Berg v. Lincoln National Life Insurance Company
2025 WL252481 (E.D. Washington, January 21, 2025)
Our client, Barbara Berg, was a long-time employee of Walmart, employed as a “Team Lead” when she became disabled primarily as the result of complex regional pain syndrome, a chronic pain condition. Walmart’s long term disability insurer, The Lincoln National Life Insurance Company (“Lincoln”) initially paid benefits but then had some of Ms. Berg’s medical records evaluated by its reviewing doctor who concluded that she was no longer disabled. Notably, Lincoln did not provide the reviewing doctor with questionnaires completed by Berg’s primary physician, Dr. Barry Bacon. Based on the reviewing doctor’s report, Lincoln terminated Berg’s long term disability benefits. Almost simultaneously, the Social Security Administration granted Berg Social Security Disability benefits, an Administrative Law Judge finding that Berg was disabled under the Social Security Administration’s rules.
Pursuant to the policy and standard ERISA practice, Berg submitted an “appeal” of the termination of her LTD benefits. Her appeal consisted of Dr. Bacon’s questionnaire answers and the Social Security Administration Administrative Law Judge’s Notice of Decision finding that Berg was disabled under Social Security rules and explaining why. In response to the appeal and additional medical records that Berg submitted, Lincoln obtained another medical records review from a different doctor, an addendum review by that new doctor, and a vocational review. But none of those reviews addressed Dr. Bacon’s questionnaire answers or the Social Security Administration Administrative Law Judge’s decision or its reasons for its decision. Lincoln then denied the appeal.
Ms. Berg hired the ERISA Law Center, we filed suit seeking reinstatement of her long term disability benefits, and the trial judge agreed with us. In court, Lincoln argued that it had reports from four doctors, all of whom concluded that Ms. Berg could work in any occupation, and it had two vocational evaluations which identified occupations she could perform – all technically true statements. But Lincoln’s doctors and vocational reviewers’ opinions did not address the persuasive and credible evidence offered by Dr. Bacon in his questionnaire answers and by the Social Security Administration Administrative Law Judge that Ms. Berg is disabled by her chronic pain condition.
ERISA regulations require plans and insurance companies which decide disability claims to consider the claimant’s doctor’s opinions and any Social Security award and if they disagree, with the treating doctor’s opinions or a favorable Social Security to explain why. But Lincoln did not do so. Lincoln only considered the Social Security award to demand that Ms. Berg repay money it had paid to her but ignored it concerning the substance of the Social Security Administrative Law Judge’s decision. Certain of Lincoln’s doctors’ reports were prepared before Dr. Bacon provided his questionnaire answers, so those doctors did not address Dr. Bacon’s opinions. Lincoln withheld Dr. Bacon’s questionnaire answers from one doctor; its final doctor acknowledged reading Dr. Bacon’s questionnaire answers but did not explain why he disagreed with them. Only Lincoln’s final doctor and its final vocational reviewer wrote reports after Lincoln received the Social Security Administration’s ALJ’s Notice of Award. Lincoln withheld the report from its vocational reviewer and either withheld the report from its final medical reviewer or that doctor simply didn’t comment upon it. Given these facts the trial judge quite reasonably concluded that Dr. Bacon’s opinions and the Administrative Law Judge’s conclusions were credible and persuasive, and that Lincoln’s doctors’ opinions and its vocational opinions were not.
If your long term disability benefits were terminated or denied by Lincoln, you need to be aware that Lincoln only “goes through the motions” and pretends to fully and fairly review your evidence and only pretends to follow and apply important policy terms. The ERISA Law Center has long experience challenging Lincoln’s unfair claim decision and can help you.
