California Court holds that Hartford Abused Its Discretion in Denying employee LTD Benefits

Claimants become frustrated and feel helpless when their disability benefits are cut off by their insurance company with the explanation that they no longer meet the definition of disability when their own treating physicians documented that they were totally disabled and unable to work in even a sedentary occupation. It has become common practice for insurance companies to deny claims based on opinions from physicians paid by insurance companies to conduct paper reviews and render opinions that the claimant is no longer disabled. How can these doctors possibly understand the claimant’s medical condition when they have never met, spoke to or examined them? How is it fair that these doctors can cherry pick which medical records they want to consider during the review process and ignore the records that are supportive of a claimant’s disability? Insurance companies are hiring doctors who often conduct incomplete records reviews, discount relevant information, and misinterpret test results to achieve the ultimate goal of denying a claiming his or her disability benefits. Fortunately some courts are not allowing these insurance companies to get away with this abuse of discretion.

This very scenario occurred in a case out of California called Stout v. Hartford Life and Accident Insurance. The Plaintiff in Stout worked for as a senior technical program manager when she began making errors at work. She was experiencing confusion, fatigue, memory loss and pain. She was eventually diagnosed with an autoimmune disorder called Sjogren’s syndrome. She applied for disability benefits when her physicians told her she could no longer work. Hartford denied her claim stating that according to their hired physicians, there was not enough medical evidence to support her inability to work in her own occupation, completely disregarding the opinions of her treating physicians who all rendered the opinion that she was disabled.

Hartford Relies on Flawed Reports In Denial of Plaintiff’s Benefits

The Court in Stout was clearly unhappy with the review performed by Hartford’s hired doctors who focused solely on the Plaintiff’s cognitive and physical conditions in isolation, never considering their cumulative effect on the Plaintiff’s ability to perform her job. The court was also critical of Hartford’s failure to have their physicians personally examine the Plaintiff or even speak to her treating physicians. Hartford’s hired doctors rendered opinions in complete contradiction to the Plaintiff’s treating doctors without ever explaining the reason why their opinions differed.

According to the Court, Hartford’s reliance on these flawed reports shows that it abused its discretion in terminating Plaintiffs claim for LTD benefits under the “own occupation” standard citing to Caplan 544 F.Supp 2d at 991-93 (holding that a plan administrator abused its discretion by relying on an expert report that showed a “total disregard for the conclusions of the Plaintiff’s treating physicians… and failed to credit the objective evidence of the claimants condition.” In addition Hartford’s attempt to rely on 2 hours of surveillance conducted during a six day period on the Plaintiff, where most of the footage depicted her grocery shopping and at the dentist was clearly insufficient to show she was capable of full time work in her own occupation.

Fortunately for the claimant, with the help of Plaintiff’s counsel, the California Judge saw through Hartford’s smoke and mirrors and held Hartford accountable for paying the claimant her past benefits she rightfully deserved remanding her claim back to Hartford for determination of future benefits.

If you or a family member have been wrongfully denied benefits by your insurance carrier please call Dell & Schaefer, our attorneys would be happy to assist you.

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