Our client, Mr. H, formerly worked as a CEO of an engineering services contractor. In February 2016 a number of medical issues, including Cardioembolic Stroke as well as associated cardiac and cognitive issues, forced Mr. H to stop working and submit his claim for disability benefits, first under his employer’s short-term disability (STD) policy and then continuing under its long-term disability (LTD) policy. Both benefits were funded and administered by Hartford. Mr. W’s occupation as a CEO was intellectually demanding and required high level of executive functioning. Under his employer’s disability policy, he would be considered totally disabled if he was unable to perform the essential duties of his “own occupation.”
After paying Mr. H for the maximum benefit period under the STD policy, Hartford denied LTD benefits on the basis that he allegedly no longer met the policy definition of disability. Specifically, Hartford determined that “there is no evidence he has any cognitive condition that is functionally impairing him from the date he ceased working to the present and beyond.” After receiving the denial, Mr. H contacted Dell & Schaefer and discussed his case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in Hartford’s denial letter and in the physician consultant’s medical reviews, and agreed to prepare and submit Mr. H’s ERISA appeal with the assistance of his appeal team.
The appeal addressed all of Hartford’s short-comings and reasons for denial, with a special focus on the review conducted by Hartford’s in-house medical consultant and peer review physicians. One of the focal issues was supportive Attending Physician’s Statement from Mr. H’s neurologist and Hartford’s reviewers’ failure to understand the complexities of Mr. H’s case and that his multiple neurological symptoms could be secondary to his past stroke deficits, a new intracranial pathology, or even the onset of dementia.
Approximately 6 weeks later, and after reviewing the appeal and hundreds of pages of exhibits and medical records, Hartford overturned its decision to terminate the claim and reinstated Mr. H’s long-term disability benefits.