Administrative Appeal by Dell & Schaefer Helps Disabled Man with Eye Disorders Get Approved for Short Term Disability Benefits with Hartford; Long Term Benefits Next
Author: Attorney Alex Palamara
This Dell & Schaefer client came to us after being denied short term disability benefits by Hartford under the Omnicare, Inc. Short Term Disability (STD) Plan. Prior to hiring us, this client was forced to leave his previous occupation on May 31, 2014 due to severe eye disorders. His conditions included: Chronic Bilateral Advanced Stage Macular Degeneration, Bilateral Nuclear Sclerotic Cataracts, Bilateral Dry Eyes, and Bilateral Choroidal Neovascular Membranes. Additionally, he also suffered from Bilateral Carpal Tunnel Syndrome, status post release, and Hypercholesterolemia. These conditions prevented our eventual client from performing the essential duties of his prior occupation as a Clinical Manager for Omnicare and the same conditions left him earning less than 20% of his pre-disability earnings.
Hartford initially ruled that our client should be approved for benefits and paid him from early June 2014 through July 11, 2014. By way of a denial letter dated August 6, 2014, Hartford informed our client that it had made a decision to terminate his claim and that no benefits would be paid beyond July 11, 2014. In the aforementioned denial letter, Hartford stated that “(w)hile we understand that you may be experiencing subjective symptoms, this in or itself does not reflect a functional impairment of such severity that it would prevent you from performing the essential duties of your occupation as a Clinical Manager.” Hartford’s decision could not be further from the truth.
Claimant Hired Dell & Schaefer
After being unsure of what to do, the claimant finally contacted a Disability Insurance Attorney at Dell & Schaefer in Mid-December of 2014. Attorney Alexander Palamara quickly took on the case as time was of the essence as the Employee Retirement Income Security Act of 1974 (ERISA) only provides for 180 days to file an administrative appeal to challenge the denial. It must be mentioned that if a timely ERISA appeal is not filed, a claimant will likely lose any right they have under the policy for further benefits and they will be unable to file an ERISA lawsuit.
Administrative Appeal filed by Dell & Schaefer
Dell & Schaefer quickly secured the administrative record from Hartford as well as medical records from our client’s treating physicians. This documentation gave us the tools needed to prove to Hartford that its decision to deny additional benefits was blatantly false. A timely administrative appeal was filed. In the appeal, we first noted the various errors of Hartford’s reviews. We then showed the seriousness of our client’s eye conditions, the objective findings found in his medical records, the strong support of his treating Ophthalmologist, as well as occupational requirements of his prior occupation which required visual acuity which our client clearly lacked. We left Hartford with no alternative but to reapprove our client’s claim.
Four weeks after the administrative appeal was filed, Hartford sent a letter that stated that it had determined that our client continues “to be Totally Disabled as defined in the STD Plan through the exhaustion of his STD benefits.” A few weeks after that letter, a benefit check was received for the remainder of the Short Term Disability Benefit period of July 12, 2014 through November 28, 2014. Though our client is completely satisfied with the outcome of the appeal, we have already moved forward with securing Long Term Disability benefits for our client. Although such claim is currently pending, we foresee such benefits being approved in a very timely manner. If not, Hartford knows a fight will ensue for what is rightfully owed to our client.
If you have been denied Short Term Disability Benefits and will need Long Term Disability benefits, please do not hesitate to contact the Attorneys at Dell & Schafer for a free consultation.