The discussion centers on a long-term disability case handled against Lincoln Financial, involving a software developer who developed severe long COVID symptoms that worsened his pre-existing multiple sclerosis. Although his claim was initially approved and paid for about 10 months, Lincoln abruptly terminated his benefits based on a review by a hired physician who claimed there was insufficient evidence of continued disability. This decision ignored consistent support from the claimant’s treating doctors and relied heavily on a single outside opinion, a common tactic described by the attorneys.

To challenge the denial, the attorney built a comprehensive appeal using multiple layers of evidence. This included new independent evaluations—a functional capacity exam and a neuropsychological assessment—both of which demonstrated significant physical and cognitive limitations. In addition, updated statements from the claimant’s treating providers reinforced that he could not safely return to work. By combining objective testing with strong medical opinions, the appeal directly countered the insurer’s rationale and left little room for denial.

As a result, Lincoln reversed its decision within just a few weeks and reinstated the claimant’s benefits. The case highlights how insurers may terminate valid claims even after prior approval, especially when relying on paper reviews instead of in-person evaluations. It also underscores the importance of submitting a thorough, evidence-driven appeal that addresses both medical and legal weaknesses in the insurer’s decision, which can often lead to a successful outcome without litigation.

This case involved a former advisory manager at KPMG whose short-term disability claim was approved by Prudential, but his long-term disability claim was denied despite no improvement in his condition. He had been struggling with severe mental health issues, including anxiety and depression related to personal circumstances, and had been consistently treating with a licensed clinical social worker and a primary care physician. Prudential relied on a paper review from an outside psychiatrist—who never examined the claimant—to argue there was insufficient evidence of disability, disregarding strong, long-term support from his treating providers.

On appeal, the legal strategy focused on strengthening and reframing the existing medical evidence rather than introducing entirely new testing, since mental health claims lack objective proof like MRIs or lab results. The attorney emphasized detailed, consistent opinions from treating providers and highlighted the flaw in relying on a non-examining consultant over professionals who had treated the claimant for years. The appeal also argued that Prudential failed to justify how the claimant could suddenly recover at the transition from short-term to long-term benefits, reinforcing that his condition and limitations remained unchanged.

The appeal was successful within about 40 days, with Prudential reversing its denial and approving long-term disability benefits. The case underscores key lessons for claimants: ensure strong and consistent medical support (ideally including a psychiatrist for mental health claims), understand that insurers often rely on biased file reviews, and recognize the importance of detailed documentation from treating providers. It also highlights the need for ongoing treatment and thorough medical records to maintain benefits, especially since mental health claims are often limited to 24 months and subject to continued scrutiny.

This case involves a disability insurance claim against Lincoln Financial Group where the claimant was initially approved for short-term disability but then denied long-term disability during the transition period—a common point where insurers reassess claims more strictly. Lincoln argued that the same medical evidence used to approve benefits was no longer sufficient and misclassified the claimant’s job as a sedentary “social worker,” rather than her actual light-duty role as a patient care coordinator. They also downplayed her documented conditions, framing them as largely subjective despite objective evidence like MRIs and EMG testing.

On appeal, the legal strategy focused on correcting the job classification, strengthening medical evidence, and introducing a functional capacity evaluation (FCE), which concluded she had no safe capacity for work. Additional support was obtained from multiple treating providers to confirm that her limitations existed even at the time of the initial denial. Importantly, the appeal argued not only that she couldn’t perform her own occupation, but also that she lacked the capacity for any full-time work, setting up protection against future denials under stricter policy definitions.

The case highlights several common insurer tactics, including ignoring relevant medical records, relying on internal doctors to justify denial, and applying greater scrutiny to younger claimants due to long-term financial exposure. It also underscores key lessons for claimants: ensure all medical evidence is submitted, verify how your occupation is defined, and build a strong, forward-looking case early. Ultimately, a comprehensive appeal that combines medical, vocational, and legal arguments can successfully overturn even well-supported initial denials.

Our disability insurance lawyers discuss a federal appellate court decision involving a long-term disability claim against Unum. The claimant, a personal injury trial attorney, had received disability benefits for 18 years due to severe depression that prevented him from performing the highly stressful duties of litigation. After many years of paying benefits, the insurer reviewed updated medical records, concluded that the attorney had improved, and terminated his benefits. The insurer even attempted to recover the benefits it had paid over the previous 18 years, claiming he had misrepresented his ability to work.

Although a lower federal court initially sided with the insurance company, the claimant appealed to the Sixth Circuit Court of Appeals. The appellate court overturned the lower court’s decision, ruling that the insurer could not simply rely on signs of improvement outside the work environment to conclude that the claimant could return to his profession. The court emphasized that the attorney’s depression was closely linked to the extreme stress of litigation, and returning him to that environment would likely trigger a relapse and make him disabled again.

The attorneys discussing the case highlight its importance for disability claimants. The decision reinforces that improvement in everyday life does not necessarily mean someone can safely return to a demanding job, particularly when the work itself contributed to the condition. Because the ruling comes from a federal appellate court, it carries significant legal weight and may influence similar disability cases in the future, offering stronger support for claimants facing benefit terminations after long periods of receiving disability payments.

Discover a disability insurance case in which disability insurance attorney Rachel Alters successfully overturned a denial by Prudential Financial for a senior technology engineer who had been suffering from severe mental health conditions, including anxiety, depression, and PTSD, along with back problems. The claimant had worked for the company for over a decade and initially received disability benefits after Prudential approved his claim. However, after about five months of payments, the insurer abruptly terminated his benefits, claiming—based on a paper review by a consulting physician—that he was capable of returning to work, even though his condition had actually worsened and his medications had been increased.

After obtaining the full claim file, Rachel Alters discovered that Prudential relied on selective excerpts from medical records and ignored the broader evidence showing the claimant’s declining condition. To challenge the denial, she worked closely with the claimant’s treating physicians to create detailed, customized medical questionnaires that addressed the insurer’s stated reasons for denial and documented the claimant’s functional limitations. These tailored physician statements were significantly more comprehensive than standard insurance forms and were designed to anticipate and rebut the opinions of the insurer’s reviewing doctors. The appeal package took months to assemble and included extensive medical documentation and physician support.

The appeal was ultimately successful, and Prudential reversed its denial within about 45 days, reinstating the claimant’s benefits based on his mental health conditions. However, the insurer did not yet approve benefits based on his physical back condition. This distinction is important because many group disability policies limit benefits for mental health claims to 24 months, while physical disabilities can qualify for benefits until retirement age. As a result, the legal team plans to continue building medical evidence related to the physical condition to potentially extend the claimant’s eligibility for long-term benefits.

When someone becomes disabled and unable to work, they may turn to their disability insurance for financial support. Unfortunately, not all claims are approved. Such was the case for Ms. A., whose disability claim was denied by Lincoln, her insurance provider. According to Lincoln, Ms. A.’s occupation as a “Medical Social Worker” was classified as sedentary work, meaning her job primarily involves sitting. Based on this classification, Lincoln denied her claim. However, Ms. A.’s actual job duties were closer to that of a Coordinator of Rehabilitation Services, which is classified as a light work occupation. This classification involves walking or standing to a significant degree, not just sitting.

Ms. A. did not take this decision lightly and took action to appeal the decision. She underwent a Functional Capacity Evaluation (FCE) to assess her ability to work. The FCE identified various limitations in her mobility, strength, and positional tolerance, among other factors. The results of the FCE concluded that Ms. A.’s abilities and tolerances fell below those associated with sedentary level work. She could not safely lift or carry any weight and could not productively sit, stand or walk without extended rest breaks in between.

PA-C Sanchez, who reviewed the FCE results, confirmed Ms. A.’a functional impairments. He attested to her inability to perform the main duties of her occupation as a Care Transitions Coordinator due to her chronic medical conditions and associated deficits. In addition, he confirmed that Ms. A. will experience good and bad days, require frequent unscheduled interruptions of work, frequently miss work, and be an unreliable employee.

Based on these findings, Ms. A. requests that Lincoln overturn their erroneous decision to deny her claim for benefits, approve her claim for long term disability benefits, forward back benefits owed, and reimburse premiums paid after disability onset. She also requests a copy of any reports created by Lincoln or its agent concerning her claim so that she may respond accordingly prior to the final determination on her claim. Additionally, she requests contact from Lincoln to arrange conferences with her treatment providers if necessary.

It is unfortunate that Ms. A. had to go through this process to receive the support she needs. Still, it is essential to recognize that insurance companies often rely on generic occupational classifications rather than considering the actual job duties of the claimant. In this case, Ms. A.’s FCE results provided concrete evidence of her functional impairments, and her treating provider confirmed her inability to perform her job’s main duties. Therefore, it is crucial to consider all available evidence before denying a disability claim.

This case involves a diesel fleet mechanic with severe degenerative disc disease and sciatica whose physically demanding, heavy-duty job became impossible due to chronic back pain supported by clear objective medical evidence (MRIs and imaging). He initially hired a non-specialized law firm that submitted a weak short-term disability insurance application with limited records, leading to a quick denial. They also handled the appeal and long-term disability claim poorly, both of which were denied, and then dropped him. By the time he sought new help, he was beyond the usual 180-day ERISA appeal deadline, but temporary COVID-related Department of Labor deadline extensions preserved his right to appeal.

We rebuilt the claim properly: obtaining full medical records, detailed support letters from treating doctors, a functional capacity evaluation showing he could perform only sedentary work (not his heavy mechanic job), and highlighting flaws in New York Life’s denial, which relied only on in-house nurse and doctor reviews with no independent specialists or functional testing. The comprehensive appeal led New York Life to overturn the denial, pay back long-term and even short-term benefits, and the same evidence supported a Social Security Disability approval. Going forward, the key issue will be the policy’s switch after 24 months from an “own occupation” to an “any occupation” standard, requiring continued strong medical proof to show he cannot perform other gainful work, even at a sedentary level.

This discussion covers a long-term disability case involving a registered nurse whose claim with Lincoln Financial was initially approved but later denied at the 24-month mark, when the policy definition changed from “own occupation” to “any occupation.” The nurse suffered from lumbar spine issues and knee problems that made the physically demanding duties of hospital nursing—lifting patients, standing, and constant movement—impossible. While Lincoln paid benefits during the “own occupation” period, they later argued she could perform sedentary nursing-related roles (like triage or chart review) based on a paper medical and vocational review, without fully accounting for her pain, functional limits, or medication side effects.

On appeal, we built a much stronger evidentiary record. We obtained an in-depth functional capacity evaluation, supportive reports from treating providers, and expert vocational input showing she could not reliably perform even sedentary work. The appeal emphasized that disability isn’t just about the ability to sit—it also involves concentration, cognitive stamina, and consistent performance, all of which were impaired by chronic pain and medication. With this comprehensive approach, Lincoln overturned the denial and reinstated benefits, though the claimant must continue providing ongoing proof. The case highlights how insurers often target claims at the “any occupation” transition and why detailed medical, functional, and vocational evidence is critical.

We discuss a successful appeal against Unum Insurance Company on behalf of a woman in her 40s who worked as a county transportation manager. After suffering a traumatic brain injury from a fall, she was initially approved for disability benefits and paid for six months. Despite ongoing cognitive impairments, memory loss, and difficulty concentrating—conditions critical to her demanding and safety-sensitive job—Unum terminated her benefits based solely on paper reviews by peer-review doctors who concluded she had recovered, without conducting any neuropsychological testing.

Long term disability attorney Rachel Alters appealed the termination by identifying this key gap in Unum’s evaluation and obtaining a comprehensive neuropsychological exam, which showed severe cognitive dysfunction preventing the claimant from performing not only her own occupation but any gainful work. The appeal succeeded, and Unum reinstated benefits. The case highlights the importance of objective cognitive testing, detailed medical documentation, and proactive claim management—especially for claimants with cognitive impairments—to both win appeals and protect benefits as the definition of disability later shifts from “own occupation” to “any occupation.”

The video discusses a resolved disability insurance lawsuit against New York Life involving a high-level software engineer who was denied both short-term and long-term disability benefits. Despite suffering from severe lower-back pain, radiculopathy, rare Tarlov cysts, and Ehlers-Danlos syndrome, New York Life denied her claims based on a paper-only peer review and ignored extensive objective medical evidence. Her medical conditions caused significant pain and cognitive difficulties that prevented her from performing the demanding analytical and programming duties of her job, and her treating physicians strongly supported her disability claim.

After her appeals were denied, the attorneys filed an ERISA lawsuit seeking recovery of both short-term and long-term benefits. Although ERISA cases carry litigation risks and limited remedies, the strong medical record made the case compelling. During court-required mediation, the claimant chose a lump-sum settlement to avoid uncertainty and further risk, resulting in a favorable resolution without a trial.