Client Wins Hartford LTD Insurance Settlement for HIV / AIDS

It is crazy that Hartford denied long term disability benefits to our client after paying for 22 years. Client initially went out on disability on April 15, 1999, due to a diagnosis of HIV/Aids, chronic hepatitis B, lipodystrophy, wasting syndrome, neuropathy/pain and fatigue. His claim was with Aetna, but after Hartford purchased Aetna, Hartford began an updated review in March 2020 to determine if he was still entitled to benefits after the client had been on disability for nearly 22 years. We have seen a lot of disability denials after Hartford purchased Aetna.  

Following a peer review report conducted in March 2020, Hartford determined that client had no viral load and that all blood chemistries have been normal, leading to a conclusion that our client’s complaints of symptoms were minimal and functional levels would suggest an ability to work. To clarify restrictions they scheduled him for an IME in June 2020 during the height of the COVID pandemic. The client was reasonably concerned about attending and Hartford agreed to have another review performed by an infectious disease doctor.

Two of the client’s doctors indicated that the client’s HIV was well controlled leading the reviewing physician to opine no necessary restrictions and limitations. Making the situation worse this opinion was forwarded to one of the client’s doctors who agreed with the level of functionality opined by Hartford’s doctor. Hartford then conducted a quick vocational analysis and found two low skill level work occupations it felt the client could do and denied the claim in late August 2020.

During the course of the appeal we were able to get the doctor who had agreed with Hartford’s doctor to clarify his position, ultimately leading him to draft a letter that although the HIV is well controlled it did not diminish the clients very real neuropathy and fatigue issues and that based on these issues the client would be disabled. We also sent the client to a FCE in March 2021 that indicated a less than Sedentary ability for full time work. Appeal was submitted April 22, 2021.

On appeal, Hartford’s reviewing doctors found restrictions and limitations that would prevent the client from performing full time sedentary work, resulting in his claim being overturned in early July 2021, we received notice that the claim had been reinstated. Given his lengthy claim history and reasonable mistrust of Hartford we negotiated a lump sum settlement for the client that was finalized in mid-September.