I mean, let’s be honest, we all knew this was coming. At 11:09 this morning, Lincoln Financial Group sent me this email. What’s next? I don’t know yet, but when I do know, I’ll probably tweet about it.
At some point I will get around to uploading the supplemental documents I added to my second letter and the letter itself. I figure if nothing else, you should see what exactly LFG gets away with ignoring and why any premuims you pay them are probably a waste. (Like I keep saying, if they can deny paying me? What cases do they even cover?)
Lincoln Financial Group’s Email
Emily,
We have completed the review of your appeal for Long Term Disability benefits. The determination is unfavorable and we will be upholding the denial. A letter is being sent to you via email with the decision.
You have a second level of appeal available if your disagree with this determination.
Thank you,
Sherri [Last name redacted] Claims Specialist Lincoln Financial Group
UPDATE 11/16/2019
I have hired an attorney to help me with my appeal. The process takes forever, and I still have not completed my second appeal against Lincoln Financial Group. To date, they have not paid me the benefits I am owed for approximately 8 months. I urge everyone to avoid buying policies with LFG. They are a horrible company making billions off people who are vulnerable and sick.
(If you’d like to share your own long term disability horror story here on emilysuess.com, please comment or send me a message through my contact form.
Hi all! A few people have asked about helping me in my fight against Lincoln Financial Group. Today’s post is in response to that question. One thing you can do to help me this week is send an email to the Dean at the Perelman School of Medicine where Dr. Lee Hartner is listed as a member of the faculty.
(The dean’s publicly listed email is evpdean@upenn.edu. Additional emails can be found here, if you’d like to CC: anyone else at the Dean’s office.)
We all know appealing to any sense of morality on the part of Lincoln Financial Group is a lost cause. However, we can and should still expect doctors, especially those charged with the education and mentoring of the next generation of medical professionals, to maintain public confidence in the profession.
Feel free to copy and paste the letter below directly into an email, or just use it as a springboard for writing your own. If you hear back from anyone, please tell me about it! Use my contact page or email me directly at speakupforemily@gmail.com.
As always, thanks for your support. I promise to let you all know as soon as I have any news to share. IF I have any news to share.
Dr. Jameson,
I have read the open letter at https://emilysuess.com/2019/06/15/open-letter-j-larry-jameson/ and would like to know your position on Penn Medicine faculty taking money—money that should be going to pay disabled consumers’ long-term disability claims—in exchange for biased medical reviews that contradict treating physicians’ professional medical opinions.
Doctors who accept payments for these underhanded disability reviews not only directly harm patients by stripping them of financial security, they are an insult to treating physicians who work to provide the best possible medical care for their patients. In Emily’s case specifically, Dr. Lee Hartner’s report is a cruel dismissal of the professional rapport Emily’s primary physician established with her patient. What Dr. Hartner did in declining to even speak with Emily’s primary physician goes beyond professional discourtesy, it’s an insult.
When you fail to call out this behavior, you protect a minority of greedy doctors at the expense of the reputation of the entire medical profession. The very least you could do is explain to Emily and the general public why you don’t seem to have a problem with that.
Updated 7/10/2019 7:31 CDT to correct a typo I just couldn’t stare at any longer.
Yesterday, Philadelphia Weekly, published a story about me and my fight to appeal Lincoln Financial Group. I hope you’ll take a few seconds to read it:
Even I find the candor of the article a little jarring. It’s one thing to tell your story, it’s something else entirely to hand it over to a relative stranger. I mean, historically, that hasn’t gone well for me, you know?
As vocal as I have been about what’s happening, there are certain things that I have avoided discussing. Deciding what to tell and how it gets told is really the only power I have in this. Letting go of that control for the PW article was terrifying, even though I had confidence and faith in the motives of the people responsible. Nonetheless, I am thankful that PW’s editor Kerith Gabriel and journalist Courtenay Harris Bond decided it was time to turn the lights on the proverbial cockroaches in my life.
On my first attempt to read the piece, I was a living, breathing ball of cringing and wincing. Fuck this is traumatic; no matter how strong anyone thinks I am. So traumatic, that 24 hours later I still haven’t read the whole thing through. Maybe I never will.
As far as I did get, I noticed that there were a couple of places the details seemed obscured or misinterpreted. I second-guessed whether I’d done a good job answering questions and laying out the facts. I started to sweat it a little, but then reminded myself I didn’t start this fire, and I don’t control this story. The larger it gets, the more interpretations of it will exist in the Universe, and that’s not something I’d have the power to change, not even in a perfectly abled body.
So I’m letting go of this step of my fight and regrouping. I know that an official decision from Lincoln Financial Group on my appeal is imminent, and I know that if it’s bad I’ll go through about five to seven days of depression where I just lie in bed, refuse to eat anything nourishing, and have imaginary arguments with the people paid to gaslight me. I’ve got some self-care to do before that happens to try and minimize the downward spiral.
I remember when Anne, a representative at Lincoln Financial Group first told me that my disability claim was up for review. She explained that after 24 months of receiving long-term disability benefits, things were changing. I was leaving the “own occupation” period and entering the “any occupation” period.
Or, put another way, instead of proving I could no longer work as a technical writer, I had to prove that I couldn’t work at all. Funny they don’t put that on the brochures, but I figured, Whatever. This changes nothing. I’m not any more abled in 2019 than I was in 2017. Let them do their review. No big deal.
Anne assured me the any-occupation review process would be conducted by an independent medical team. I swear she called it a “team” though I can’t prove it, because she said it in a phone call. (If I had one do-over to spend on this insurance stuff, I’d refuse any and all phone communication and insist they put every last word in writing.)
In reality the “independent” review was conducted by one dude: Brian L. Samuels MD, and he worked for a company called Professional Disability Associates (PDA). Brian’s report was an insult to medical practitioners everywhere. An utter failure to provide an objective, fact-based summary of my abilities. So I looked him up, discovered he didn’t seem to be doing much in the way of clinical work anymore—and that he was paid more than $29,000 from pharmaceutical companies in 2016 alone—and concluded he was probably just collecting some easy money before he completely retired.
I also looked up PDA, to see who in the hell would hire such a careless medical consultant. That’s when I confirmed what I instinctively knew to be true—that there was nothing independent about any of this bullshit.
PDA’s business profile at Inc.com describes it as “a consulting company that provides specialty risk resources including medical and vocational consulting services to disability insurers and self-insured employers.” If you wipe the bullshit spin off that statement, what you’re left with is something like “We sell medical opinions for cheap to help you get out of paying claims.” And it’s not like PDA denies that this is what they do. On their own website they explain: “We are trusted advisors dedicated to providing expert opinions that help companies make better decisions.”
I made sure to point this out in my first letter to Lincoln Financial Group. Not that they cared. In response to my appeal, they paid for another sell-out doctor’s opinion. The new guy, Lee P. Hartner MD, doubled down on the Samuels nonsense. But instead of lazily focusing on errors and omissions in my medical records, Hartner really went for it. He read a disability determination written by my actual doctor and decided—even though she had conducted a complete medical examination and he possessed nothing more than documents—that he knew what was really up. Now, not only was I fit to work full-time, I was also, to my complete surprise, in remission.
A perfunctory online search for Lee indicated he wasn’t any better than Brian. Though he’s reported significantly less money from pharmaceutical companies, he pops up in more court filings. Always the “independent expert” for a big insurance company, though not always in connection with the same review outfit. Whether Lee had to move companies because his opinions always led to lawsuits or whether he was just trying to cash in on every available opportunity is anybody’s guess. But neither scenario paints a particularly noble picture of him. Especially when you remind yourself that his paid opinions are stripping disabled people—stroke, brain cancer, and leukemia patients, for example—of their financial security in a health care system so broken they’re probably already drowning in run-of-the-mill medical debt.
For my appeal review, Lee was contracted by Reliable Review Services out of Boca Raton, FL. Bloomberg’s profile of the business describes them thusly: “The company caters to employers, third party administrators, and disability insurers.” So, yeah, there’s no chance I’m being screwed by any of these guys. No chance at all.
I guess I’m writing all of this for a couple of reasons. Firstly to my fellow disableds out there fighting a similar nightmare perpetuated by unscrupulous doctors who see us as medical records and not people: what’s happening to you is wrong. What they are doing may be legal, but it is not ethical. Don’t let them convince you that you’re a faker or a taker.
Second, to my doctors and to my primary physican in particular: I’m sorry you spent so much time trying to do right by me only to have some pissant sellout halfway across the country deny you the professional courtesy of presuming you know what you’re talking about.
This is an open letter to Castle Connolly Medical, published at: emilysuess.com/open-letter-castle-connolly-top-doctors
I am writing about a concern I have regarding Lee Hartner, a doctor named in your Top Doctors list at www.phillymag.com. If there is a better place to direct this communication, please let me know whom I should contact, and I will write them directly.
My name is Emily Suess, and I am a disabled brain cancer patient who lives in Urbana, IL. In March of this year, my long-term disability insurance carrier, Lincoln Financial Group, cancelled my disability claim and stopped paying my benefit. Following the cancellation of my benefit, I, as the claim holder, have been forced into a lengthy appeals process while I go unpaid by my insurer.
During that appeals process, Lincoln Financial Group acquired the services of Reliable Review Services (RRS). In exchange for payment, RRS provided a doctor to support LFG’s denial of benefits. That doctor was Lee Hartner, MD, PA – MD423656.
That Dr. Hartner accepted money to wrongfully claim my brain tumor is not disabling and I am able to return to work not only has consequences that are devastating to me financially, it calls into question the reputation of Castle Connolly and the “Top Doctors” designation.
In
the report Dr. Hartner was paid to provide, he casually dismissed my primary
physician’s determination of disability–which is meticulously supported and
documented in progress notes–and told the insurer that I am able to return to
work.
Dr. Hartner’s report claimed that I am in “remission.” Having never heard this from any of my treating physicians, I was shocked to first see it in a report which attempts to discredit my primary physician’s observations so that Lincoln Financial Group can justify cancelling my claim.
Furthermore,
in his report for Lincoln Financial Group, Dr. Hartner noted phone calls he
made to my primary physician in relation to my case, presumably to lend
credence to the assumption he would complete a thorough review. However, after
playing phone tag with my primary physician for a bit, he eventually told her
office staff that he “did not need to talk with [her] at this time.” He never
spoke with her, and this is documented in written correspondence between me and
my primary physician’s office.
There did seem to be conflicting information coming from my oncologist’s office at the time of Dr. Hartner’s report that was contrary to my primary physician’s findings. However, Dr. Hartner made no good-faith attempt to investigate further. When I had a chance to ask my oncologist’s office about it, a written statement deferring to my primary physician’s opinion on the matter (citing the infrequent visits required by medical oncology and my primary physician’s familiarity with my full history as reasons for his statement) was provided.
Even if Dr. Hartner wasn’t sure of my primary physician’s disability determination, and he was too busy to bother looking further, I would have expected a finding of “insufficient documentation” or “conflicting reports.” Certainly nothing so ridiculously biased in favor of Lincoln Financial Group as his report turned out to be. Even my own oncologist had the humility to acknowledge he didn’t have the most informed opinion on the matter.
My purpose in writing this letter is to ask that Castle Connolly be made aware of what has happened to me and that your physician-directed research team thoughtfully review whether it is appropriate for Dr. Lee Hartner to keep the designation of Top Doctor. While what he did appears to be legal, I believe—based on the information you present on your website—that you hold those who make your list to a slightly higher standard.
I also ask that you inform me if and how this matter will be addressed, as I believe patients who use your list for finding physicians should know to what extent they can trust it.
It might seem like pure snark to ask you that question, but I am one hundred percent sincere. Ever since I received a copy of the report you wrote to support Lincoln Financial Group’s cancellation of my long term disability claim, I’ve been asking myself, “Why would someone—a doctor no less—do this?” And the thing I keep coming back to is this adage:
Hurt people hurt people.
(It’s trite, for sure. But if you take the time to unpack them, you’ll find sayings like this apply in a lot of circumstances. That’s how clever little baby sayings grow up to be cliches, after all. )
In my ongoing quest to hold Lincoln Financial Group and its “experts” accountable for being greedy, disingenuous shitstains on an otherwise flawless healthcare sys—Bah! I can’t keep a straight face.
Ahem. What I was saying is that a friend graciously offered to help me research the key players in this nightmare of mine, including Lincoln Financial Group, Professional Disability Associates, Reliable Review Services, Dr. Brian Samuels, and you. And so far, your name has turned up in a handful of lawsuits from the last decade where a long-term disability insurer is named as the Defendant and you are their “expert” reviewer. In addition to Reliable Review Services, you have contracted with mcmc, and MES Solutions.
That. We. Know. Of.
There’s this 2011 court filing where a leukemia patient sued Hartford Life and Accident Insurance Company.
Then this one from 2010 in which a patient with Multicentric Castleman Disease sues Coventry Healthcare of Nebraska.
And this one from 2016 where MetLife retained you as an “Independent Physician Consultant” in a case against Babcock & Wilcox Technical Services, LLC Long Term Disability Plan.
I literally read this line from that last filing with my mouth gaping open:
“Dr. Hartner, however, again concluded that Mr. Smith is not totally disabled, despite conceding that he is ‘not qualified to assess whether [Mr. Smith’s anxiety] results in any restriction or limitation as that is outside the purview of my specialty.'”
At this point, all I can do is assume that you’re one of those sick fucks that just really likes doing this sort of thing to disabled people.
So I ask again, Dr. Lee Hartner. Who hurt you? Why are you like this?
This is an open letter, published at: emilysuess.com/open-letter-j-larry-jameson
I am writing about a concern I have regarding Dr. Lee Hartner, Clinical Associate Professor of Medicine at the Perelman School of Medicine. If there is a better place to direct this communication, such as a board or other governing body within the school, please forward this email as you see fit. Alternately, please let me know whom I should contact, and I will write them directly.
My name is Emily Suess, and I am a disabled brain cancer patient who lives in Urbana, IL. In March of this year, my long-term disability insurance carrier, Lincoln Financial Group, cancelled my disability claim and stopped paying my benefit. As you probably know, this is an industry-standard practice designed to save the insurance company money. Following the cancellation of my benefit, I, as the claim holder, have been forced into a lengthy appeals process while I go unpaid by my insurer.
During that appeals process, which is ongoing, Lincoln Financial Group acquired the services of Reliable Review Services (RRS). In exchange for payment, RRS provided a doctor to support LFG’s denial of benefits. That doctor was Lee Hartner, MD, PA – MD423656.
That Dr. Hartner has accepted money to wrongfully claim that my brain tumor is not disabling and that I am able to return to work is not only devastating to me financially, it reflects poorly on the reputation of the organizations with which he is associated–including the University of Pennsylvania and the Perelman School of Medicine.
In the report Dr. Hartner was paid to provide, he casually dismisses my primary physician’s determination of disability–which is meticulously supported and documented in progress notes–and instead he leans heavily on a previous report submitted by another reviewer and said reviewer’s interpretation of conversations with my oncologist. (It should be noted that previous review–by a Dr. Brian Samuels–was also purchased by Lincoln Financial Group, although it was via a different firm, Professional Disability Associates. Apologies if this is getting a bit confusing, it was designed to be that way.) Dr. Hartner also seized on a lack of information–a logical fallacy if ever there was one–in earlier reports to prop up a claim that I am not disabled.
Perhaps the most disturbing part of Dr. Hartner’s report is that he claims I am in “remission.” Having never heard this word uttered by any of my treating physicians, I was shocked to first see it in a report written by a complete stranger who has never even met me, had an opportunity to review my complete medical history, hear from me firsthand, or perform an in-person medical examination. While I realize all such doctors called upon to complete an “independent” review would be equally unfamiliar with my case, I would never expect any of them to make such a claim apropos of nothing.
What’s more, in his report for Lincoln Financial Group, Dr. Hartner notes phone calls he made to my primary physician in relation to my case, presumably to lend credence to the assumption he would complete a thorough review. However, after playing phone tag with my primary physician for a bit, he eventually told her office staff that he “did not need to talk with [her] at this time.” He never spoke with her, and this is documented in written correspondence between me and my primary physician’s office.
After conferring with my primary physician, my oncologist provided a written statement deferring to my primary physician’s opinion on the matter, citing the infrequent visits required by medical oncology and my primary physician’s familiarity with my full history as reasons for his statement.
My purpose in writing this letter is to ask that the School of Medicine be made aware of what has happened to me and that they thoughtfully consider whether it is appropriate for Department of Medicine faculty to consult on behalf of the insurance industry–an industry that has proven time and time again its priority is profit, not patients.
More directly I ask, Dr. J. Larry Jameson, how important to you is public confidence in your doctors? Are the ethical standards for Department of Medicine faculty and students beyond reproach? If you were in my shoes–broke, disabled, and living with an inoperable brain tumor–would you trust the doctors of the world not to cash in on your tragedy?
My last post about LFG canceling benefits on a brain cancer patient (me) contains a lot of text buried in an admittedly difficult to read PDF format. I hate how inaccessible that is, so I have uploaded audio of me reading that post to my YouTube channel. (Apologies that’s it a little rough around the edges, I’m doing the best I can with what I’ve got.)
In the audio file, I even read the progress notes from my primary doctor and the report from Lincoln Financial’s shady hired gun, Dr. Lee Hartner.
I urge anyone considering purchasing a long term disability policy from Lincoln Financial Group to save themselves the trouble and the heartache. They are dishonest and will deny benefits to anyone—including a patient like me who has an inoperable brain stem tumor. If they don’t cover a patient with brain cancer, then who will they cover? I’m afraid the answer is no one.
If you would prefer reading the original post, click here.
Finally, if you have been denied long term disability benefits by Lincoln Financial Group and would like to share your story on this website, please contact me. This is not an isolated incident. The company, its employees, and the third-party doctors who are paid to submit false claims about patients need to be held accountable for their actions.
Turns out being denied disability benefits is a lot like being married to a narcissistic, philandering jerk. Who knew!
***
“It’s not that you aren’t entitled to have multiple partners if that’s what you want. It is your life after all. And I didn’t force you to propose; I wasn’t even the one to bring up marriage. But my beef with you now is that YOU promised to do this whole monogamous thing, and that it was a lie.I never would have consented to this and you knew that.
If you’d have been up front from the start about your unwillingness to keep your dick in your pants, I could have said, ‘Nah, that shit ain’t for me,’ and you’d be someone else’s problem.
Instead, you’re having a mantrum™ because you’re being held to account for your wedding vows.
–Me to my ex-husband, 2008
***
This might be a weird parallel to draw, but I feel much the same way about Lincoln Financial Group today as I did about my ex-husband over a decade ago. I’m not mad that Lincoln Financial Group doesn’t want to pay disability benefits, I’m mad that they got me to buy a policy based on their industry-standard pie-crust promises to provide a modest monthly income if the unimaginable happened.
Well, the unimaginable did happen, but instead of honoring the policy, they hired strangers to gaslight me and stopped paying my claim.
And so now I’m over here like, “Look, LFG, no one’s making you sell disability policies, and no one’s making you call disabled people liars. If what you really want to sell is a junk policy that doesn’t pay, fine. Knock yourself out. Just, you know, present it as the trash it is so that I can say, ‘Nah, that shit ain’t for me,’ and you can be someone else’s problem.”
***
One thing I learned from being married to a compulsive liar for four and a half years is that being gaslit is psychological torture. I mean, sure you hear stories and read about the damage it causes, but when you live it. Jesus H. Christ on a bike. It’s really something.
Survival for me during my marriage to Husband X was only possible by repeatedly and publicly sharing the truth, because people like him count on their marks to be too scared and too ashamed to go public. It’s the same for companies like LFG.
I tell you all this because I’m about to share some very sensitive and very private information in a very public manner. Those of you who have never endured a situation like this might even wonder what in the world is wrong with me. All I can say is this: I’m not doing anything wrong; Lincoln Financial Group is.
I’ve been spinning my wheels trying to explain my story to people for a couple of months now, but I think it would be more effective for you to see exactly what Lincoln Financial Group knows about me. Once you read that, and then read their response, you can make an informed decision about this whole mess. Maybe you have a policy with them, maybe you don’t. Maybe you’ll continue to give them money, or maybe you won’t. Maybe you’ll look at an insurance plan or investment plan offered through HR at your new employer by Lincoln Financial Group and say, “Nah, that shit ain’t for me.”
Anyway, unlike the folks at LFG, I’m going to be totally up front: There’s only a small part of me that’s doing this to keep you from becoming their next mark. But there’s a HUGE part of me that’s doing this because I want to have even the slightest impact on their earnings report next quarter. (Also, if people started faxing Xeroxes of their hairy butts to 402-361-1460, that’d cheer me up too.)
So here we go, I give you an ever-so-lightly redacted report written by my primary physician and submitted as part of my first appeal to Lincoln Financial Group:
Of all the people unfortunate enough to be involved in this clusterfuck of Lincoln Financial Group’s making, my primary physician has known me the longest. She was my doctor back when the men of the medical world still thought I was whiny and just had fibromyalgia, the debilitating condition they pooh-poohed as the self-inflicted curse of the 30-something fat woman.
After I submitted the detailed note above (given to me by my primary physician to use as part of my appeal) Lincoln Financial Group’s claim rep responded* sharing their paid consultant’s report. They’re basically saying my primary is full of shit and that they plan to deny my appeal, but because they’re so kind I get an additional 21 days to submit more stuff they’ll probably just ignore. Here’s that correspondence and report:
Finally, an addendum written by my oncologist, which I recently requested in writing because LFG’s consultants claimed my oncologist said things that my oncologist’s office denies saying:
It should be noted that I have not yet sent this addendum from my oncologist to LFG, as I’m still composing a letter and waiting on a couple of additional documents to send along with it before the June 19 deadline.
***
Right now it feels like LFG wants to drag this thing out. The way their policies are written, a claimant who is denied disability benefits has to go through a first and second appeal before she can file suit. From my perspective, I can’t see how that’s more cost effective for them than just honoring the damn policy. But who knows. Since it’s all just a numbers game for them, maybe they’re betting on me to die before they ever have to pay another penny.
If I do die before this matter is settled, please know that my last wish was for you to help me spread the truth of their horribleness far and wide.
EDIT 6/9/19: You can send a fax to Lincoln Financial Group for free from your computer using FaxZero.com. It doesn’t necessarily have to be a Xerox of your butt for it to get their attention about my denied disability benefits.
* It should also be noted that aside from basic things like my name, age, and diagnosis, LFG’s consultant is wrong about pretty much everything. He, like their first consultant, has never met me but made money off of my being denied disability benefits.
It’s been a while since I’ve updated you guys on appealing Lincoln Financial Group. There are a couple of reasons for that:
Constantly worrying about money and maybe losing your house is kind of stressful.
It turns out that being depressed about brain tumor stuff, being unable to work, and having no money is EXCEEDINGLY. FUCKING. DEBILITATING.
These things move painfully slowly by design, because the longer Lincoln Financial Group gets away with not paying a claim, the more money the company and its CEO can hoard.
As things stand currently, I have submitted my appeal to them and it’s queued up for their review. If they don’t make things right, and decide to deny me again, then we move on to the Second Appeal. If (or should I say when?) they deny the second appeal, then–and only then–can I sue them.
Honestly, I’m surprised they don’t have a clause that forces policyholders to complete Appeal Elevensies before they can be taken to court. I should shut up, in case they’re looking for ways they can be even worse to their policyholders.
Anyway, I was going to post an entertaining version of my appeal letter here on the blog, but I can’t right now. Sadly this bullshit with Lincoln Financial Group is only one of several fires we’re dealing with at the moment, thanks to my homeowner’s insurance premiums unexpectedly rising 20% from last year, and some confusion with the IRS.
But back to the long-term disability stuff. I do have the official appeal letter that I could share, but I don’t want to just put that up on the blog for all to see. I’ve considered making it a Patreon post, so it’s only available to patrons. But I’m not sure if that really serves any meaningful purpose. I don’t know, I’ll wait and see what people think. I could see how someone in a similar situation would benefit from seeing how another person handled their appeal. Eh. I don’t know yet, OK? Stop pressuring me.
(Also, about Patreon: the new chapter of Who You Gonna Believe will be available to all subscription tiers starting tomorrow at 10:00 AM CT. So keep your eyes peeled for that. If you’re not already one of my patrons, you can get access for a $1 pledge.)
I’m going to drop a couple of other links if you’d like to help support our cause this month, because, like I mentioned at the top of this post, we’re kind of low on income for the foreseeable future.
