A Hartford Disability Benefit Lawsuit Victory for Truist Banker with Lupus

Our client found us after she was denied continued disability insurance benefits by the Hartford.  Unfortunately, by the time she found us, she had already filed an appeal, which was unfortunately denied. This left her with a final avenue of filing an ERISA lawsuit in Federal Court, a task we never shy away from.

Her story was an interesting one. In fact, her claim went back 15+ years. Prior to filing her claim for disability benefits, our now client worked as a Consumer Loans Sales Coordinator for SunTrust Banks.  She was an employee of SunTrust since 1996. Unfortunately, due to various issues including systemic lupus erythematosus (SLE) and its associated symptoms, memory issues, gastrointestinal issues and back issues, our client was forced to stop working in July of 2004. Thankfully, her employer at the time, SunTrust, provided coverage under a self-funded long term disability insurance policy. This means that if SunTrust (or its 3^rd part administrator, Sedgwick) were to find that she was disabled under the terms of the policy, then SunTrust would pay benefits.

This SunTrust policy was a typically disability insurance policy, but it contained a unique definition of disability that is not often found any more in group disability insurance policies. Under the Sun Trust Policy, one is considered “Disabled” if they are “receiving benefits under the United States Social Security Act.” This is unique as most disability insurance providers like to make their own decision whether a claimant is disabled. However, this policy stated that if the Social Security Administration finds that one is disabled then they will agree. Luckily, our now client was approved for Social Security Disability Benefits and these benefits under the Sun Trust LTD Plan were paid.

Our client remained on claim for some time, actually over 15 years with benefits being paid consistently every month with no issue. However, in late 2019, things got interesting. In 2019, a gigantic financial merger occurred which our client would have never believed would have an impact on her long term disability claim, but unfortunately it did. In December of 2019, BB&T Bank and SunTrust Bank merged.  The new bank that emerged from this merger was called Truist Financial Corporation. What is interesting about this merger is that it lead to a change in employee benefits provided to the employees and ex-employees of SunTrust. For instance, with Truist Financial, now new employees would be covered under a disability insurance policy with Hartford Life and Accident Insurance Company (The Hartford). This would not be like the previous SunTrust self-insured policy. Instead it would be a normal policy fully insured by The Hartford. With regards to the former SunTrust employees that are already on claim, they received notice of certain changes in December 2019.

In fact, by way of a letter dated December 27, 2019, our client received notice from the Hartford that there would be “a change in the administration of (her) LTD claim through SunTrust/Sedgwick.”  The letter further stated that this “change in administration will not change the plan of benefits applicable to your claim.” It also mentioned that there would be “no change in the LTD plan provision that affect your LTD benefit levels.” And it continued that all “of the provisions of the LTD plan that were in effect as of the date you became disabled will remain the same.”

Lastly, this December 27, 2019 correspondence from the Hartford noted that her “benefits will be provided through a fully insured policy from the Hartford rather than through a self-funded plan from SunTrust.” This meant that it was now Hartford’s financial responsibility to pay the disability benefits and that it would be coming out of Hartford’s pocket. Thus, while news of the merger likely didn’t even register with our now client that this could impact her LTD claim, the fact that a new entity would now be paying benefits and taking a new hard look at her claim should have been cause for concern.

Additional cause for concern was how The Hartford treated this file. Almost immediately after taking over the financial responsibility for this claim, the Hartford denied this claim in April of 2020 stating that there she had “not continued to provide proof of your ongoing Disability.” What is interesting about this denial letter is that The Hartford did not cite the definition of disability in this denial letter. Confused (and please note that Social Security Disability Benefits were still being paid), our client sent in additional medical evidence to support her claim and benefits were reapproved via a June 3, 2020 letter.

Following the reapproval, our client felt relief. Unfortunately, this feeling was short lived as The Hartford sent a denial letter the next month in July 2020 stating that it had completed a review of her claim and had “determined that (she did) not meet the policy definition of Disability beyond 07/17/2020.” What is interesting about this July 2020 denial letter is that this denial letter also did not cite the definition of disability.  Instead of citing the relevant policy language, The Hartford stated that it believed she was not prevent from performing the essential duties of Any Occupation and it even listed numerous occupations that it believed she can do. Shocked, but knowing this decision was wrong, our now client filed her own appeal with the assistance of her husband/caretaker.

Unfortunately, the appeal was not successful. While a gallant effort was made to convince The Hartford that she remained medically disabled, the Appeal failed to argue the relevant Policy language. And unfortunately this appeal was denied via an April 21, 2021 Denial letter. This denial letter informed our now client that her administrative remedies had now been exhausted, which meant that her final potential recourse was to file a lawsuit in Federal Court.

What is very interesting about the April 21, 2021 is that, yet again, The Hartford failed cite the definition of Disability. It did state that its “decision is based upon a full and fair review of Policy language” but in denying the claim The Hartford again concluded that it found that she “did not meet the Any Occupation definition of Disability…”.

Discouraged, our client was about to walk away from her claim as she did not believe a litigious fight was in her best interest and she did not believe that a law firm would take on her case as she was only owed an additional 2 years of benefits on her claim due to her age. Fortunately, she found our firm through an online search and she contacted us and spoke with Attorney Palamara.

Upon initial review of each of the denial letters, Attorney Palamara smelled that something funny was occurring as none of the denial letter mentioned the definition of disability. This was odd as this definition essentially controls the case. Thankfully, our client had a copy of the policy that was provided to her in December 2019 when the bank merger occurred. Remember that this new policy provided by The Hartford contained all the original plan provisions of the policy that was in force when our client became disabled in 2004. Following a review of this policy, it became crystal clear as to why none of the Hartford’s denial letters mentioned the definition of disability. It was because they could not deny this claim as our client remained receiving Social Security Disability benefits.

Now we cannot say for certain that Hartford’s Senior Ability Analyst (who signed the April 2020 and July 202 denial letters) and Appeal Specialist (who signed the April 2021 Final Denial Letter) acted with nefarious intent, however, the fact that neither of them cited the definition of disability in any of the denial letters might be telling. Additionally, the fact that the Hartford took control of this file in December 2019 and was already denying this woman’s claim less than 4 months later is also telling. Please note that at the time of the initial denial letter, our now client was 62 years old and had less than 3 years remaining on her claim. It was almost immoral how The Hartford had treated this file and this human being.

Following the completion of his review, Attorney Palamara agreed to take on this claim and almost immediately filed a lawsuit. With our allegations quite clear and the governing policy filed as an exhibit, the only options left for Hartford was to reinstate our client or lose this lawsuit. Thankfully, the attorney who represents The Hartford realized that an error was made and quickly convince his client to reinstate this woman’s claim and pay all back benefits.

At the present time, our client is back on claim and feels very confident that she will remain on claim until her policy expired in late 2022. While this story has a happy outcome, The Hartford put this former SunTrust/Truist employee in a terrible predicament and left her without LTD benefits for over a year.

If you have been harmed by any improper actions by The Hartford or if you have been denied benefits by them or any disability insurance company, do not hesitate to reach out to us and Attorney Alexander Palamara as we always offer a free consultation and enjoy taking on claims against these insurance companies.