Court upholds Hartford’s denial of long-term disability benefits to a quality technical specialist suffering from cervical disc herniations and vertigo

Lucy Sanzone was struck in the head by a fifty-pound iron rod that fell off a store shelf and suffered cervical disc herniations at the C6-C7 level. As a result of this injury, she began to suffer from neck and back pain and vertigo, and filed a claim with Hartford for long-term disability benefits after she stopped working in October 2004.

Based on the job description provided to Hartford as part of making its assessment for long-term disability benefits, it was determined that Ms. Sanzone’s occupation was sedentary in nature. Following continued treatment with her neurologist and an orthopaedic surgeon, Hartford approved Ms. Sanzone’s claim for long-term disability benefits on April 21, 2005.

Shortly thereafter, Hartford performed disability surveillance of Ms. Sanzone on July 23 & 24, 2005, where she was observed getting in and out of her car, driving, sitting, standing, bending, and lifting boxes. Hartford then conducted a field interview with Ms. Sanzone, where she signed a statement that, among other things, indicated that she could sit for a maximum of 15 minutes at a time. However, during this three-hour field interview, the interviewer from Hartford noted that she sat for as long as 32 minutes at a time, and there were no visible signs of pain or discomfort during this meeting.

Hartford’s case manager then sent a copy of the statement Ms. Sanzone gave at the field interview, her job description, and a copy of the surveillance videotape to her treating orthopaedic surgeon, Dr. Jarolem. Based on this information, Dr. Jarolem reversed his previously stated position that she was unable to work, stating: “I perceive there to be no restrictions or limitations precluding the work capacity noted above [in her job description].” Hartford then cut off Ms. Sanzone’s long-term disability benefits beyond October 31, 2005.

Ms. Sanzone appealed the denial of her long-term disability benefits on November 14, 2005. Hartford upheld its original denial of her disability benefits on November 30, 2005, and Ms. Sanzone filed suit thereafter.

At trial, the court ruled that Hartford’s decision to deny long-term disability benefits was not wrong. In particular, the court noted that Ms. Sanzone’s reported restrictions and limitations were contradicted by the surveillance videotape, and she had failed to continue to treat with a neurologist despite her continued vertigo. Based on the evidence in the administrative record, the court ruled that Hartford’s decision was not wrong, and long-term disability benefits would not be reinstated.

Comment: In this case, it was not surprising that Hartford prevailed, as the claimant’s treating doctors started that she could return to work. It is impossible to win a disability case without support from the treating physicians.

See Sanzone v. Hartford Life & Accident Ins. Co., No. 06-61135-CIV, 2008 U.S. Dist. LEXIS 3704 (S.D. Fla. Jan. 3, 2008).

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