Attorney Alexander Palamara gets LTD Benefits Reinstated for former Walmart Manager
A former Manager of Quality Assurance at Walmart is again receiving Long Term Disability (LTD) benefits following an appeal filed by Dell Disability Lawyers.
Our now client was only recently hired by Walmart in May of 2017. He loved his job and began to shine at his occupation until he unfortunately suffered a serious shoulder injury in late 2017. After this initial shoulder injury, additional injuries and issues arose including hip issues, back issues, neck issues, hand issues, osteoarthritis, etc. Due to these issues, it became impossible for him to continue working his occupation as a Manager of Quality Assurance for Walmart. Thankfully, his employer provided its employees with disability insurance coverage and thankfully that coverage was with Lincoln.
After stopping work in January of 2018 on the advice of his treating providers, this former Walmart employee filed for both short term disability (STD) and long term disability (LTD) benefits. Initially, both claims were approved and he received full short term disability benefits (which paid for half a year) and even LTD benefits which were ultimately paid for 24 months.
Unfortunately for our client, his continued claim for LTD benefits was denied after Lincoln had paid for 24 months. The reasoning was simple: The policy had a change in definition of disability and now Lincoln reviewed this claim under the new definition of disability and concluded that he was no longer disabled.
The Change in Definition of Disability
Like most group LTD policies, to initially be awarded benefits, a claimant must merely prove that he or she is “unable to perform the material and substantial duties of his own occupation.” However, following 24 months of benefits, it typically gets a little more difficult to continue to qualify under LTD policies. At the 24 month mark, two things happen: (1) claims for mental health issues are no longer considered as there is typically a 24 month limitation for mental health claims; and (2) what it means to be disabled changes. Following 24 months of benefits, in order to continue to receive benefits, the claimant must now prove that he or she is “unable to perform, with reasonably continuity, the material and substantial duties of Any Occupation.”
“Any Occupation” is typically defined meaning “any occupation that the Covered Person is or becomes reasonably fitted by training, education, experience, age, physical and mental capacity.
The Claim Denial
With the claim of this former Walmart employee, after conducting its review to determine whether he would qualify under the Any Occupation standard, Lincoln concluded that he did not.
By way of a May 20, 2020, denial letter, Lincoln informed our now client that, based upon an “independent” review by a physician consultant who specialized in orthopedic surgery, it now found that our client had the ability to perform certain sedentary occupations. Knowing that there was no way he could perform the sedentary occupations of “Director, Records Management” and “Supervisor, Production Clerks”, our now client contacted our firm and quickly hired Attorney Alexander Palamara to represent him.
After speaking with the former Walmart Manager and reviewing the denial letter, Attorney Palamara quickly recognized the common recipe used by Lincoln for denying this claim. After agreeing to take on this claim, Attorney Palamara quickly ordered the claim file and was able to examine it as well as the “independent” consultant’s report. After digesting the information, Attorney Palamara quickly identified holes in Lincoln’s arguments and conclusions. In addition to finding the short comings in Lincoln’s denial, Attorney Palamara also gathered updated records and additional letters of support from his client’s treating providers. The Attorney also arranged a Functional Capacity Evaluation (FCE) for his client. The evidence in support of this claim was better than ever, especially due to the fact that the FCE found that his client had a “below sedentary” work capacity.
The Administrative Appeal
An appeal was timely filed. Included with the appeal were the updated records, the arguments as to why Lincoln’s decision was faulty, and the additional proof (such as the FCE results) as to why our client was and is disabled and unable to even perform a sedentary occupation.
Following a brief review by Lincoln, we were informed via a January 2021 letter that Lincoln had now “determined that benefits will be reinstated.” Lincoln had now agreed that our client was disabled from “Any Occupation.” Less than 10 days later, a check for the back benefits owed was received. Our client was ecstatic to hear this news and to be back on claim.
Moving forward, our client rests assured that Dell Disability Lawyers will continue to do whatever it takes to keep our client on claim until he is able to return to work or until his policy expires at age 67.
If you have had a claim denied by Lincoln, please contact our firm at once. We always offer a free consultation and we love taking on claims to prove insurance companies wrong.
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Q: Can I be denied from short term disability insurance for postpartum? Or can I fight this?
A: You can always file an appeal of a denied STD claim. The denial letter will explain your options, how to appea... Read More >
Q: If a dependent turns 18 in December, does Lincoln subtract their dependent amount from LTD payments even though child is now an adult and receives benefits directly until graduation?
A: The dependent offset is lifted only when the SSA provides written notice it is ending. Typically that is at hi... Read More >
Q: LTD return to work? What if I require training or want to continue education, will I continue to receive payment during this period?
A: If you are still unable to perform the material duties of your occupation or any occupation then yes you shoul... Read More >
Q: What if I never received longterm policy and I never agreed or signed agreement fee with disability insurance company?
A: Erica:The repayment of government benefits such as ssdi or state disability benefits is allowed if your po... Read More >
Q: Should I accept the buyout from Lincoln Financial? I have 7 days to decide.
A: Kendra, it was a pleasure speaking with you today. Thank you for reaching out for the free consultation. We ar... Read More >
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Q: If I return to work only part time and decide I can't continue, will Lincoln Financial base my income on when I worked part time or full time?
A: Kara, it would depend on the language in the policy. There is even a chance you could transition into long ter... Read More >
Q: Does Lincoln Financial apply offsets to all claimants equitably?
A: Jerry, yes, Lincoln Financial may seek to recover an overpayment of benefits pursuant to the contractual langu... Read More >
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