Hartford Disability Denial of Insurance Agent with Fibromyalgia and Chronic Fatigue is Reversed

A Utah Federal Judge reversed a Hartford long term disability insurance benefit denial on the basis that it was “unreasonable and, thus, arbitrary and capricious”. The judge’s opinion in this case is a great victory for disability insurance claimants disabled by Fibromyalgia or by Chronic Fatigue Syndrome. Additionally, the Judge that decided this case should be commended for seeing through Hartford’s bullshit review of the file and taking the time to actually understand the Plaintiff’s inability to work.

The plaintiff in this case was a 60 year old male, previously employed by Van Gilder Insurance Company as a health insurance salesperson. The Plaintiff initially filed and was approved by Hartford for Short term and long term disability benefits in Jun 2006. Approximately 3.5 year later, Hartford denied the claimant’s benefits in February 2010, which was a few months after the definition of disability changed from “own occupation” to “any gainful occupation”. Hartford relied on the following information in order to deny the long term disability claim:

  1. Six non consecutive days of video surveillance (one day had the claimant playing golf for 4.5 hours)
  2. Three different file medical reviews by doctors hired by Hartford
  3. Hartford sent a representative to the Claimant’s house to interview him
  4. Hartford had their hired doctors call and speak with three of the claimant’s treating physicians; and
  5. Hartford sent the video surveillance to the treating doctors asking if they though the claimant’s medical condition was consistent with the video surveillance. (One of the claimant’s treating doctors responded that he thought the claimant could work 40 hours a week based upon his activities in the videos.)

The claimant and his Utah disability attorney filed an ERISA lawsuit against Hartford. After several month of litigation the Plaintiff won! The Utah Court’s primary basis for reversing Hartford’s denial was that Hartford should have exercised their right to have the Claimant physically examined by a doctor of their choice. The judge stated,

The Court recognizes that physical examinations are not requisite in all cases for an insurer’s decision to be reasonable. But the Court also considers Defendant’s decision to conduct file reviews rather than a physical examination as another factor in the overall assessment of whether Defendant acted reasonably. Calvert, 409 F.3d at 295. In Calvert, the Sixth Circuit Court of Appeals stated, “while we find that [Defendant’s] reliance on a file review does not, standing alone, require the conclusion that [Defendant] acted improperly, we find that the failure to conduct a physical examination… may, in some cases raise questions about the thoroughness and accuracy of the benefits determination.” Id. The Court finds this reasoning applicable to the current case.

The Utah court discussed that Fibromyalgia and Chronic Fatigue are subjective medical conditions and stated,

Fibromyalgia and Chronic Fatigue Syndrome, are problematic for insurers and courts evaluating disability claims because proving the diseases is difficult given the subjective nature of the symptoms. See Welch v. UNUM at 1086, 87 (citing Walker v. Am. Home Shield Long Term Disability Plan, 180 F.3d 1065, 1067 (9th Cir. 1999) (“Because proving the disease is difficult… fibromyalgia presents a conundrum for insurers and courts evaluating disability claims”). Compare Jordan v. Northrop Grumman Corp. Welfare Benefit Plan, 370 F.3d 869, 872 (9th Cir. 2004) (“[F]ibromyalagia’s cause or causes are unkown, there is no cure, and, of greatest importance to disability law, its symptoms are entirely subjective.”); Hawkins v. First Union Corp. Long-Term Disability Plan, 326 F.3d 914, 919 (7th Cir. 2003) (noting that fibromyalgia “itself can be diagnosed more or less objectively by the 18-point test …but the amount of pain and fatigue that a particular case of it produces cannot be”); with Boardman v. Prudential Ins. Co. Of Am., 337 F.3d 9, 16 n. 15 (1st Cir. 2003) (“While the diagnoses of chronic fatigue syndrome and fibromyalgia may not lend themselves to objective clinical findings, the physical limitations imposed by the symptoms of such illnesses do lend themselves to objective analysis”).

Fibromyalgia disability claims are often challenged by disability insurance companies. In the past few years the condition has become more recognized and Court’s are coming down on disability insurance companies that do not give fair weight to the diagnosis. Our disability attorneys have represented hundreds of claimants disabled by fibromyalgia and understand the disabling effects it has on a person’s ability to work 40 hours a week.

The court discussed Hartford’s wrongful reliance on on 6 days of video surveillance. The court stated that Hartford had paid the claimant for more than three years and the video surveillance did not prove that either the claimant’s medical condition had improved or he was capable of working 40 hours a week. The video surveillance did not reveal any new information about the claimant and was not substantial evidence supporting the insurance company’s decision to terminate benefits. The court specifically stated that 4.5 hours of golf out of 6 days of surveillance “is not substantial information regarding Plaintiff’s ability to maintain a full time job.” The court also states that people receiving disability insurance should not be dissuaded from leaving their homes for fear of losing their benefits.

You can read the Court’s 19 page full opinion by clicking here (PDF).

Leave a comment or ask us a question

Questions About Hiring Us

Do you help Hartford claimants nationwide?

We represent Hartford clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Hartford disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Hartford. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Hartford.

How do you help Hartford claimants?

Our lawyers help individuals that have either purchased a Hartford long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Hartford:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Domonic W.

I must say, words can’t express my inner-feelings for the fabulous job that Dell & Schaefer firm have done for me. I was so impress with the outline of my disability appeal, it was totally organized. Dell & Schaefer keep me abreast with the entire proceedings. To have an attorney that has your interest at heart is a phenomenal thing. Dell & Schaefer was referred to me by a friend. It was a true blessing. I would return a favor, by referring Dell & Schaefer to anyone that needs an attorney.

Thank You, Dell & Schaefer and Stephen Jessup, for being there in my time of need.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us