CNA Risk Consulting Director With Pulmonary Hypertension Wins Minnesota Hartford Long-Term Disability Insurance Appeal After Paper Review Denial
Hartford approved our client’s long-term disability claim, paid it for about three months, and then cut him off without ever examining him. Our client was a Risk Consulting Director for CNA in Minnesota, a field job that sent him up ladders and across commercial rooftops, until severe pulmonary hypertension and a cluster of related heart, lung, and spine conditions forced him out of work.
An insurer that pays a claim and then pulls the rug out is nothing new to our office. We have beaten that move against Hartford and every other major carrier more times than we can count. Attorney Alexander Palamara appealed, and Hartford overturned the termination and reinstated our client’s benefits.
The way this appeal was built, around the single job duty our client could no longer perform safely, holds lessons for anyone whose insurer has judged them against a generic idea of work instead of their real job. If The Hartford or any other disability insurance company has denied or terminated your benefits, speak with one of our lawyers. We represent claimants nationwide, and you pay no fee unless we recover your benefits.
Table Of Contents
- 1. Why this case matters for every Hartford claimant
- 2. A field job built on ladders, rooftops, and hazardous sites
- 3. Pulmonary hypertension and the conditions that came with it
- 4. Hartford paid, then pulled the rug out after a paper review
- 5. His pulmonologist refused to sign off on light work
- 6. The Functional Capacity Evaluation: strong enough, but not safe on a ladder
- 7. Building the appeal around the job Hartford never analyzed
- 8. Hartford overturns the termination
- 9. Has Hartford cut off your disability benefits?
Why This Case Matters for Every Hartford Claimant
Hartford terminated long-term disability benefits for a field risk consultant with pulmonary hypertension on the strength of a paper review, then reversed itself on appeal. Here is what every claimant should take from how this case was won.
- Passing most of a physical test does not mean you can do your job. Our client’s Functional Capacity Evaluation found enough strength for Medium work and matched 90 percent of his job demands. He still won, because his policy required only that he be unable to perform one or more essential duties, and safely climbing ladders to rooftops was one of them. Identify the duty you can no longer perform safely, and build your evidence around it.
- “Normal work activity” is not your occupation. Hartford ended benefits without ever analyzing what a Risk Consulting Director actually does. During the own-occupation period, the question is whether you can perform the essential duties of your own occupation, which is why the duties of your pre-disability occupation must be documented in detail: the physical demands, the travel, and the conditions you worked in.
- Resting test results cannot measure a full workday. Hartford’s reviewer leaned on normal oxygen readings taken at rest and clear lung exams. Pulmonary hypertension strains the right side of the heart, and as with many heart disease disability insurance claims, what matters is how the body holds up under sustained exertion, not how it looks in an exam room chair.
- Your specialist’s written disagreement is evidence. When Hartford asked our client’s pulmonologist to agree that he could do light work, she checked “No” and later explained in writing why. If your insurer sends your doctor a form built around its reviewer’s conclusions, make sure your doctor answers it and explains the functional reasons behind the answer.
- An approval followed by a cutoff, with nothing changed, is a weakness to exploit. Hartford paid this claim and then stopped, with no evidence that our client had improved. Social Security, meanwhile, found him disabled. When an insurer reverses itself, make it explain what changed. If you are still receiving benefits, the steps that help prevent a Hartford disability benefit denial start with current records and restrictions tied to your actual job.
A Field Job Built on Ladders, Rooftops, and Hazardous Sites
What the Job Actually Required
Our client worked as a Risk Consulting Director for Continental Casualty Company, the CNA insurance company that employed him. The title sounds like a desk job. It was not. He evaluated commercial and industrial properties on site and wrote the technical reports underwriters relied on, across a five-state territory in the Upper Midwest. As a recognized subject matter expert, he was routinely assigned the largest and most complex accounts in that territory.
His employer’s job analysis and his own description of the work set out a role that demanded:
- On-site inspections of foundries, manufacturing plants, hospitals, and warehouses, some covering more than a million square feet
- Climbing vertical and extension ladders, from about 20 feet to well over 100 feet, for mandatory roof inspections
- Climbing multiple flights of stairs and entering crawl spaces to inspect boilers, air conditioning units, and imaging equipment
- Driving himself between accounts, with a single inspection lasting anywhere from half a day to three days
- Exposure to extreme heat and cold, dust, fumes, gases, chemicals, and vibration
When His Body Could No Longer Keep Up
Before he became ill, our client was exceptionally fit. He hiked, swam, walked several miles a day on hilly terrain, and maintained his own property. Pulmonary hypertension took that away. Walking on flat ground now left him tired and short of breath. He hired help for yard work and snow removal. He no longer felt safe on a ladder.
He tried to return to work, and the attempt confirmed what his doctors were documenting. Long drives between accounts became dangerous; more than once, he nearly fell asleep at the wheel. He struggled to climb ladders to reach rooftops and became lightheaded, dizzy, and unsteady once he got there. In a job built on independent work at heights in hazardous facilities, those symptoms put him and everyone around him at risk.
His treating providers documented the same problem long before Hartford’s review:
- A family medicine physician recommended time off because he was fatigued and his job required climbing ladders
- His pulmonologist recorded that shortness of breath kept him from performing his job duties safely
- His cardiologist noted that he felt unsafe climbing onto roofs because of his shortness of breath
- His sleep study report urged caution when driving while sleepy or tired, in a job that required him to drive himself across five states
Pulmonary Hypertension and the Conditions That Came With It
How the Diagnosis Was Confirmed
Pulmonary hypertension is high blood pressure in the arteries that carry blood from the heart to the lungs, which forces the right side of the heart to work harder with every beat. It is chronic, it often progresses, and its symptoms rise and fall from one day to the next.
Our client’s diagnosis did not rest on a guess. A right heart catheterization, a procedure in which a thin tube is threaded into the heart to measure the pressures inside it directly, confirmed severe pulmonary hypertension. International guidelines treat that test as the reference standard for diagnosing pulmonary hypertension. His treatment included daily vasodilator medication, which relaxes and widens the blood vessels in the lungs, along with diuretics, lifelong blood thinners, and nightly breathing support.
What the Rest of the Record Showed
His treating providers documented a set of related conditions that compounded the problem:
- Recurrent blood clots, including a deep vein thrombosis (DVT) in the left leg and small pulmonary emboli in the lungs
- Moderate obstructive sleep apnea with nocturnal hypoxia, meaning his oxygen levels dropped repeatedly while he slept
- Heart failure with preserved ejection fraction (HFpEF), a form of heart failure in which the heart pumps normally but stiffens and fills poorly
- Acute hypoxic respiratory failure, a diagnosis given when the lungs cannot deliver enough oxygen to the blood
- Chronic swelling (edema) in both legs that persisted despite compression therapy
- Cervical radiculopathy caused by severe narrowing of a nerve passageway (foraminal stenosis) at C5-C6, which compressed a nerve root and required spinal fusion surgery
- Nonobstructive coronary artery disease and type 2 diabetes
The objective testing backed every one of those diagnoses:
- Echocardiograms showing an enlarged right ventricle, the heart’s right pumping chamber, severely enlarged at first, with the wall between the heart’s chambers flattened in a pattern consistent with pressure and volume overload on the right side
- A cardiac MRI showing reduced right ventricular pumping function, a thickened right ventricle, and scarring where the right ventricle meets the septum, which the report linked to pulmonary hypertension
- A chest CT showing enlarged pulmonary arteries
- Overnight oximetry showing his oxygen saturation falling to 88 percent or lower, with 93 separate drops in blood oxygen in a single night
- Pulmonary function testing showing moderate impairment in the lungs’ ability to move oxygen into the blood
- Repeated examinations documenting pitting edema, swelling that holds a dent when pressed, in both legs
None of this describes a man who had recovered. It describes a progressive, variable cardiopulmonary disease that left him exhausted, breathless, and dizzy whenever he pushed his body.
Can you get long-term disability insurance benefits for pulmonary hypertension? Yes, when the medical record shows how the disease prevents you from performing the essential duties of your job.
Hartford Paid, Then Pulled the Rug Out After a Paper Review
An elimination period is the stretch of time a claimant must remain disabled before long-term disability benefits become payable. Our client satisfied it, and Hartford approved his claim under a group policy that defines disability as being “prevented from performing one or more of the Essential Duties” of your occupation.
Under an own-occupation definition of disability, a claimant qualifies if he cannot perform the essential duties of his own occupation, even if he could do some other job. Under an any-occupation definition, a claimant must show he cannot perform any job he is reasonably qualified for by education, training, and experience. Hartford’s policy applied the own-occupation standard for the first two years after the elimination period before switching to an any-occupation definition.
The policy defines an essential duty as one that is substantial rather than incidental, fundamental to the occupation, and cannot reasonably be omitted or changed.
About three months into benefits, Hartford terminated the claim. The decision rested on a paper review. A paper review, also called a file review or peer review, is an evaluation in which an insurer’s consulting doctor judges a claimant’s ability to work from records alone, without ever examining the person. Being denied disability benefits based on a paper review is a pattern we see constantly.
Hartford’s reviewer was Taj M. Jiva, M.D., board certified in internal medicine with a subspecialty in pulmonary disease. The termination letter, signed by Senior Ability Specialist Kyle Poffenroth, adopted his conclusion: “While your symptoms are acknowledged, there is insufficient evidence of functional deficits to justify restrictions and limitations.”
Normal at Rest Is Not the Same as Able to Work
Dr. Jiva built his conclusion on daytime oxygen readings of 94 to 98 percent, clear lung exams, normal left ventricular function, and normal blood tests for heart strain. Every one of those findings was a snapshot taken while our client sat in an exam room. None measured what happened when he climbed, bent, walked a warehouse floor, or worked a full day.
Even Hartford’s letter conceded that our client’s oxygen dropped into the low eighties during sleep and that his right ventricle was enlarged. It simply decided those findings did not matter during the day.
The National Heart, Lung, and Blood Institute lists shortness of breath, fatigue, chest pain, and dizziness that may lead to fainting among the symptoms of pulmonary hypertension, and notes that early on, breathlessness may appear only with exercise. As attorney Palamara wrote in the appeal, the fact that oxygen levels look normal at rest “does nothing to address his ability to tolerate physical exertion, environmental exposures, or prolonged activity over the course of an eight-hour workday.”
An Impairing Diagnosis He Said Did Not Exist
Dr. Jiva’s own report listed pulmonary arterial hypertension, obstructive sleep apnea, nocturnal hypoxia, recurrent blood clots, and leg edema. He then concluded there was “no impairing diagnosis from a pulmonary medicine standpoint.” He emphasized the normal results and passed over the abnormal ones: the right ventricular enlargement, the recurrent drops in oxygen, the persistent edema, and the fatigue documented visit after visit.
The physical ability questionnaire attached to his report contained no restrictions and no quantified abilities. When our client’s pulmonologist sent a letter disagreeing with him, Dr. Jiva issued an addendum stating that the new information did not change his determination. We saw the same contradiction in our Lincoln appeal for a Red Hat sales manager with heart failure, where the reviewer conceded serious impairment and cleared the claimant for work anyway, a denial we also reversed.
Can Hartford Deny Benefits Without Examining You?
It can, and it often does. An independent medical examination (IME) is an in-person exam by a doctor the insurer selects and pays for. Hartford’s policy gave it the right to have our client examined by a physician whenever reasonably necessary, and Hartford never used it. Instead, the termination letter concluded there was “no support of ongoing restrictions and limitations from normal work activity,” without defining normal work activity or comparing it to a single duty of his job.
That omission is striking, because the same letter quoted Hartford’s own claim guideline, which tells the analyst to compare the policy definition, the “Essential Duties of the occupation,” and the medical and vocational information. Hartford printed that instruction in its letter and then skipped the step. We have seen Hartford run this playbook before, including in our Hartford appeal for an SAP solution advisor cut off by an internal paper review, a termination we also reversed.
His Pulmonologist Refused to Sign Off on Light Work
Hartford did reach out to our client’s treating pulmonologist, but not to learn what she knew. It sent her a form stating its position that he could perform full-time light duties and asked whether she agreed. She checked “No.” Insurers routinely send treating doctors forms like this, one of the ways disability insurers try to influence doctors in claim decisions.
In a follow-up letter, she explained that pulmonary hypertension is chronic, with variable symptoms and an unknown rate of progression, and that she could not endorse Hartford’s light work assessment for that reason. In a later letter, she wrote that despite optimal treatment, our client still experienced fluctuating shortness of breath, lightheadedness, and fatigue: “There may be times that he is unable to complete even light office work or a ‘desk job'”. She stated plainly that she disagreed with the denial assessment.
Those opinions came from the specialist who had managed our client’s care for well over a year. Hartford set them aside in favor of a one-time reviewer who never met him. In our Hartford appeal for a BMW technician with a failed hip replacement, a single box a treating provider checked on a form like this one became the engine of the termination, a denial we also reversed. Here, the pulmonologist refused to sign off, and Hartford terminated anyway.
The Functional Capacity Evaluation: Strong Enough, but Not Safe on a Ladder
A Functional Capacity Evaluation (FCE) is a standardized, hands-on assessment that measures how much physical work a person can actually sustain, under direct observation, over several hours. Hartford never ordered one, so we did. A licensed occupational therapist put our client through a four-hour Own Job FCE designed to compare his abilities, task by task, against the demands of his occupation. The protocol is supported by published, peer-reviewed reliability and validity research.
Strength Was Never the Problem
The weight handling results placed our client at the Medium level of work. Under federal rules, medium work involves lifting no more than 50 pounds at a time, with frequent lifting or carrying of objects up to 25 pounds. Overall, he matched 90 percent of his job’s demands.
What does it mean if an FCE says you can do Medium work? It describes your strength, not whether you can safely perform every essential duty of your occupation. An insurer could try to spin those numbers into a reason to deny. They were nothing of the kind. Our client never claimed he was too weak to lift a clipboard. He claimed he could no longer safely do the parts of his job that mattered most, and the testing proved it.
Where the Job Demanded More Than He Could Safely Give
The barrier was dizziness, reproduced again and again whenever he moved from a low position to standing or performed the physical tasks his job required. The evaluator documented:
- Ladder climbing: dizziness after only a limited number of rungs, forcing him to tighten his grip to keep his balance; his job required frequent ladder climbing, and he did not match it
- Balance on a ladder: rated inadequate for a job that required it
- Crouching, repetitive squatting, and trunk rotation while standing: each discontinued because of worsening dizziness
- Rising from low positions: dizziness after bending, kneeling, crouching, and squatting, and during stair climbing
- Rest breaks: seven additional breaks, about 26 minutes in total, every one of them initiated by the evaluator because of observed signs of fatigue and dizziness
- Visible instability: holding onto tables, walls, and chairs to steady himself, along with irregular gait, shortened steps, shaking, and shortness of breath
The evaluator’s conclusion was direct. Because his occupation required accessing roof structures and elevated heights, and because she recommended no ladder climbing, our client “does not match his previous job position as a Risk Control Consulting Director.” In practical terms, he could lift a box, but he could not reliably climb to a roof, stand up after inspecting equipment near the floor, or move through a sprawling facility without stopping to steady himself.
Effort Testing That Shut the Door on Exaggeration
Insurers often answer an FCE by suggesting the claimant held back. This one closed that door. Our client showed no functional inconsistencies on any of 13 consistency measures and no low effort on any of 3 grip strength validity tests. He self-limited on only 4 of 23 tasks, within the normal range for motivated participants, and the evaluator attributed those to fatigue and dizziness, not lack of effort.
Building the Appeal Around the Job Hartford Never Analyzed
ERISA, the Employee Retirement Income Security Act, is the federal law that governs most employer-provided long-term disability insurance plans. An ERISA administrative appeal is the formal internal review a claimant must request from the insurer before suing over a denied group long-term disability insurance claim, and federal law requires the insurer to provide a full and fair review. It is also the last real chance to add evidence to the record.
Hartford’s letter gave our client 180 days to appeal. We used that window to build evidence rather than rush a thin response, which is exactly why a claimant should take their time filing an ERISA appeal. By the time attorney Palamara submitted it, the record included the FCE, updated records from our client’s treating hospital systems, his personal impact statement, and a new decision from the Social Security Administration.
Social Security Found Him Disabled
The Social Security Administration approved our client’s claim for Social Security Disability Insurance (SSDI) benefits, concluding that he could not engage in substantial gainful activity, meaning work that pays above a monthly earnings threshold Social Security sets each year. That decision does not bind Hartford, but it is highly persuasive. A separate government agency, applying its own standard and reviewing the medical and vocational evidence, reached the opposite conclusion from Hartford’s paper review.
Federal claims regulations require a disability insurer that denies a claim to explain why it disagrees with a Social Security disability determination the claimant submits. The award came after Hartford’s termination, so the appeal put it squarely in front of Hartford’s final review.
Hartford Had Already Found Him Disabled
The appeal also confronted the timing. Hartford had reviewed the same medical evidence, found our client disabled, and paid his claim. Nothing in the record showed improvement before it reversed course; if anything, the evidence had grown. This did not happen by accident. The only new element in the file was a reviewer who never examined our client and never asked what his job required.
Hartford Overturns the Termination
Once an appeal is filed, the insurer generally has 45 days to decide, with one 45-day extension for special circumstances. Hartford needed only about a month. Its Appeals Specialist, Regina Martin, overturned the termination.
Hartford found that our client’s medically supported restrictions were incompatible with one or more of the essential duties of his occupation, and that he was “unable to safely and reliably perform one or more of the material and substantial duties of his own occupation.” The restrictions Hartford itself recognized were:
- The need for additional breaks
- An indoor, climate-controlled environment
- Avoidance of climbing
- Avoidance of environmental irritants
- Reduced walking
Those restrictions track the evidence Hartford could have gathered itself: the FCE findings, the treating pulmonologist’s opinions, and the job duties and workplace hazards documented by his own employer. Hartford reinstated the claim and sent it to its Disability Benefit Manager for payment.
Our client’s lungs did not improve between the termination and the reversal. What changed was the evidence in front of Hartford. That is the difference between a desk review and reality.
Has Hartford Cut Off Your Disability Benefits?
As attorney Palamara wrote in the appeal, “This is not a case where the evidence has changed, rather, it is a case where the interpretation of that evidence has been selectively manipulated to justify a predetermined outcome.” Hartford ultimately agreed.
If Hartford or any other disability insurance company has terminated your long-term disability benefits, the clock is already running. Federal ERISA rules give you at least 180 days to appeal a denied group long-term disability claim, and what you submit in that window may be the only evidence a court ever sees. Do not let a reviewer who never met you have the last word.
Our long-term disability lawyers have fought for claimants since 1979. We have helped tens of thousands of people and recovered more than $2 billion in benefits from every major disability insurance company. We represent claimants nationwide, and you pay no fee unless we win your benefits. Contact our office for a free consultation today.
