Our client, Mr. G, formerly worked as a District Sales Manager at an International Travel Destinations company. In August 2014 a number of medical issues, including chronic pain, cervical and thoracic spinal Ankylosing Spondylitis (AS) forced Mr. G 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. Under his employer’s disability policy Mr. G would be considered totally disabled if he was unable to perform the essential duties of “any occupation” for which he was qualified by education, training and experience and with additional consideration of his functional limitations and transferable skills. Essential duties included, among other things, the ability to work the number of hours required for a regularly scheduled work week.
After paying Mr. G for 24 months under the Policy’s “own occupation” definition of disability, Hartford denied continued LTD benefits on the basis that he allegedly no longer met the policy definition of disability. Specifically, Hartford Life stated that “from the combination of all the medical information in [his] file that [he is] able to perform full time seated work 8 hours per work day.” After receiving the denial, Mr. G 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 evidence it relied on and agreed to prepare and submit Mr. G’s ERISA appeal with the assistance of his appeal team.
The LTD appeal addressed all of Hartford’s short-comings and reasons for denial, with a special focus on the medical records on and around the date of Hartford’s denial which confirmed that all available objective testing and physical examinations conducted throughout 2015 and 2016 confirmed that Mr. G’s AS had steadily progressed his cervical spine down through his hips and that the associated pain he suffered was both chronic and persistent throughout his body. The appeal next addressed the incomplete and flawed Independent Medical Examination (IME) conducted by Hartford’s 3rd Party Medical Vendor, including the IME physician’s cursory 20 minute examination of Mr. G, his limited review of only a portion of Mr. G’s medical records and his disproportionately large fee received for the service provided.
Just over six weeks later, and after reviewing the appeal and hundreds of pages of exhibits and medical records, Hartford overturned its decision to terminate benefits and reinstated Mr. G’s long-term disability benefits.