After appeal filed by Attorney Jay Symonds, Hartford overturned its previous denial of long term disability benefits for Tennessee Claims Supervisor
Author: Attorney Jay Symonds
Our client, Ms. G, formerly worked as a Claims Supervisor for a large national insurance carrier. In November 2012 a number of medical issues, including Relapsing/Remitting Multiple Sclerosis forced Ms. G to stop working and submit her claim for disability benefits first under her employer’s short-term disability (STD) policy and then continuing under its long-term disability (LTD) policy. Both benefits were administered by Hartford. Under her employer’s disability policies Ms. G would be considered totally disabled after 24-months if she was unable to perform the essential duties of any gainful occupation, which was defined as any occupation she was qualified to perform by education, training and experience.
After paying Ms. G for more than two years under the LTD Policy, Hartford denied further LTD benefits on the basis that she allegedly no longer met the policy definition of disability. Specifically, Hartford stated that, based on video surveillance and a 3rd party medical records review, Ms. G was “capable of working full time sedentary level work.” After receiving the denial, Ms. G contacted Dell & Schaefer and discussed her 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 Ms. 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 and significant inconsistencies with its medical reviewer’s findings. The appeal next addressed Hartford’s reliance on the video surveillance. Noting that there are extreme cases where surveillance activity is so inconsistent with a claimant’s reported limitations that a simple viewing of the surveillance may constitute sufficient evidence, Attorney Symonds established that Ms. G’s observed activities were not conclusively outside the range of activities of someone incapable of sedentary work. Further, the activities recorded were not inconsistent with Ms. G’s reported limitations as noted in her statements to Hartford and the reports from her treating physician. And finally, during an interview with Hartford’s Field Investigator, Ms. G, with no knowledge of the surveillance, informed the investigator that she had performed the activities observed on surveillance. In response the investigator did not ask a single question about the event; how it impacted her physically or cognitively; how she felt during and after the event; or how she felt the next day or week. Therefore, Hartford’s failure to any questions did not evidence a full and fair review.
Approximately six weeks later, and after reviewing the appeal and hundreds of pages of exhibits and medical records, Hartford overturned its decision to terminate benefits, reinstated Ms. G’s LTD benefits and paid full back benefits to date. Attorney Symonds continues to represent our client to best ensure that Hartford will not terminate her benefits again. Feel free to call our disability attorneys for a free consultation on this or any matter relevant to your disability claim.