Hartford Agrees to Overturn its Previous Denial of Long Term Disability Benefits for an Employee of Adventist HealthCare who suffers from RSD/Complex Regional Pain Syndrome

Our client, who previously worked as a Registered Nurse for Adventist HealthCare since 1996, came to us after being denied continued ERISA long term disability (“LTD”) benefits by Hartford Life and Accident Insurance Co. Prior to being denied, our client had previously received benefits from January 27, 2010 through October 31, 2014. By way of a denial letter dated October 23, 2014, Hartford informed our client that benefits would terminate because it felt that she no longer satisfied the definition of disability in the policy which required her to be “prevented from performing one or more of the Essential Duties of Any Occupation.”

Under most LTD policies, this “Any Occupation” definition of disability typically becomes effective after benefits have been paid for 24 months. Prior to the “Any Occupation” definition, most policies require that the person be “prevented from performing one or more of the essential duties of Your Occupation.” Thus, it becomes more difficult to qualify for LTD benefits after the new definition of disability kicks in and this is the time when most people on claim get denied.

Our client was fortunate enough to receive benefits beyond the change in definition of disability. Our client’s fortune, however, changed nearly 3 years after the change in definition. In the aforementioned denial letter of October 23, 2014, Hartford found that she no longer satisfied the “Any Occupation” definition of disability based on covert surveillance, an in person interview they had conducted with our client, a review by Hartford’s Medical Case Manager and a report of an Independent Medical Evaluation.

Finding Dell & Schaefer

After receiving the notification of denial from Hartford, the denied Registered Nurse found our law firm and spoke with Attorney Alexander Palamara. Within days of contacting our firm, a letter of representation was sent to Hartford, the claim file was ordered and updated medical records were being requested so that a timely administrative appeal could be filed to challenge Hartford’s decision.

After reviewing all of the documentation, we were able to see that our client suffered from Complex Regional Pain Syndrome/Reflux Sympathetic Dystrophy of the Right Lower Extremity, Right Posterior Nerve Injury, Neuropathic Right Foot Pain, Neuralgia of the Nerves of the Right Foot and Ankle, Right Midfoot Osteoarthrosis, Right Ankle Osteophytes, Lumbar Spine Pain, Lumbago, Thoracic Spine Spondylosis, Degenerative Changes of the Thoracic Spine, Obesity, Type 2 Diabetes Mellitus, Asthma, Reactive Airways Disease, Aspiration Pneumonitis, Acute Pharyngitis, Connective Tissue Disorder, Right Pole Renal Calculus, Essential Hypertension, Mixed Hyperlipidemia, Irritable Bowel Syndrome, Gastroesophageal Reflux Disease (GERD),Tachycardia, Recurrent Cellulitis, Polycystic Ovaries, Saeture-Chotzen Syndrome and Recurrent Anxiety and Depression. The medical records made it crystal clear that Hartford’s decision was blatantly wrong and that our now client should still be receiving LTD benefits from the Hartford. Furthermore, a review of Hartford’s claim file showed that the documentation it relied upon to deny the claim was unreliable at best.

Administrative Appeal Filed

A timely administrative appeal was filed that challenged Hartford’s decision to deny our now client’s claim for continued LTD benefits. The appeal noted that Hartford’s Independent Medical Examination’s review was not based on medical records or an examination of our client, but rather it was based on the IME examiner’s review of covert surveillance that he observed. Due to this covert surveillance, the IME examiner found that our client had the ability to work 40 hours per week if she “is able to sit and change positions frequently.” This doctor ignored the findings of our client’s treating physicians and ignored the objective documentation. Furthermore, the IME examiner ignored the fact that the covert surveillance video was stale due to the fact that it was shot in August and September of 2013, one year before the IME examiner performed the review and before our client had 2 more major surgeries.

Beyond criticizing Hartford’s reviews, the administrative appeal summarized the objective medical evidence which proved that our client was still “prevented from performing one or more of the Essential Duties of Any Occupation.” Two weeks and two days after we sent the appeal to Hartford, Hartford sent us a letter agreeing that its denial was incorrect and informed us that her benefits were to be immediately reinstated with all past benefits owed to be sent at once.

Although our client faced months without her LTD benefits from Hartford, she is happy that Hartford made the correct decision and reinstated her claim. Our client knows that Dell & Schaefer will continue to do whatever it takes to keep her on claim until her policy expires.

If you have been denied disability benefits by Hartford or any other disability insurance provider, please do not hesitate to contact the Attorneys at Dell & Schafer for a free consultation.

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Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

Chad B. (Illinois)

I originally spoke with 3 other long term disability lawyers about my case before contacting Dell and Schaefer. None of those law firms would take it. They said the chances of me winning was not good. After finding Dell and Schaefer online I spoke with one of the attorneys that has since left. He did take my case but later it was picked up by Rachel Alters. Rachel is amazing and a very intelligent attorney. She not only won my case but also was able to get my back pay for 6 months.

I also cannot say enough about Sonia Nogueira. Sonia was always quick to answer any of my questions. I would usually hear back from her within hours of sending her a email. I do not know where I would be if I hadn’t contacted them. My family and I cannot thank them enough. Don’t let an insurance company tell you they are not responsible for paying you. I paid them for 20 years monthly and they looked for any reason they could not to have to pay me when I needed my benefit. Thank you Rachel and Sonia for all you guys do.

Paul L. (New York)

Words can only scratch the surface regarding my experience working with Attorneys Dell & Schaefer. It’s a very emotional experience making the decision to utilize disability insurance. The unknowns were/are scary. From the very first phone call, the support staff was/are very professional and reassuring. I have been working with Attorney Steven Dell for approximately 10 years. He is confident, reassuring, listens to and addresses all my concern, and is extremely dilligent in understanding my specific policies for how they impact me. It is very reassuring that Steven handles and deals with the insurance company on my behalf. Attorney Dell’s team, and specifically Merlin, Attorney Dell’s assistant, is simply fantastic. Her professionalism and attention to detail have made all my communications with the office seamless.

Simply put, my experience with Dell & Schaefer made the emotional rollercoaster experience of my neck surgery seem like a walk in the park.

Thank You, Thank You, Thank You, to both Attorney Steven Dell and to Merlin for how you have helped me over these past 10 years.

Dilligence, Reassurance, Professionalism at every step, Confidence, Results.

With 10 years experience with working with Dell & Schaefer, taking that step to call Attorneys Dell & Schaefer was one of the best professional and personal decisions I have ever made.

You want to know what you can do – the below comment about posting your first name and last name initial on our website. Put up my full name, phone number, and email address. I will gladly speak to anyone about your office and tell them my story and how instrumental Steven and Merlin have been in my life over the past 10 years.

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