District Court Affirms Lincoln National’s Denial of Long-Term Disability Benefits After In-Person Examination Concluded That Plaintiff Did Not Suffer Cognitive Impairment Precluding Work

In Copeland v. The Lincoln National Life Insurance Co., No. 1:19-CV-1033, 2024 WL 4471155 (W.D. Mich. Oct. 11, 2024), Michigan Western District Judge Jane M. Beckering affirmed Defendant Lincoln’s determination denying Plaintiff’s claim for long-term disability benefits under an employer-sponsored benefit plan, finding that Lincoln equally weighed and fairly considered all the evidence in the record and obtained an in-person examination before concluding that Plaintiff was not entitled to LTD benefits.

Plaintiff was employed as a Computer Programmer and Analyst at Edward Rose & Sons, when she stopped working and sought disability benefits due to chronic fatigue syndrome, fibromyalgia, dysthymia, degenerative back disease, and epilepsy/seizure disorder. Lincoln denied Plaintiff’s claim after an in-house medical review by neurologist, Dr. David Hoenig, as well as an independent medical examination (“IME”) by neuropsychologist Dr. Christopher Contardo both concluded that Plaintiff was not functionally impaired from performing her occupation. Dr. Hoenig opined that Plaintiff did not have significant cognitive deficits from a neurological perspective, and past neuropsychological evaluation was negative for significant cognitive pathology. After performing updated cognitive testing, Dr. Contardo concluded that Plaintiff did “not have any significant cognitive deficits with regards to academic achievement, verbal learning and memory, non-verbal learning and memory, language functioning, visuospatial processing, processing speed, or executive functioning. In its denial letter, Lincoln also reasoned that the restrictions and limitations outlined by Plaintiff’s treating providers were not medically supported and were inconsistent with the true objective medical evidence in the file and on examination.

Plaintiff appealed, submitting updated records and several physician support forms arguing that Lincoln’s reviewers “failed to appreciate the multitude of factors identified: her ongoing seizure disorder, depression, chronic fatigue, back disease and medication effects have left her unemployable.” After a further nurse review of the updated information, Lincoln upheld the denial finding there was no evidence in the file of physical functional limitations, and neurocognitive testing, peer review, IME, and neurology notes did not support Plaintiff’s cognitive concerns. Plaintiff submitted a second appeal, this time relying primarily on an opinion by the Social Security Administrative Law Judge, who determined that Plaintiff was not disabled prior to April 30, 2018. The ALJ also discredited the medical opinions of several of Plaintiff’s treating providers, finding that they were not consistent with the objective evidence and overstated Plaintiff’s limitations. Lincoln again upheld the denial after another nurse review reached the same conclusion as Drs. Contardo and Hoenig, that Plaintiff had no significant neurological or cognitive limitations. The instant lawsuit ensued.

Upon review of Lincoln’s claim file (also known as the Administrative Record), the Court found that Plaintiff failed to satisfy her burden of demonstrating continuous disability throughout the elimination period. The Court reasoned although medical records demonstrated that Plaintiff experienced some cognitive decline, and Plaintiff had consistent subjective complaints, the records did not show such a drastic decline to prevent her from performing any of the main duties of her occupation. The Court distinguished case law cited by Plaintiff criticizing the plan administrator for discrediting the claimant’ s subjective complaints as unlike Plaintiff’s claim, no in-person examination was sought. The Court further found that Lincoln had adequately considered the ALJ decision, which was based on a different record. And, contrary to Plaintiff’s assertion, the Court also found that Lincoln adequately considered the intellectual aspects of Plaintiff’s occupation in its assessment of the claim.

If Lincoln National Life Insurance Company or your insurer has denied or otherwise limited your disability insurance claim, contact us for assistance.