A Federal Court in Michigan has recently determined that Lincoln Life abused its discretion when it terminated a claim, finding that Lincoln’s decision making process was lacking in terms of analysis of the evidence. The claimant had provided extensive evidence documenting a history of back pain, along with objective testing which supported the impairments in functionality.
The Court also took issue with Lincoln’s reliance upon a file review which was conclusory and lacked meaningful consideration of the evidence, holding that “conclusory and unsupported statements that the documentation was insufficient to support a finding of disability” did not demonstrate a deliberate and principled decision-making process.
The Court thus awarded the claimant his back benefits.
All too often, insurers rely upon file only reviewing doctors, who are regularly used by them to support the denial or termination of claims. These opinions are often lacking meaningful analysis of the medical evidence, and are often simply an outright rejection of the medical evidence.
Peshke v. Lincoln Life