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SMDA convinces Lincoln National Life to overturn claims denial Decision

Lincoln National Life recently overturned its decision to deny an SMDA client’s claim after we filed an administrative appeal of Lincoln’s claim’s denial decision.

Our client had worked for FoMoCo for more than a decade when the facility where she worked was sold as part of a corporate restructuring. She had ongoing health issues which had previously resulted in a leave of absence and a claim for LTD benefits which had been approved and paid by the prior LTD carrier.

After the sale occurred she returned to work for a period of time. During this time the new employer changed disability insurance carriers to Lincoln National Life. When the client experienced a recurrence of her prior problem she filed a claim for benefits with Lincoln National.

Lincoln denied her request for LTD benefits finding that her medical condition was pre-existing as she had been diagnosed and treated before the Lincoln National Policy’s effective date. SMDA filed an administrative appeal convincing Lincoln that even though the client was diagnosed and treated before the effective date of the Lincoln policy she would still qualify for coverage because its policy included a clause providing for continuation of coverage if the employee was insured by the prior carrier and was able to satisfy the prior carrier’s pre-existing condition exclusion.

The entire purpose of this clause is to prevent employees from losing coverage when an employer switches Disability insurance carriers. Otherwise, each and every employee would be susceptible to disqualification for every condition that they have treated for prior to the effective date of the new policy. Kudos to Lincoln National for recognizing their error and doing the right thing.