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Dell & Schaefer Successfully Appeals Denial Of Benefits To Former Excel Energy Employee

Attorney Victor PeñaAuthor: Attorney Victor Peña

Ms. H contacted our firm following her receipt of a letter from her disability carrier, Hartford, terminating her disability claim after being paid disability benefits for nearly 8 years. Ms. H had been receiving long term disability (LTD) benefits since 2008 due to Severe Major Depression, Major Depressive Affective Disorder and a panic disorder. Before going on disability, Ms. H had worked as a Case Specialist for 15 years.

Throughout the entirety of her claim with Hartford, Ms. H’s treating physicians had consistently supported that Ms. H remained unable to work as a result of her medical conditions. Her medical conditions caused Ms. H to suffer debilitating symptoms including lack of energy, lack of motivation, on and off suicidal ideation, isolation, crying episodes, irritability, anxiousness, compulsive eating habits, and no motivation to socialize in addition to a number of other symptoms.

Despite the overwhelming support of Ms. H’s treating physicians, Hartford hired a physician to perform a peer review of Ms. H’s medical file. According to the peer reviewer, the treatment records of Ms. H’s psychiatrist and therapist did not support a psychiatric impairment. Ms. H’s psychiatrist disagreed with Hartford’s peer reviewer but Hartford chose to rely on the solitary opinion of its peer review physician, which supported its decision to terminate Ms. H’s benefits, and to disregard and ignore the opinions of Ms. H’s treating physicians, which remained consistent throughout the history of her 8 year claim.

Appeal by Attorney’s Dell & Schaefer on behalf of Ms. H

When Ms. H contacted our firm, she spoke with Attorney Victor Peña. Attorney Peña went over Ms. H’s claim and agreed to take on her case. After reviewing the claim file from Hartford it became apparent that Hartford’s decision had been founded on an inadequate review by its peer reviewer, Dr. John Zincone. According to Dr. Zincone, there was a lack of information documented by Ms. H’s treating physicians. Moreover, Dr. Zincone attempted to attack Ms. H’s credibility despite never having examined her or even spoken with her. Dr. Zincone failed to acknowledge the fact that Ms. H’s treating physicians had been treating Ms. H for over 10 years. Ms. H’s treating physicians were therefore in a better position to assess Ms. H and make credibility determinations regarding the accuracy of her symptom reporting yet none of Ms. H’s treating physicians had ever shown any reason to question Ms. H’s symptom reports.

Ms. H’s appeal pointed out the errors in Hartford’s review and highlighted the support in Ms. H’s medical file including objective exam findings which supported Ms. H’s inability to perform in any occupation. The appeal stressed the fact that Hartford had failed to perform an in person examination of Ms. H yet relied on a doctor’s opinion that made a credibility assessment of Ms. H without the doctor seeing her even once.

Following the appeal submission, Hartford recognized its error and agreed to overturn its denial and reinstate Ms. H’s disability claim. Hartford has issued a check for all back benefits owed and with the help of Attorney’s Dell & Schaefer Ms. H will have the best chances of staying on claim for as long as she needs to.

Read more about Hartford disability claims.



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