Ms. Z had spent several years working as an analyst for major retailer, Target Corporation. Although she spent years working with Target, and greatly enjoyed her job, she soon began experiencing severe and chronic neck pain as a result of spondylothesis and rheumatoid arthritis, a chronic inflammatory disorder that often affects the small joints in the hands and feet. Ms. Z’s days were often spent in discomfort and pain. She began missing days from work due to her pain and discomfort, and when she would go to work she would be in too much pain and discomfort to be productive. Ms. Z found herself with no choice but to file a claim for long-term disability benefits under the Target Corporation Long-term Disability Plan, administered and funded by The Hartford.
The Hartford Terminates Long-Term Disability Claim Prior To Any Gainful Occupation Period Commencing
Initially, Ms. Z was pleased that The Hartford saw her claim for what it was, and that they did not fight her. After all, she was a well-compensated employee with Target and had no reason to voluntarily leave a great job with great pay for a fraction of her prior income – certainly The Hartford could see the logic in that. Furthermore, her medical issues and disability claim were strongly supported by her treating physicians and the medical evidence. For the first 24 months of the disability claim, also known as the “own occupation” period (the period that you must be disabled from performing the duties of you own occupation), The Hartford paid Ms. Z’s claim, and only requested that she submit updated claim forms and attending physician forms completed by her treating physician on a regular basis, which she complied with.
With approximately four months left until the end of the “own occupation” period, The Hartford sent Ms. Z a letter advising her that she would not qualify for “any gainful occupation” (the period that in order to qualify for benefits you must be unable to perform the duties of any gainful occupation for which you are qualified by education, training and experience) benefits and states, “[she] will not meet the policy definition of Disability beyond October 8, 2013.” Apparently, Hartford shares psychic abilities with Theresa Caputo, the Long-Island Medium, since it can apparently now predict the future, and predicted Ms. Z would not qualify for long-term disability benefits 4 months into the future.
Appeal Must Be Submitted Within 180 Days Of Receipt Of Termination Of Benefits, Not Within 180 Days Of Receipt Of Last Benefit Payment
Following receipt of Hartford’s letter terminating her claim, Ms. Z contacted Dell & Schaefer, and discussed her case with Attorney Cesar Gavidia. Mr. Gavidia noted that an anticipatory termination of benefits is a common strategy by disability insurers to avoid paying the claim beyond the “own occupation” period of benefits, and also to begin the time period in which an appeal of a denial of benefits is required to be submitted. Under ERISA, the claimant has 180 days from the date they receive a denial or termination of benefits to appeal the disability insurance company’s decision. In cases where a denial is made in anticipation of a specific future date expiring, the rules are no different. The appeal must be submitted within 180 days from the date the letter advising benefits will be terminated is received. Unfortunately, many unknowing claimant’s wait until the benefits actually cease, often missing the deadline or being left with very little time to craft an effective appeal.
Hartford Reverses Disability Denial Following Submission of Appeal Prepared by Attorney Cesar Gavidia
Ms. Z’s appeal, which included over 17 exhibits, medical records, various pieces of objective and subjective evidence of disability, was timely submitted to The Hartford. Soon after its submission, the Hartford advised that that Ms. Z’s claim would be reinstated and that benefits would be paid up to the current date. The Hartford has continued to pay Ms. Z’s claim for benefits in accordance with the terms of the Target Long-term Disability Plan. Cesar Gavidia continues to manage our client’s claim in an effort to prevent disability benefits from being denied again.