Our client’s claim was terminated after being paid for a period of time under his own occupation coverage, which he had secured through his employment. Lincoln Insurance terminated the claim despite the fact that he continued to suffer from intractable chronic pain and the impact of the heavy narcotics he was compelled to utilize to combat the pain.
Frankel & Newfield filed an appeal, providing the results of neurocognitive testing, which clearly revealed marked limitations in cognition. While this was sufficient to get the claim reversed, Lincoln next took the position that the claim was a mental or nervous claim, on the purported basis that the Issues were psychological and not due to the impact of his narcotic pain medications. Mental/nervous claims in most policies are subject to a 24 month benefit limitation, and many insurance companies try to get claims reclassified whenever this is a possibility.
We strategized that continuing payments was the goal and developed claim support for the physical impairment to be submitted toward the conclusion of the 24 month period for mental/nervous claims.
We then bombarded Lincoln with powerful support for the physical impairment, relying upon his Social Security award findings, his treating doctor’s support, medical literature and a strong and direct attack of Lincoln’s position. Ultimately, Lincoln yielded.
Our client is once again receiving his benefits under the physical disability clause in his policy.
If you have a physical disability and your long term disability insurance company attempts to re-classify your claim, you must take a very strong position and be prepared for a serious challenge. Call our office to learn how we can help you fight back.