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Court Finds Lincoln Life Determination An Abuse Of Discretion

Monday, August 15th, 2011

A Federal Court in Michigan has reinstated a claimant’s long term disability insurance benefits which were wrongfully terminated by Lincoln Life Insurance. The claimant had been disabled since 2000, and his benefits were terminated by Lincoln Life in June 2008, based upon a determination that the claimant could perform work in a sedentary capacity.

Lincoln relied upon the Dictionary of Occupational Titles (DOT) as a reference, despite the fact that the DOT has not been revised since 1991. On appeal of the claim termination, Lincoln obtained an IME, which not surprisingly found that the claimant’s pain was “out of proportion” to the physical examination and diagnostic studies. This is an all too typical comment provided by doctors hired by insurance companies on ERISA disability claims.

Lincoln also relied upon the medical opinion of a nurse, an action that drew skepticism from the Court, which noted that “When a plan administrator’s explanation is based on the work of a doctor in its employ, we must view explanation with some skepticism.” The Court found that Lincoln’s review was limited and that it ignored the claimant’s reports of constant pain. The fact that Lincoln ignored prior assessments of limited functionality guided the Court in its decision.

As a result, the Court ordered benefits to be reinstated, and permitted the claimant to seek attorney’s fees. Grabowski v. Lincoln National Life Ins. Co.

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