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Lincoln Financial Reverses Disability Denial

The case involves an IT security infrastructure professional whose job was primarily sedentary but required significant concentration, responsibility, and availability to respond to company security and technology issues. He suffered a major heart attack that required open-heart surgery and also had diabetes and chronic back problems. Although the surgery improved his condition, he continued to experience substantial fatigue, difficulty focusing and concentrating, medication side effects, and limitations related to his other medical conditions. Lincoln Financial initially approved his long-term disability claim and paid benefits for approximately one year.

After about a year of benefits, Lincoln conducted a medical peer review and determined that the client had recovered sufficiently to return to full-time work. The decision was based solely on a review of his medical records; Lincoln did not require an Independent Medical Examination (IME) or Functional Capacity Evaluation before terminating benefits. According to attorney Rachel Alters, the insurer appeared to rely heavily on medical records showing that the client was improving after surgery. However, improvement from a life-threatening cardiac event did not mean he had recovered enough to work 40 hours per week in a demanding IT security position. His treating physicians continued to report significant fatigue, concentration problems, medication side effects, and other limitations that prevented him from returning to work.

Attorney Rachel Alters developed a detailed appeal challenging Lincoln’s conclusion and documenting how the client’s cardiac condition, diabetes, back problems, fatigue, and other limitations affected him collectively. Key components of the appeal included:

• Working with the client’s treating physicians, including his cardiologist and doctors treating his other medical conditions, to document his continuing restrictions and limitations.
• Emphasizing the combined effect of his multiple medical conditions rather than evaluating his heart condition, diabetes, and back problems independently.
• Arranging a Functional Capacity Evaluation (FCE), which produced supportive findings showing that fatigue, back problems, and other limitations interfered with his ability to sit and function for prolonged periods.
• Demonstrating that improvement following open-heart surgery did not establish an ability to sustain full-time employment.
• Connecting his medical limitations to the actual demands of his IT security position, which required concentration, interaction with others, immediate responses to security or technology problems, and potentially being available outside normal working hours.

Stress was another important consideration. The client’s cardiologist advised him to avoid stressful situations, and his previous work environment was highly stressful. Although stress avoidance was not the only reason his doctor recommended against returning to work, it was one component of the broader medical picture. The attorneys also emphasized that insurers may focus too narrowly on whether someone with a sedentary occupation can physically sit for several hours rather than considering the cognitive, interpersonal, reliability, and stress-related demands of the actual occupation.

The appeal was successful, and Lincoln Financial reinstated the client’s long-term disability benefits. However, the attorneys are already preparing for another potential review because the policy’s definition of disability is expected to change after approximately 24 months from whether he can perform his own occupation to whether he can perform any gainful occupation. Because his original IT position was already sedentary, the appeal helped establish evidence that his limitations extend beyond his specific job and affect his ability to sustain other sedentary employment as well.

To prepare for that transition, Alters advised the client to continue discussing his functional limitations with his treating physicians and ensure the medical records clearly document whether he can perform any type of work on a full-time or part-time basis—not merely whether he can return to his previous IT position. The case demonstrates the importance of evaluating the combined impact of multiple medical conditions, obtaining functional evidence such as an FCE, and connecting medical restrictions to the real-world demands of sustained employment when challenging a disability benefit termination.