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University Of California Nurse In Remission Wins Lincoln Financial Appeal
The case involves a registered nurse who had worked for many years within the University of California medical system. In approximately 2021, she was diagnosed with breast cancer and underwent surgery and chemotherapy. Although her cancer treatment was successful, she experienced significant lasting side effects that left her unable to return to work. Lincoln Financial approved her long-term disability claim and paid benefits from approximately 2021 through 2025.
During those four years, the client’s policy transitioned from an own-occupation definition of disability to the more demanding any-occupation standard. Lincoln continued approving benefits even after that transition, meaning it had previously determined that she could not perform not only her nursing occupation but also other occupations for which she was qualified, including potentially sedentary work. After years of payment under that standard, however, Lincoln required her to attend an independent medical examination (IME).
The client attended the examination, where the physician reviewed her history, asked questions, and performed a physical examination. Shortly afterward, Lincoln terminated her benefits based largely on the IME physician’s findings and conclusions. When attorney Caesar Gvidia reviewed the denial and the examination report, he identified inconsistencies between what the physician had actually observed during the examination and the ultimate conclusion that the client could return to work. Lincoln also had not performed functional testing to determine what the client could realistically sustain in a work environment.
Gvidia developed an appeal focused on obtaining evidence of the client’s actual functional capacity and determining whether she could realistically perform another occupation. Key components included:
- Arranging functional testing to objectively assess the client’s physical capabilities and limitations.
- Obtaining a vocational assessment that considered her education, work history, earning capacity, medical restrictions, and functional limitations.
- Comparing the new functional evidence with Lincoln’s previous findings supporting disability under the any-occupation standard.
- Identifying inconsistencies between the IME physician’s observations and his ultimate conclusions regarding her ability to work.
- Highlighting findings such as swelling and other symptoms that were documented during the examination and were consistent with the client’s longstanding medical records.
- Working with the client’s treating physicians to evaluate the functional testing and explain why its results were consistent with their examinations and treatment history.
The functional testing provided particularly strong evidence. It established that the client was unable to perform even sedentary work, which was consistent with Lincoln’s prior determination that she qualified for benefits under the any-occupation definition of disability. Those findings directly conflicted with the IME physician’s conclusion, even though the IME itself had documented symptoms consistent with the client’s medical history and had not included comparable functional testing.
The appeal also demonstrated an important distinction between medical treatment and disability evaluation. Treating physicians generally focus on diagnosing conditions, managing symptoms, and helping patients improve; they do not necessarily conduct detailed testing to determine how long a patient can sit, stand, bend, twist, or sustain other activities throughout a workday. Functional testing can therefore provide evidence that may not otherwise appear in routine treatment records while allowing treating physicians to confirm whether those measured limitations are consistent with what they have observed clinically.
Within approximately one to one-and-a-half months after the appeal was submitted, Lincoln overturned its termination and reinstated the client’s long-term disability benefits. The outcome was especially significant because Lincoln had already paid the claim for approximately four years and had previously accepted that the client could not perform any occupation before reversing course based on the IME.
The case demonstrates that successfully completing cancer treatment does not necessarily mean that a person has recovered the functional capacity necessary to return to full-time employment. Lasting physical symptoms, pain, treatment-related limitations, and associated cognitive difficulties can continue affecting a person’s ability to work long after cancer treatment ends. When an insurer challenges an established