Hartford is ordered to pay long-term disability benefits to a telecommunications manager
Many companies offer short and long-term disability insurance coverage to protect a portion of an employee’s monthly income in the event the employee is unable to work as a result of a sickness or injury. Employees pay the premiums for this insurance on a monthly basis so they’ll have something to fall back on if they ever become sick or injured. Of course, many individuals have a sense of security because of this. However, most employees are unaware that once a claim for disability benefits is submitted, the disability insurance company has a “structural conflict of interest”, as it is usually the long-term disability insurance company that both administers and pays any approved claim.
This structural conflict is significant as a claim denial allows the insurance company to keep the money for itself and increase its profits. Fortunately for disability claimants, the courts are required to consider this structural conflict of interest as one of many potentially bias factors that inappropriately motivate a disability insurance company to deny disability benefits.
As a disability insurance attorney that has handled thousands of claims against every major disability insurance company, I am constantly trying to educate potential claimants about the tactics of disability insurers. A recent case is a victory for disability policyholders as it exposed the “signs of bias” exhibited by Hartford Life and Accident Insurance Company throughout its decision making process.
Disability claim history
Robert Montour worked as a telecommunications manager for Conexant Systems for approximately 37 years. He was insured under Conexant’s group disability plan, which was funded and administered by Hartford Life & Accident Insurance Company. In July 2003, Montour filed for disability due to acute stress disorder, and his claim was approved in January 2004 following the plan’s 180 day elimination period. In approximately June 2004, he began treating with an orthopedic surgeon and he was diagnosed with degenerative changes to his right knee and back. Montour underwent arthroscopic surgery on his right knee in October 2004. In September 2004, Montour notified Hartford of his physical disabilities. Montour completed psychotherapy treatment in April 2005 and his primary disabling condition was back pain which was documented by his orthopedic surgeon during appointments in April 2005, December 2005 and May 2006.
Montour’s orthopedic physician maintained that he was physically unable to work in any occupation because of back and knee pain and placed the following restrictions on his physical activities:
- no sitting for more than 15-20 minutes at a time;
- no prolonged walking;
- no standing greater than 15 minutes at a time;
- no lifting or carrying greater than 10 pounds;
- no work at or above shoulder level;
- no moderate pushing activities;
- no moderate pulling activities; and
- no driving greater than 30 minutes.
Hartford’s calculated plan to deny disability benefits to Montour
Although Hartford had been paying Montour since January 2004, in November 2004 they began to orchestrate their plan in order to deny future disability benefits.
STAGE 1: In November and December 2005, Hartford hires two private investigating companies to conduct disability video surveillance on Montour over the course of four nonconsecutive days. During the surveillance, he was observed making two twenty minute trips to pickup his grandchildren from school and one trip of about 2.5 hours conducting errands at various stores. He was also observed to be away from his home on two occasions for about an hour and forty minutes. During this time he was observed bending once at the waste and picking up a small bag of medication.
STAGE 2: In March 2006, a Hartford investigator conducted a 4.5 hour personal interview with Montour at his home, during which time Montour reviewed Hartford’s video surveillance and explained why he cannot work. The investigator documents his observation of Montour and documented Montour’s complaints of pain during the interview.
STAGE 3: In May 2006, a Hartford nurse case manager submitted letter’s to Montour’s treating orthopedic and primary care physician surmising that Montour was capable of performing “sedentary to light” work and soliciting their agreement. Montour’s orthopedic doctor returned the letter indicating that he disagreed with Hartford’s conclusions.
STAGE 4: In July 2006, Hartford hired Dr. Brown, a consulting physician to conduct a file review of Montour’s medical records for the 2003-2006 period, including X-rays and MRIs of Montour’s back, pharmacy records, Hartford’s video surveillance and the personal interview report. Dr. Brown acknowledged that medical evidence supported Montour’s chronic pain but found that Montour nevertheless was capable of working full-time with modest restrictions, such as changing positions every thirty to forty-five minutes.
STAGE 5: In July 2006, Hartford hired a vocation rehabilitation expert to complete an Employability Analysis Report, which evaluated Montour’s experience, qualifications, and the physical restrictions indentified by Dr. Brown. The expert concluded that Montour was capable of working in a high-level managerial capacity in five different fields.
STAGE 6: In August 2006, Hartford terminates Montour’s benefits and advises him that he no longer meets the policies definition of disability.
Montour takes action following his denial of disability benefits
Following the denial of disability benefits, Montour’s disability plan required him to submit a written appeal to Hartford with any additional information that would further support his claim. Montour hired a vocational expert and submitted a vocational appraisal report stating that he was “not employable in any setting”. Furthermore, he submitted information showing that the Social Security Administration (SSA) considered him to be totally disabled. In response, Hartford once again hired a different consulting physician to review Montour’s records and the additional evidence submitted. The new Hartford doctor once again concluded that the activities depicted on the surveillance videos exceeded the activity requirements of a sedentary job and he could therefore perform a sedentary job. In February 2007, Hartford affirmed their previous decision to deny disability benefits.
In June 2007, Montour filed a lawsuit against Hartford in the California United States District Court seeking payment of his long-term disability benefits. In April 2008, the district court entered a judgment in favor of Hartford and concluded that although Hartford had a structural conflict of interest as both the administrator of the insurance policy and payor of benefits, it did not abuse its discretion in determining that Montour failed to provide sufficient evidence to demonstrate disability within the meaning of the policy.
Following his defeat at the district court level, Montour submitted an appeal to the United Stated Court of Appeals For the Ninth Circuit. In September 2009, the appellate court reversed the district court decision and held that Montour is entitled to long-term disability benefits as Hartford abused its administrative discretion and was “improperly motivated” by its conflict of interest. The appellate court concluded that Hartford abused their discretion and wrongfully denied benefits for the following reasons:
- Hartford overstated and over relies on the video surveillance of Montour;
- Hartford’s nurse case manager took an advocacy position in her letter’ to Montour’s physicians soliciting their agreement with her lack of disability conclusion;
- The doctors hired by Hartford failed to appropriately review the video surveillance;
- Hartford failed to present evidence on its part to “assure accurate claims assessment” in order to ensure a neutral review process.
- Hartford conducted a “pure paper” review rather than conduct an in-person medical evaluation of Montour;
- Hartford failed to consider SSA’s determination of disability when it was Hartford that required Montour to apply for social security disability.
While Mr. Montour finally won his entitlement to disability benefits, it is an extreme injustice that he had to battle Hartford for more than three years without receiving payments. In many cases, the involvement of a disability insurance attorney from the initial submission of an application for benefits can prevent a disability insurance carrier from implementing and executing a calculated plan to deny disability benefits.
About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of disability lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. Attorney Gregory Dell is a nationally recognized disability insurance attorney and the author of a long-term disability insurance law book published by Thomson Reuters, which is a legal reference for attorneys and judges. For a free consultation, please call 800-828-7583 or use our contact page.
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My ex-employer had Hartford as their insurer for the Short Term Disability and Long Term Disability. I was was approved for all through my Short Term Disability (with many headaches and hurdles with both the employer and Hartford). The last day of my Short Term Disability was 4/9/09, to begin the Long Term Disability on 4/10/09. I was denied and all my insurances (medical & dental) canceled unless I paid my employer out of pocket. (I didn’t find out the insurances were canceled until I went to fill a prescription 5/17/09. I had already went to a few docotor’s appt. which I was later billed for and lab work that I had done.) I had mediastinoscopy surgery on 4/9/09 — there was no way I could return to work on 4/10/09. I lost my job. Hartford’s reason for denial was that there was not sufficient evidence that I was disabled and unable to return to work. I am still disabled and have been diagnosed with Interstitial Lung Disease and CVID-Common Variable Immunoglobin Deficiecy.
Hartford just hired a Doctor to call my doctor for a review. Turns out the Hartford doctor was an advocate for me and said she thought I had a genuine problem. She also said that if it were a psychological condition, I may have better luck getting an approval for disability. My doctor agreed with the interviewing docotr that it could be psychological if that were able to help my claim..
I was an employee of NYS amd purchased both short and long term disabity. NSY doctors put me out of work. An “update form” was sent. None of my providers retirned the form, saying the state doctors see me as disabled, but they don’t. No checks or correapondance from The Hartford has surfaceced in over 8 to 10 months. Who do I call?
Mary, in order to have a successful disability claim you must have the support of your treating physicians. It is highly unusual that Hartford has not contacted you in 8 to 10 months. If you have specific questions, I would suggest you call us at 800-828-7583.
Jim, it is great to hear that Hartford hired a doctor that supports your claim. If your medical condition is not psychological you need to be cautious as your policy may limit mental nervous conditions to only 24 months of benefits. if you have a secondary psychological medical issue then you should seek treatment and submit this new information to Hartford. Also make sure you request a copy of the report from the doctor that Hartford sent you to. You should check out our videos and frequently asked questions on IME exams.
Hello Mr.Dell,
I have been receiving long term disability offset against SSDI from The Hartford since Jan 2007. I didn’t get an on record favorable decision for SSDI until Feb of 2009. When I received back pay for myself and my dependent daughter I repaid The Hartford for the overpayment as I had agreed to do from the beginning.
My concern is that since late Nov 2006 The Hartford has done periodic reviews on my condition usually requiring me to have my doctor fill out paperwork and updating them on my medication and medical condition. The last time I had to send in paperwork from my doctor was March of 2009 and the paperwork was sent to me and I took it in to the physician to fill out and sent it back to them. The next review came in Sept 2009 and was a call requesting medical information and that I send information about current doctors I’m seeing and current medications.
Yesterday 9/27/2010, I was called for a review by The Hartford and the woman just asked me a list of questions which seemed rather vague compared to previous reviews. She didn’t seem familiar with my illness at all. She wanted to know what my daily routine was. She only wanted to know new medications, but not the entire list. She asked what doctors I was seeing. She ask if I was able to complete daily activities such as cook my own food, do laundry or drive a car. When she had gotten the answers to all the questions she was ending the call and asked me if I had any questions. I told her that usually the review involved some paperwork and should I expect to receive some paperwork for my doctor to fill out? She said that she might fax something to my primary physician and then asked for his name again. She then told me not to be alarmed if my next review comes later than I expect because they aren’t doing them as often now.
I’m not exactly sure what all this means. I’ve read so many horror stories about claims being canceled. The form they have online for a physician to complete, “The Attending Physician’s Statement of Functionality” requires my signature. I’m not sure what she will be faxing to my doctor.
My job before becoming disabled was as an RN in a busy Trauma/Burn ICU. I was told by the woman who was previously handling my case with The Hartford that in order for my claim to be canceled I would have to be able to preform in a similar work setting to that I’d previously worked, which was not a sedentary position. It requires a higher level of functioning before cancellation as compared to social security disability. The amount Hartford pays me on top of the SSDI each month is to keep my income at 66.5% of what I made before I became disabled.
I’ve always felt that The Hartford had done well by me. Maybe I’m just being paranoid after reading all the stories. I’ve not noticed anyone filming me as I’ve read on in previous stories. My case has never been referred to another doctor that I know of. But, I’ve been reading stories across the internet which report that once the SSDI back pay is returned the long term disability companies often cancel claims.
Should I be afraid? What measures can I take to protect myself?
Ms. Anne, Hartford is one of those companies that is unpredictable. I do not know how your policy defines disability and I don’t know anything about your restrictions and limitations, therefore I cannot tell you whether you need to be concerned about your claim being denied. If I had the opportunity to review your disability policy, medical records, and claim forms that you have submitted to Hartford, then I could provide you with a good answer.
After reading this I am shocked I did not research prior. the original story sounds just like mine. I need Help. I am working on the appeal by myself and have no idea what i am doing? I feel way duped by hartford and their employees. I won my Social security they have 10 whole minutes of video me doing nothing!!!! Four days 10 mins??? I have had back surgery in 1993 when I was 23. Over the years my back worsened. I have two fusions. As well as two disks that have yet to be touched? I was given total disability sept 15th 2009 thru Social Security. I was in the hearing for 15 mins before being granted full benefits after 3 years of fighting. hartford helped me fight stating at one point I am disabled. As soon as I got SS BAM they dumped me like a hot potato. I am entitled to life insurance 77,000 til 66. I also should be supplemented with income for myself and dependant.
My husband has been out of work since July 2010. He had cervical stenosis w/nerve damage to both arms. He had surgery in Nov 2010. He was on short term disability up until Feb ’11 that he started receiving LTD. It is now only March’11 and the Insurance Co is notifying us that the benefits will stop today. They are telling us that the neurosurgeon has released my husband for work 100%! That Dr. is on vacation right now so the office staff cannot do anything for us. My husband was referred to a pain mgt. Specialist that only has him on Strong controlled meds & cannot even do therapy on him because he is in so much pain. He is also in the Hearing Stage for SSDI but dont know how soon that would be. The LTD is the only thing taht helps us pay for Dr. visits, meds, bills, etc. etc… I know for a fact my husband is NOT 100% READY TO RETURN TO WORK! The Dr. only did 1 fusion when he was supposeed to do 3, and is still in pain. Don’t know what else to do!
Veronica, unfortunately we see this situation often. The neurosurgeon probably thinks that if he says your husband cannot return to work, then the neurosurgeon thinks the surgery was a failure. Some surgeons have egos and think that if they operate then the person must be better. Obviously your husband is still suffering and the neurosurgeon may not understand this. This claim denial can be overturned but it is going to require a coordinated effort between all of your husband’s doctors. It’s also going to require an evaluation of exactly what the neurosurgeon told Hartford. Send us a copy of your denial letter and we will contact you to discuss your options.
I was approved for disability in August, well that’s when I received my award letter anyway. My wife applied and received money for my children, which they’re not aware of yet. I’m holding off because we’re moving and now they want me to go for an IME? Which, I hear, is never going to benefit me. The Hartford pays me the difference so I get $2660 gross benefit every month. I’m worried about the IME now. They already lied to get an interview with me saying they wanted to interview me on my open claim, which I thought was for my premium wavier benefit since they were already paying me for the LTD. So they showed me the videos I wasn’t doing anything they could use and 1 video you couldn’t even tell it was me. That was June and they continued to pay me and now I have to go to an IME? A federal appellate court judge, and my world renowned Neuro says I’m disabled why the IME now.
Mark,
Hartford has the right to make you go to an IME exam whenever they want. They are obviously trying to build a case in order to stop paying your long term disability benefits. You should request to have a videographer present at the IME exam. I would not trust that the IME doctor you see is going to be honest. You must go to the IME exam or your benefits will be denied and you will not be able to have them reinstated. If Hartford continues to give you problems, then contact us for a free consultation to discuss your Hartford disability claim.