Lincoln Denial Reversed

Wednesday, June 22nd, 2022

We represent a 60 year senior executive with a very large regional hospitality group, who had to stop working as a result of a heart attack. Lincoln Life denied the claimant’s long term disability (“LTD”) benefits because they claimed he could still work at his old job. However, after we sued, Lincoln Life agreed to pay the LTD benefits. Issues regarding interest on the past due benefits, attorney fees and costs still remain unresolved.

Lincoln life has stated that it will require additional information to continue paying LTD benefits, even though the claimant’s condition is permanent and will not improve. It is possible that Lincoln Life’s assertion is simply boilerplate language included in an approval letter. However, any additional documentation would be cumulative and duplicative.

The LTD policy does not require the claimant to prove he is unable to perform any other type of full time work. The letter approving LTD benefits implies that Lincoln Life may require the claimant to apply for Social Security Disability (“SSD”) benefits, which requires a claimant to prove they are unable to perform any type of full time work. My client does not contend that he is unable to perform any type of work.

One of the first questions that a claimant is asked at an SSD hearing is, “Why can’t you work?” I will not allow my client to risk being accused of Social Security fraud. I advised my client that if Lincoln Life requires him to apply for SSD benefits, to testify that he believes he probably could do some type of full time work other than his prior occupation. Then, when asked why he applied for SSD benefits, my client will testify that Lincoln Life told him they would take away his LTD benefits unless he applied. That should protect the claimant from Social Security fraud, which is a felony, and subject Lincoln Life to a qui tam action under the False Claim Act. See U.S. ex. rel. Loughren v. Unum, 2008 WL 4280133 (D.Mass. 09/15/2008).

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