/8/2019
Audio: Lincoln Financial Group Denied Disability Benefits to Brain Cancer Patient 6/14/2019
Open Letter to J. Larry Jameson, Dean Perelman School of Medicine 6/15/2019
Open Letter to Castle Connolly Medical Regarding “Top Doctor” Lee Hartner 6/24/2019
I’m in the News Again 7/2/2019
Lincoln Financial Group Denies My Appeal 7/9/2019
An Open Letter to Penn Medicine Doctors 8/1/2019
Don’t Be Like Bob 11/23/2019
About My Disability Case Against Lincoln Financial Group 1/7/2020
Media Coverage of My Appeals Case
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