A New York claimant, Ms. Ingravallo, filed an ERISA lawsuit after 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. Upon review of the administrative record, the New York Court found that Hartford abused its discretion in denying Ms. Ingravallo’s continued disability benefits and that its decision to deny benefits was arbitrary and capricious for 3 primary reasons. Our firm did not handle this disability claim.
Hartford Failed To Give Weight To The Social Security Administration’s Award Of Benefits
The Court in this matter first points out that a plan administrator is not obligated to determine a claimant is eligible to receive disability benefits solely due to an award of benefits by the Social Security Administration. However, prior Court decisions regarding this issue are clear that this does not mean that an award of Social Security benefits is irrelevant and may be disregarded. This is especially true in instances where the plan administrator benefits financially as a result of the award of Social Security benefits, but then denies continuation of long term disability benefits.
After Hartford initially approved Ms. Ingravallo’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 Ms. Ingravallo was no longer eligible to receive benefits, it failed to give the SSA’s favorable decision any weight. Hartford stated that the SSA used a different definition of disability and different criteria for awarding or continuing to approve disability benefits. The Court rejected Hartford’s argument and found that both Hartford’s and the SSA’s definitions of disability were essentially the same. Hartford defines disability as “injury or sickness [that] causes physical or mental impairment to such a degree of severity that You are… continuously unable to perform the material and substantial duties of your regular occupation.” The SSA defines disability as, “physical or mental impairment or impairments [that] are of such severity that the claimant is… unable to do his previous work.” And the SSA’s definition is actually more restrictive because it goes on to require that the claimant not be able to “engage in any other kind of substantial gainful work which exists in the national economy.”
The administrative record does not reflect whether the SSA conducted any review of Ms. Ingravallo’s claim while continuing her benefits. However, it is undisputed that, at the time of Hartford’s denial in 2010, she continued to receive SSDI benefits. Due to the fact that Hartford both assisted Ms. Ingravallo in obtaining the SSDI benefits, and benefitted financially as a result of the award of SSDI benefits, it should have at least provided a better reason for why it did not give any weight to the Social Security Administration’s favorable decision.
Hartford Failed To Consider Contrary Medical Evidence Consistent With Multiple Sclerosis
The New York Judge acknowledges that Hartford was not required to give special weight to the opinions of Ms. Ingravallo’s treating physicians. However, 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.
Ms. Ingravallo 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 opined that “all neurological experts attest” that their presence “correlate well with the degree of a patient’s disability”. Hartford utilized two physicians to conduct peer reviews of Ms. Ingravallo’s medical records. The first peer review physician noted that he also reviewed the MRIs, but he did not contradict her neurologist’s opinion regarding their significance on Ms. Ingravallo’s limitations. The second peer review physician completely failed to mention the neurologist’s opinion and stated that his opinion was based on a “lack of medical information.”
The Court found that Hartford’s decision to rely on the opinions of its peer review physicians was arbitrary and capricious because Ms. Ingravallo’s neurologist discussed an important finding that was significant to her limitations and her disability, that Hartford’s peer review physician entirely failed to address. Before rendering its decision to deny benefits, Hartford should have conducted further investigation regarding the MRI findings and the effects of the “black holes” on Ms. Ingravallo’s functionality.
Hartford Was Wrong To Rely On Surveillance Video
While Hartford was paying Ms. Ingravallo continued long term disability benefits, it conducted yearly reviews of her claim to determine her continued eligibility for benefits. During the last review, Ms. Ingravallo gave information to Hartford that she was not able to perform some daily activities, such as dressing, bathing, using the toilet, cooking and caring for her children, and that she required assistance from her husband and mother for these activities. In contrast, her neurologist informed Hartford that she did not require assistance to perform daily activities. In an effort to sort out this discrepancy, Hartford conducted video surveillance of Ms. Ingravallo to determine what activities she was actually capable of performing.
The video depicted Ms. Ingravallo pushing a baby stroller from her home to a pharmacy two blocks away and returning 90 minutes later with some bags hanging from the stroller. She is also seen unloading bags and plastic jugs from her car, and taking her toddler out of the car. Hartford determined that this video was evidence that Ms. Ingravallo was able to perform activities “outside of her self-stated limitations and her physician provided limitations.”
Ms. Ingravallo viewed the surveillance video and stated that it depicted her average level of functional ability. She also stated that pain in both of her legs prevented her from standing or walking more than 10-15 minutes (the time it took her to walk two blocks), she had “pins and needles” in her hands and feet which limited her manual dexterity and ability to sit for more than one hour, after which point she needed to put her feet up to relieve the numbness and tingling, and she suffered from daytime fatigue.
The Court found that Hartford heavily relied on the surveillance video when making its determination to deny benefits. Although the video shows Ms. Ingravallo doing activities she should not be able to do, Hartford’s “definition of disability depends on Ingravallo’s ability to do work, not her ability to do chores.” The Court found 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.
Ms. Ingravallo 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 Ms. Ingravallo’s condition has improved such that she was no longer disabled from performing full-time sedentary work was arbitrary and capricious. The Court granted Ms. Ingravallo’s motion for summary judgment and awarded her benefits and attorney’s fees, with judgment withheld until the amount of benefits due was determined.
Attorneys Dell & Schaefer have represented hundreds of claimants with Hartford long term disability insurance policies and we have litigated against Hartford for claimant’s nationwide. If you have questions regarding your claim for disability benefits, or if your disability claim has been denied, feel free to call Disability Attorneys Dell & Schaefer for a free consultation.