Can a Hartford denial of your long term disability claim be overturned? Yes it can.
Our firm recently filed an ERISA lawsuit, on behalf of our New York client after The Hartford determined that, after paying long term disability benefits for over 3 years due to her diagnosis of Relapsing-Remitting Multiple Sclerosis, she no longer met the Plan’s definition of disability and was no longer eligible for continued benefits. The New York court reviewed the administrative record and found that The Hartford had abused its discretion in denying our client’s claim.
There are 3 ways that The Hartford wrongfully denied our client’s Long Term Disability claim.
- The Hartford failed to consider the Social Security Administrations Notice of Award.
After Hartford initially approved our client’s claim for long term disability benefits, it offered her assistance with applying for Social Security benefits. With Hartford’s assistance, the Social Security Administration rendered a “fully favorable” decision and she was awarded benefits. Accordingly, Hartford applied an offset to her long term disability benefits as a result of her also receiving the SSDI benefits. However, when Hartford determined that our client was no longer eligible to receive benefits, it failed to give the SSA’s favorable decision any weight.
- The Hartford Did Not Consider Contrary Medical Evidence regarding Multiple Sclerosis.
The New York Judge acknowledged that although The Hartford was not required to give special weight to the opinions of our client’s treating physicians, The Hartford is not permitted to rely on medical reports which support its denial of benefits without further investigation and consideration of more detailed reports which provide medical evidence to the contrary. Our client was treated by her neurologist just prior to Hartford’s denial of benefits. His report specifically documents the presence of “black holes” on her most recent Brain MRIs and in his opinion “all neurological experts attest” that their presence “correlated well with the degree of a patient’s disability”. The Hartford had two physicians conduct peer reviews of our client’s medical records and both reviews failed to mention the documentation from the neurologist regarding the MRI findings. The Court found that The Hartford’s decision to rely on the opinions of its peer review physicians was arbitrary and capricious due to the fact that our client’s neurologist discussed an important finding that was significant to her limitations and her disability which Hartford’s peer review physician entirely failed to address. The Hartford should have conducted further investigation regarding the MRI findings and the effects of the “black holes” on our client’s functionality.
- The Hartford Was Wrong To Rely On Surveillance Video
While The Hartford was paying our client her continued long term disability benefits, it conducted yearly reviews of her claim to determine her continued eligibility for benefits. During the last review, our client gave information to Hartford that she was not able to perform some daily activities and that she required assistance from her husband and mother. In contrast, her neurologist informed The Hartford that she did not require assistance to perform daily activities. In an effort to sort out this discrepancy, Hartford conducted video surveillance of the client to determine what activities she was actually capable of performing.
The Court found that Hartford heavily relied on the surveillance video when making its determination to deny benefits. The Court stated that the video surveillance did not contradict her statement that she was not able to sit for most of a workday, nor did the video show that she was able to perform work-related tasks, such as sitting, standing or walking, for 8 hours per day, 40 hours per week.
The client suffered from Relapsing-Remitting Multiple Sclerosis which, as the name suggests, is a disease process that fluctuates over time. The Court found that, based on the above reasons, Hartford’s determination that the client’s condition has improved such that she was no longer disabled from performing full-time sedentary work was incorrect. The Court granted our client’s motion for summary judgment and awarded her benefits and attorney’s fees, with judgment withheld until the amount of benefits due was determined.
Our firm has handled claims against The Hartford for over 20 years and we can assist you too. For more information please visit www.disabilitydenials.com or call 1-800-562-9830 to discuss your particular Disability Insurance issue. Be sure to download a copy of our free e-book: Disability Insurance Policies, How to Unravel the Mystery and Prove Your Claim.