Long term disability attorneys Greg Dell and Alex Palamara discuss why disability insurers like Lincoln often deny appeals even when multiple treating doctors support a claimant’s disability. Greg points out a common pattern: claimants may have four or five supportive medical sources, plus objective testing such as functional capacity exams. Yet disability insurance companies routinely rely on a single doctor—paid by the company—who performs only a “paper review,” never examines the claimant, and highlights isolated normal findings to justify a denial.

Alex explains that although this practice is unreasonable, insurance companies are often allowed to do it under current law. In many jurisdictions, a claimant not only must prove disability but must also show that the insurer’s denial was “arbitrary and capricious.” Because insurers only need one medical opinion to claim they had a “reasonable basis,” courts frequently uphold their decisions unless the claimant can expose flaws in that doctor’s review.

Greg adds that some states have outlawed “discretionary clauses,” which gave insurers the power to interpret their own policies with judicial deference. When these clauses are banned, courts apply a de novo (fresh) review and evaluate the evidence independently. Under de novo review, judges weigh multiple treating doctors against the insurer’s lone reviewer, making it easier for claimants to prevail—especially when the insurer’s doctor never examined the claimant and provides little justification.

Alex also highlights that insurers sometimes fail to send reviewing doctors the full file, meaning their conclusions may be based on incomplete information. This becomes another point of attack in litigation.