Hartford Denies Disability Benefits To Home Depot Employee 3 Weeks Before Change of Disability Definition
Our client was a former in-store merchandising associate responsible for the movement of merchandise, display set up, signage installation, inventory and merchandising strategies who went out on disability due to mental health conditions as well as physical medical conditions related to chronic back pain, SI joint pain and hip pain that potentially required replacement. Hartford initially approved our clients claim based only on his mental health diagnoses, which was limited to a maximum of 24 months of payments under the policy.
Unlike the majority of employer provided policies that define disability for the first 24 months of benefits as the inability to perform the duties of one’s own/regular occupation, our client’s policy with Hartford only affords 18 months of disability benefits under the own occupation period of disability, and then defines disability as the inability to work at any reasonable occupation. Three weeks to the change from “own occupation” disability and “any occupation” disability Hartford advised our client that it was terminating his claim for disability following a medical file review that determined our client’s mental health condition was not severe enough to prevent him from returning to his former occupation with Home Depot.
Following receipt of the denial letter our client contacted our office. In reviewing the denial letter, it was clear that there were multiple obstacles to overcome when preparing and submitting the appeal. First, Hartford’s denial came during the “own occupation” definition of disability which could provide Hartford another opportunity to review and deny the claim in that Hartford could approve for the remainder of the “own occupation” period and then determine that he was not disabled from “any occupation” and require another appeal, thus providing Hartford additional bites at the apple. Second, as noted the policy contained the 24 month mental health limitations, which meant that in appeal the decision Hartford could once again find that there was only support for a mental health condition, pay the remainder of the 24 months and deny any additional benefits for non-mental health related conditions. Third, and related to the second, was the need to bolster the medical information in support of our client’s physical medical conditions in order to not only establish these conditions as disabling as it related to his own occupation but also as it related to his ability to perform any occupation as defined by the policy.
In preparing the appeal we focused on a three prong attack to address the above noted items. First, we obtained updated mental health records and sent his mental health provider a detailed Behavioral Health Statement that would clarify work related restrictions and limitations stemming from our client’s psychiatric conditions. Next, we had out client undergo functional capacity testing to determine his residual functional abilities as set forth by Department of Labor guidelines to establish he would not be able to meet the requisite physical ability of his medium level occupation, and also that he would not have residual physical ability for even Sedentary work that he might be capable of based on his training, education and experience. Finally, we performed a Vocational Assessment to not only establish an inability to perform his occupational duties but also to show he had no transferrable skills to other occupations that could be performed considering his physical restrictions and limitations. Armed with this information we submitted his appeal.
Prior to the expiration of its 45 day deadline to render a decision on the appeal, Hartford notified our office that it would be exercising its right to a 45 day extension as it was still awaiting medical and vocational reviews. However, prior to the expiration of the extension period Hartford advised our office that it was overturning its denial of benefits and reinstating benefits through the own occupation period and into the any occupation period on account of our clients physical and psychiatric medical conditions.
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