Dorian Law Takes Meta Employee’s Lincoln LTD Denial to Judgment — and Wins the Question That Decided the Case
Decision · N.D. Cal. · October 21, 2026
On October 21, 2026, a federal judge in the Northern District of California held that The Lincoln National Life Insurance Company wrongly denied a Meta employee’s long-term disability claim under the Policy’s pre-existing condition exclusion, found him Disabled from May 15, 2024 through at least February 5, 2025, denied Lincoln’s cross-motion, and sent the claim back to Lincoln with instructions. Dorian Law represented the claimant from the administrative appeal through the bench trial.
Fuchs v. The Lincoln National Life Insurance Company, No. 3:25-cv-05810-TLT (N.D. Cal. Oct. 21, 2026)
Order Granting Plaintiff’s Motion for Judgment in Part (Dkt. 65), Hon. Trina L. Thompson, after a Rule 52 bench trial held August 24, 2026. De novo review.
- Pre-existing condition denial: rejected. Lincoln used the wrong effective date of coverage because it did not apply the Policy’s Rehire Terms.
- Disability: proven by a preponderance of the evidence under the Own Occupation standard from May 15, 2024 through at least February 5, 2025.
- Lincoln’s motion for judgment: denied.
- Remand: Lincoln is ordered to determine whether disability continued beyond February 5, 2025 and to calculate the monthly benefit, including any offsets. The claim remains pending on remand.
A Meta employee, a brain injury, and a rehire six months later
The claimant worked at Meta as a Product Content Strategist from March 9, 2020 until June 23, 2023. In August 2023, after his employment ended, a mountain-biking accident in Telluride, Colorado left him with a traumatic brain injury and multiple fractures.
On December 20, 2023 — just under six months after his termination date — he signed an offer letter to return to Meta as a Content Designer, and disclosed on his application that he was neurodivergent. He started work on January 22, 2024.
He had expected to keep recovering. In April 2024 he learned, in his words, that his “brainwaves were out of sync,” and his neurology team told him not to expect natural improvement in memory or cognitive ability. He stopped working on May 15, 2024. His long-term disability claim listed traumatic brain injury, post-concussion syndrome, visual perceptual impairments, diplopia, and right fourth cranial nerve palsy. Lincoln’s own reviewing psychiatrist later described the condition as TBI with cognitive impairment assessed as Mild Neurocognitive Impairment, with deficits that “persisted and cause the current impairment.”
Lincoln administers Meta’s California Voluntary Disability Plan. It approved that claim and paid it through the end of the maximum benefit period on May 13, 2025. Lincoln also insures and administers Meta’s LTD Policy. On December 18, 2024, it denied the LTD claim under the Policy’s pre-existing condition exclusion — and, as the Court later found, never made any determination about whether he was Disabled at all.
What Lincoln got wrong
The exclusion, and the date that decides it
The Policy’s exclusion is a standard “3/12” clause. It bars benefits for a disability that begins in the first 12 months after the claimant’s effective date of coverage if the claimant received a physician’s advice or treatment for the condition in the three months before that date. Everything turns on which date is the effective date of coverage.
Lincoln used January 22, 2024, the day he started his second stint at Meta. That produced a look-back window of October 22, 2023 to January 21, 2024 — squarely inside his post-accident treatment — and a disability onset inside the 12-month window. On those dates, the exclusion applies.
The provision Lincoln skipped
Meta LTD Policy, Section 3 — Rehire Terms
“If a former Employee is re-hired by [Meta] within 6 months of his termination date, all past periods of Active Employment with [Meta] will be used in determining the re-hired Employee’s Eligibility Date. If a former Employee is re-hired by [Meta] more than 6 months after his termination date, he is considered to be a new Employee when determining his Eligibility Date.”
Under the Policy, an employee’s effective date of coverage is his Eligibility Date. The claimant was terminated June 23, 2023 and accepted Meta’s offer December 20, 2023, within six months. If the Rehire Terms apply, his three prior years of Active Employment count toward his Eligibility Date, his effective date of coverage for exclusion purposes reaches back to 2020, and a May 2024 disability falls nowhere near the 12-month window. The exclusion drops out of the case.
Lincoln’s two answers, and why the Court rejected both
First, Lincoln argued that “re-hired” means the day he actually started work — January 22, 2024, more than six months after termination — so he was a new employee. The Court looked to the ordinary meaning of the undefined term, as the Ninth Circuit directs in Gilliam v. Nevada Power Co., 488 F.3d 1189 (9th Cir. 2007). Merriam-Webster defines the verb “hire” as giving someone work in exchange for wages; its thesaurus lists “engage” as a synonym. Black’s Law Dictionary (12th ed. 2024) defines it as engaging another’s labor for payment. The Court concluded that “hire” means “to engage.” It also held that if “re-hired” simply meant “in Active Employment” — a term the Policy separately defines — the word “re-hired” would be surplusage. In the alternative, the Court found the term ambiguous and applied contra proferentem under Blankenship v. Liberty Life Assurance Co. of Boston, 486 F.3d 620 (9th Cir. 2007), construing the ambiguity against the insurer. Either way: he was re-hired on December 20, 2023.
Second, Lincoln argued that the Rehire Terms do nothing in this Policy because their only function is to credit past service against an Eligibility Waiting Period, and Meta chose a waiting period of “None.” The Court rejected that reading because it would render the provision meaningless. Ninth Circuit law requires each provision of an ERISA plan to be read so that none is rendered nugatory.
The Court also addressed Lincoln’s argument that the claimant’s reading would hand re-hires free retroactive coverage for the months they were gone. It does not. A re-hire still has to return to Active Employment and work at least 20 hours a week before any coverage exists; the Rehire Terms change only the reference date the exclusion is measured from. The Court found no absurd result.
From the Order
“Simply put, the Court declines to interpret the Policy in a manner that effectively writes the Rehire Terms out of existence.”
Fuchs v. Lincoln National Life Ins. Co., Dkt. 65 at 18 (N.D. Cal. Oct. 21, 2026)
Disability was proven with Lincoln’s own physicians’ opinions
Because Lincoln stopped at the exclusion, it never decided whether the claimant met the Policy’s definition of Disabled. The Court resolved that question itself for the period the record supported.
Lincoln had sent the file to two physicians selected through Dane Street. Its psychiatrist, Dr. Martin Lipschutz, opined that full impairment was supported from May 15, 2024 and ongoing, with reassessment recommended on February 5, 2025 when cognitive rehabilitation was expected to be complete. Its neurologist, Dr. Laura Edinger, supported restrictions on screen use from May 15, 2024 onward. Meta’s job evaluation form described a sedentary Content Designer role spent 60 percent of the day typing, with modified duty available only short-term and no part-time option. Read together, nothing in Lincoln’s neurologist’s opinion showed he could perform the Substantial and Material Acts of his own occupation with reasonable continuity, and its psychiatrist’s opinion supported Disability through February 5, 2025.
Two further pieces mattered. First, Lincoln’s payment of state disability benefits for nearly a year was relevant evidence of Disability under the Ninth Circuit’s August 2026 decision in Mendoza v. First Unum Life Insurance Co., No. 25-3080 (9th Cir. Aug. 10, 2026) — relevant, though not a presumption. The Court was able to compare the two plans’ definitions because, on October 5, 2026, it granted our motion to admit Meta’s state disability plan document outside the administrative record under Opeta v. Northwest Airlines Pension Plan, 484 F.3d 1211 (9th Cir. 2007). Second, in its response to the Court’s supplemental questions, Lincoln stated that the record “does not clearly establish Disability beyond 2/5/25” — which the Court read as a tacit concession that the record did establish Disability through that date.
Beyond February 5, 2025, the Court found the administrative record “simply not developed enough” to decide disability either way. A treating physician’s note said he could not return to full, unrestricted duty until at least September 8, 2025, but the record contained nothing about whether cognitive rehabilitation was completed or how he functioned afterward, and the Court held that the note and the state disability payments, standing alone, were not enough. On that basis it exercised its discretion to remand for an initial determination of disability after that date and the monthly benefit amount, rather than awarding benefits through the date of judgment. (Under the Policy’s Elimination Period, benefits on a May 15, 2024 onset would not have become payable until at least November 11, 2024 in any event.) We argued for the full award; the Court drew the line where it found the evidence ran out. That is an honest description of where the case stands, and it is why the matter remains pending.
The argument the AI did not find
Before this case was filed, the Policy and Lincoln’s denial letters were run through general-purpose AI tools with a single instruction: find every argument that supports payment of benefits. After extensive prompting — including attempts to lead the tools toward the rehire provision directly — they concluded Lincoln was right.
The argument the Court adopted came from reading the Policy as one integrated instrument: the exclusion, the eligibility provisions, and the Rehire Terms as a single mechanism, with each term given effect. That is how an ERISA litigator reads a group policy. In this matter, the tools did not.
The practical point is for claimants, not for the firm. A person who feeds a denial letter into an AI tool and is told the insurer is correct may walk away from a valid claim. The denial letter in this case was wrong, and the tools agreed with it. An unfavorable AI assessment is not a substitute for having the complete policy read by someone who knows what to look for.
How the case was built
Dorian Law handles claims using the Litigation Back Approach: the outcome in federal court is reverse-engineered, and the administrative appeal is written as the trial record it will become. In an ERISA case the Court generally decides on the administrative record, so the evidence, the policy provisions, and the insurer’s response to the claimant’s position all need to be in that record before the lawsuit is filed.
Here is what that looked like in this case. The June 5, 2025 appeal letter invoked the Rehire Terms, set out the December 20, 2023 acceptance date, and included the dictionary definitions of “hire” that the Court would later rely on. Lincoln answered on June 11 and 12, 2025, taking the position that accepting an offer is not being hired. A July 3, 2025 reply addressed that position point by point. Lincoln issued its final denial on July 9, 2025 and confirmed that administrative remedies were exhausted. The complaint was filed the next day, July 10, 2025. The record Lincoln built in rejecting the argument became the record the Court used to reject Lincoln’s reading.
Brent Dorian Brehm reviewed the Policy, identified the provision Lincoln had not applied, wrote the appeal, briefed the cross-motions for judgment, and argued the bench trial. There was no hand-off between the lawyer who found the argument and the lawyer who tried it. On a claim like this one, where the decisive issue was a single clause in a 70-page group policy, that continuity is the asset.
Dorian Law prepares every case to be tried, and tries it when a reasonable resolution is not offered. The Policy and the record decide whether a case should settle; the insurer’s preference does not.
Three dates to check in your own file
If you left an employer and came back, and your LTD claim was denied as pre-existing, pull these dates before you accept the denial:
- Your termination date. The last day of the earlier period of employment.
- The date you accepted the new offer. Not your start date — the date you signed or accepted.
- Your start date. The date the insurer is probably using as your effective date of coverage.
If the gap between the first and second date is under six months, find the rehire, reinstatement, and eligibility language in your group policy and read how the three work together. The result in this case depended on the specific wording of Meta’s Policy; whether your policy produces the same result is the question to answer before you accept the denial.
Who this ruling matters for
- Meta employees, and anyone insured under a Lincoln group LTD policy, whose claim was denied under a pre-existing condition exclusion. Rehire and reinstatement provisions appear in many group policies; whether yours reads like Meta’s is something to check, not assume.
- Anyone laid off or terminated and rehired by the same employer within months. In this case the insurer used the latest start date as the coverage date. If yours did the same, the policy may say otherwise.
- Anyone with a traumatic brain injury, post-concussion syndrome, or cognitive impairment claim whose short-term or state disability benefits were paid and whose LTD claim was then denied. Under Mendoza, payment of the earlier claim can be relevant evidence of disability, and a pre-existing condition denial often turns on how the policy is read rather than on your medical records.
Dorian Law is a California boutique firm whose entire practice is the litigation of denied disability, life, accidental death, and ERISA benefit claims, in federal courts nationwide. Consultations are free, and we review the policy and the denial letter ourselves before telling you whether there is a case.
Questions this decision answers
In an order filed October 21, 2026, Judge Trina L. Thompson of the Northern District of California held that Lincoln erred in denying long-term disability benefits under Meta’s LTD Policy based on the pre-existing condition exclusion, because Lincoln did not apply the Policy’s Rehire Terms when it set the claimant’s effective date of coverage. The Court found the claimant Disabled under the Own Occupation standard from May 15, 2024 through at least February 5, 2025, denied Lincoln’s cross-motion for judgment, and remanded the claim to Lincoln to determine disability beyond that date and the monthly benefit amount. The case number is 3:25-cv-05810-TLT.
A 3/12 exclusion bars LTD benefits for a disability that begins within the first 12 months after the claimant’s effective date of coverage, if the claimant received a physician’s advice or treatment for the condition (or a related one) in the 3 months immediately before that effective date. Both conditions must be met. The exclusion is only as accurate as the effective date the insurer uses, which is why the date, not the medical records, was the deciding issue in Fuchs.
Rehire Terms are a provision, common in Lincoln group policies, stating that an employee re-hired within a set period (six months in Meta’s Policy) has all past periods of Active Employment counted when determining his Eligibility Date. Because the effective date of coverage is the Eligibility Date, a re-hire with more than 12 months of prior service will have an effective date well outside the pre-existing condition look-back window. In Fuchs, the Court held that Lincoln was required to apply the Rehire Terms and that reading them as inapplicable because the employer chose no waiting period would write the provision out of the Policy.
It depends on the policy’s rehire or reinstatement language, but under the Policy at issue in Fuchs the answer was yes. The Court held that “re-hired” means “to engage,” so the claimant was re-hired when he accepted Meta’s offer on December 20, 2023, inside the six-month window, even though he did not start work until January 22, 2024. Coverage itself still did not begin until he returned to Active Employment; the Rehire Terms changed only the date from which the pre-existing condition exclusion was measured.
No, but it is evidence in your favor. In Mendoza v. First Unum Life Insurance Co., No. 25-3080 (9th Cir. Aug. 10, 2026), the Ninth Circuit held that prior payment of short-term disability benefits is relevant evidence of disability but does not create a presumption of entitlement to LTD benefits. In Fuchs, the Court treated Lincoln’s payment of state disability benefits from May 22, 2024 through May 13, 2025 as relevant evidence supporting its finding of Disability, alongside the opinions of Lincoln’s own reviewing physicians.
Yes, and it is a common denial when the injury happened shortly before coverage began or resumed. In Fuchs, the claimant’s TBI occurred in August 2023, he returned to work in January 2024, and he stopped working in May 2024 after cognitive decline; Lincoln’s reviewers confirmed he was treated for the TBI during the look-back period. The denial failed anyway because the Policy’s Rehire Terms moved the effective date of coverage back to 2020. The medical facts are often not the issue in a pre-existing condition denial; the policy reading is.
Because the administrative record ended in early 2025. The Court found Disability through February 5, 2025, the date Lincoln’s own psychiatrist recommended reassessment, but the record contained nothing about whether cognitive rehabilitation was completed or how the claimant functioned afterward. Lincoln had never progressed past its pre-existing condition review. Exercising its discretion under Mongeluzo v. Baxter Travenol, the Court remanded for Lincoln to make an initial determination on disability beyond that date and to calculate the monthly benefit, including any offsets. The Court noted that remand is not a second bite at the apple where the insurer’s first decision was simply wrong; here the record was underdeveloped.
About this result. The order described above resolved cross-motions for judgment under Rule 52 and remanded part of the claim to Lincoln; the matter remains pending. Results depend on the facts and law of each case, and prior results do not guarantee a similar outcome (Cal. R. Prof. Conduct 7.1). Medical and employment facts are stated as found in the Court’s order. Attorney advertising.