In this video, attorneys Gregory Dell and Stephen Jessup discuss the importance of medical documentation by a treating physician. They need to include what impact that condition has on the claimant’s ability to do his or her job. Mr. Jessup won a recent case against Lincoln Financial Group when, on a second administrative appeal, he was able to present convincing evidence that the claimant, who suffered from multiple sclerosis (MS), could not do her job.
After several years of working with the MS diagnosis, the claimant’s condition deteriorated. She was fatigued, fell a lot, and could not concentrate. She filed a claim for short term disability benefits, which Lincoln approved. When she applied for long-term disability benefits based on the same diagnosis and medical information, Lincoln denied her claim and her subsequent appeal.
Lincoln requires a second administrative appeal before an ERISA lawsuit can be filed and this when Mr. Jessup got involved. A new treating physician evaluated the claimant’s condition, ordered a functional capacity evaluation (FCE) test, and concluded, without question, that she could no longer perform the duties of even a sedentary job.
On this second appeal, Lincoln had a different physician review the claimant’s medical records. This second reviewer agreed the claimant was disabled, so Lincoln awarded her benefits and also paid her back benefits.
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