HCA Healthcare ICU Nurse Coordinator With Coronary Artery Disease Wins Florida Hartford LTD Insurance Appeal After Denial at 24 Months
The Hartford paid our client’s long-term disability benefits for more than two years. Then his policy switched to an “any occupation” standard, and the insurer cut him off. He was a Clinical Nurse Coordinator in a cardiovascular ICU for HCA Healthcare in Florida, a critical care nurse with coronary artery disease whose career ended with a heart attack and quadruple bypass surgery, followed by a cascade of cognitive, pulmonary, and neurological problems.
Our office has fought and beaten this kind of termination many times: years of payments, followed by a sudden conclusion that a disabled professional can handle a desk job after all. Attorney Alexander Palamara appealed, and The Hartford reinstated his benefits all the way back to the day it stopped paying.
How we won matters to anyone facing a denial, because the most damaging evidence against the insurer came from its own experts. If The Hartford or any other disability insurance company has denied or terminated your benefits, speak with one of our long-term disability lawyers. We represent claimants nationwide, and you pay no fee unless we recover benefits for you.
Table Of Contents
- 1. Why this case matters for every Hartford claimant
- 2. A critical care nurse whose bypass surgery changed everything
- 3. The Hartford cuts him off at the any-occupation change
- 4. The Hartford’s IME and paper review: two experts, one convenient conclusion
- 5. How our appeal turned The Hartford’s experts against its denial
- 6. New evidence The Hartford could not explain away
- 7. The Hartford reinstates his benefits
- 8. Speak with one of our lawyers today
Why This Case Matters for Every Hartford Claimant
The 24-month mark is where many claims are lost. The Hartford approved this ICU nurse’s heart disease disability insurance claim, paid it through the own-occupation period, and terminated it under the stricter definition that followed. If your policy has the same switch, expect your claim to be reviewed from scratch, and build evidence that rules out all work, not just your old job.
The insurer’s own experts can sink the insurer’s denial. The Hartford’s reviewing physician admitted he was not a pulmonary specialist and agreed that an in-person functional evaluation would help determine whether our client could return to work. Its neuropsychologist documented the walker, the oxygen tubing, and the uncontrolled crying. Every one of those admissions sat in the claim file. After any denial, request your complete claim file and read each report line by line.
A failed validity test does not end a cognitive claim. The Hartford treated one “invalid” neuropsychological exam as proof our client had no cognitive limitations at all. We answered with a new evaluation that ran its own validity measures and found no sign of malingering. Understanding how neuropsychological testing works in long-term disability insurance claims is essential when an insurer questions your effort.
A “sedentary” job is not an easy job. The Hartford said our client could work as a nurse case manager, utilization review coordinator, or nurse auditor because those jobs are performed sitting down. Each one demands sustained concentration, clinical judgment, and precise communication, the exact abilities his cognitive decline had taken. For professionals, the mental demands of a desk job deserve as much scrutiny as the physical ones.
Silence from your doctors gets used against you. The Hartford sent its neuropsychologist’s report to two of our client’s treating physicians, then pointed to their lack of response in its termination letter. Our appeal answered with a detailed letter from his pulmonologist addressing any occupation, part time or full time. Strong support from your treating physician only helps if it is in writing and in the file.
A Critical Care Nurse Whose Bypass Surgery Changed Everything
Our client spent nearly two decades in intensive care units. For the last seven years, he worked as a Clinical Nurse Coordinator in the cardiovascular ICU, overseeing care for critically ill cardiac patients, coordinating treatment plans, and supervising nursing staff. Before nursing, he had been an executive chef. His long-term disability insurance came through a group policy offered by HCA Healthcare and insured by Hartford Life and Accident Insurance Company, which operates under The Hartford brand.
His steepest decline began with a COVID-19 infection that became Long COVID, followed by pneumonia. Then came a heart attack and quadruple coronary artery bypass grafting (CABG x4) to treat severe multivessel coronary artery disease. The surgery was complicated by prolonged mechanical ventilation, and his providers suspected an anoxic brain injury, meaning damage caused by a lack of oxygen to the brain. He never worked again.
Coronary artery disease is a narrowing or blockage of the arteries that supply blood to the heart, and bypass surgery uses blood vessels from elsewhere in the body to reroute blood around the blockages. Can you collect long-term disability insurance benefits after bypass surgery? When the surgery leaves lasting damage that prevents you from working, as it did here, the answer is yes.
By the time The Hartford reached its any-occupation review, his medical record documented:
- Multivessel coronary artery disease with angina and a completely blocked right coronary artery, treated with CABG x4 (ICD-10 Z95.1)
- Chronic respiratory failure with hypoxia (ICD-10 J96.11), requiring daily supplemental oxygen
- Chronic obstructive pulmonary disease (ICD-10 J44.9) and obstructive sleep apnea treated with CPAP
- Pseudobulbar affect (ICD-10 F48.2)
- Memory loss and cognitive decline following surgery
- Gait ataxia (unsteady, uncoordinated walking), poor balance, and right-sided weakness requiring a cane or walker
- Major depressive disorder, anxiety, and post-traumatic stress disorder
- Rotator cuff tears in both shoulders, knee osteoarthritis, and thumb arthritis that required joint reconstruction surgery
The Hartford Cuts Him Off at the Any-Occupation Change
An own-occupation definition of disability asks whether you can perform the duties of your own job; an any-occupation definition asks whether you can perform any job that fits your education, training, and experience. Our client’s policy measured disability against his own occupation for the first 24 months after the elimination period (the waiting period before benefits begin), then against the any-occupation definition of disability after that.
So what happens when long-term disability changes from own occupation to any occupation? In this case, The Hartford conceded our client still could not work as a critical care nurse, then decided he could work almost anywhere else. The termination letter, signed by Ability Analyst Ruby Cardosa, put it plainly:
“Clinical supports a functional limitation preventing you from performing one or more of the Essential Duties for your own occupation, however no limitation to a sedentary position.”
Five nursing jobs on paper
A Transferable Skills Analysis (TSA) is a vocational review that matches a claimant’s education, training, and work history to other occupations the insurer believes he can perform. The Hartford’s TSA produced five nursing jobs:
- Nurse Consultant: $4,916.67 per month
- Nurse Case Manager: $6,136.00 per month
- Utilization Review Coordinator: $4,870.00 per month
- Nurse Auditor: $6,933.33 per month
- Pre-Op Nurse: $5,078.50 per month
Each salary cleared the policy’s earnings threshold of 60% of his adjusted pre-disability earnings, or $4,703.13 a month. On paper, the math worked. In reality, the entire analysis was built on two expert opinions that could not carry the weight.
The letter also dismissed our client’s Social Security Disability award in a single sentence. Social Security approval does not guarantee private disability insurance benefits, but an insurer that rejects an SSDI award should explain why.
We see this pattern with nurses constantly. Our Sun Life appeal for an ICU nurse cut off after 24 months followed the same script, and we won that one on appeal too.
The Hartford’s IME and Paper Review: Two Experts, One Convenient Conclusion
A neuropsychological exam that declared every score invalid
An independent medical examination (IME) is an evaluation performed by a doctor the insurance company selects and pays. A performance validity test is a measure built into neuropsychological testing to check whether the person taking it is giving full effort. The Hartford sent our client to board-certified neuropsychologist Dr. James R. Boone, whose report became the foundation of the cognitive side of the denial.
Dr. Boone’s report concluded that our client:
- failed two to three performance validity tests, including the Test of Memory Malingering (TOMM) and the Word Memory Test, which The Hartford called non-credible or insufficient effort
- scored worse than people with advanced dementia, moderate to severe brain injury, and PTSD
- produced invalid results on the MMPI-3, a personality and symptom questionnaire, because of elevated validity scales
The Hartford adopted Dr. Boone’s conclusion that “there are no supported restrictions or limitations.” It sent his review to two of our client’s treating physicians, noted that neither responded, and declared our client mentally capable of full-time work.
A paper review that cleared him for desk work on oxygen
A paper review, also called a file review, is an opinion from a doctor who never examines the claimant and relies only on medical records. Claimants who are denied disability insurance benefits based on a paper review often learn that the reviewer’s specialty has little to do with their illness. Dr. Illy Domninitz, MD, MPH, holds certifications in occupational and environmental medicine, undersea and hyperbaric medicine, and public health and preventive medicine. He is not a cardiologist or a pulmonologist.
Dr. Domninitz concluded our client could perform full-time sedentary work. Under the federal definition of sedentary work, that means lifting no more than 10 pounds at a time, sitting most of the day, and walking or standing only occasionally. Yet the same review acknowledged our client’s pulmonologist had prescribed daily supplemental oxygen as medically necessary, and then conceded:
“Evaluating your functional capacity without oxygen would require clinical documentation of your activity tolerance and vital signs off oxygen, which is not available in the records.”
In other words, The Hartford’s own reviewer said the records could not answer the question, then answered it anyway. We have watched The Hartford lean on a non-examining reviewer before, including in our Hartford appeal for a risk consulting director with pulmonary hypertension, another paper-review termination we reversed.
How Our Appeal Turned The Hartford’s Experts Against Its Denial
An ERISA administrative appeal is the written appeal a claimant must file with the insurer before challenging a group disability insurance denial in federal court. Can you appeal a Hartford long-term disability denial? Yes, and for most employer-sponsored policies, you must appeal before you can sue; ERISA’s claims procedure rules entitle you to a full and fair review.
Attorney Alexander Palamara built our client’s appeal on a simple premise: The Hartford’s own experts had already documented a man who could not work.
The reviewer who admitted he lacked the evidence
Dr. Domninitz’s own report undercut his conclusion at nearly every turn. He:
- acknowledged he was not a pulmonary specialist and deferred to the pulmonologist on oxygen use
- agreed “that an in-person functional IME would be extremely beneficial in assessing for the claimant’s overall function capacity related to daily activities to include return to work”
- confirmed there was no current physical functional testing, no updated pulmonary function testing, and no six-minute walk test in the file
- recognized that our client’s laughing and crying spells, attributed to pseudobulbar affect, would reasonably affect his ability to communicate
Pseudobulbar affect is a neurological condition that causes sudden, uncontrollable episodes of laughing or crying that do not match how a person actually feels. Dr. Domninitz even spoke with our client’s internist, who described a formerly brilliant, emotionally stable ICU nurse whose cognition declined sharply after bypass surgery. The internist said the crying spells could not be faked and that an in-person evaluation was needed. The Hartford never ordered one.
As attorney Palamara wrote in the appeal, “Oxygen dependence directly implicates endurance, stamina, mobility, safety, pace, reliability, attendance, and the ability to function continuously in a competitive work setting.” A reviewer cannot defer to the pulmonologist on oxygen and then treat oxygen dependence as a minor footnote.
What The Hartford’s neuropsychologist saw with his own eyes
Dr. Boone labeled the testing invalid, but his own behavioral observations described a man in obvious distress. During the exam, our client:
- walked slowly with a walker while on continuous nasal oxygen
- had a persistent facial twitch that worsened with stress and fatigue
- had episodes of uncontrolled crying
- showed a right-hand tremor
- wore sunglasses because the fluorescent lighting overwhelmed him
- needed multiple breaks and at one point tried to leave the evaluation
Even inside the supposedly invalid profile, his working memory and processing speed scored in the impaired range, and a daily-living scale in Dr. Boone’s own report showed he needed help preparing meals, doing laundry, taking medications, and managing his finances.
What happens if you fail effort testing on a neuropsychological exam? It does not automatically mean you are exaggerating. A board-certified neuropsychologist had tested our client about a year earlier and seen the same low effort scores. That evaluator still judged the results valid, explaining that such low scores are typically seen in the middle or later stages of dementia.
Dr. Boone rejected that interpretation without explaining why profound vascular, pulmonary, and neurological disease could not produce inconsistent performance. The appeal put it directly: “These are not the observations of a neurologically intact individual capable of sustaining full-time competitive employment in cognitively demanding occupations”.
Desk jobs that demand everything he had lost
The five occupations in The Hartford’s TSA are not simple sit-down jobs. Nurse consultants, case managers, utilization reviewers, and auditors:
- interpret complex medical records
- document clinical findings
- coordinate care
- communicate with providers and patients
- make decisions that affect patient safety
A lapse in memory or judgment in those roles has real consequences.
The record showed our client could not meet those demands. His speech-language pathologist documented uncontrolled laughing and crying, frequent interruptions, and poor situational awareness, and noted he could not set up a telehealth session without help. She concluded he was not able to return to work. The Hartford also assumed he could handle and finger objects frequently at a desk while he was recovering from reconstructive thumb surgery.
The appeal summarized the problem: “Hartford’s attempt to characterize these occupations as merely ‘sedentary’ fundamentally ignores the substantial cognitive and executive functioning demands inherent in professional nursing-based occupations.”
New Evidence The Hartford Could Not Explain Away
Rebutting The Hartford’s experts was half the job. The other half was giving the Appeals Specialist new, objective evidence that answered the exact questions the denial claimed were unanswered.
A cognitive functional assessment with built-in validity checks
A cognitive functional assessment (CFA) measures how cognitive deficits affect a person’s ability to perform work tasks, such as following instructions, keeping pace, and completing a workday. A licensed clinical psychologist evaluated our client using tests validated for remote administration: the Reynolds Intellectual Assessment Scales, Second Edition (RIAS-2), the Wisconsin Card Sorting Test (WCST-64), and the Structured Inventory of Malingered Symptomatology (SIMS).
In everyday terms, the results described a man who could still talk about what he knew but could no longer hold on to new information, adapt when a task changed, or keep up a working pace. The scores told the same story:
- Composite Memory Index: 48, below the 0.1 percentile (profound impairment)
- Nonverbal Memory: below the 0.1 percentile, and he could not reach the starting score for his age group
- Nonverbal Intelligence Index: 73, 4th percentile (borderline impairment)
- Verbal Intelligence Index: 117, 87th percentile (high average)
- Wisconsin Card Sorting Test: impaired cognitive flexibility, set-shifting (switching between rules or tasks), and problem-solving
That contrast is the point. His verbal skills still reflected the sharp clinician he had been, while his memory had fallen below the bottom tenth of one percent. The psychologist called it a “clear and meaningful decline” from his prior functioning.
The psychologist also addressed effort head-on. Elevated SIMS scales were traced to genuine cognitive impairment, not feigning, and the report concluded the “test results appear to be a valid estimate of the patient’s current functional level with no indication of malingering.” Because he tested at home with unlimited breaks, the psychologist noted his performance in a real workplace would likely be worse.
The assessment also rated his work-related abilities. It found moderate to severe impairment in his ability to:
- maintain concentration and persist at tasks
- maintain pace
- switch between tasks
- remember and follow detailed instructions
- make work-related decisions
- complete a normal workweek without interruptions from physical and cognitive symptoms
It rated his ability to keep a consistent work pace without unreasonable rest periods as severely impaired. Its conclusion was direct: our client “does not possess the required cognitive capacity for work at this time.”
A pulmonologist who knew him before and after
His pulmonologist, board-certified in internal medicine, pulmonary disease, critical care medicine, and sleep medicine, had treated him for years. He had also known our client for more than a decade before that, first as a ward secretary in the ICU, then as a nursing student, and finally as a colleague in the surgical ICU. Few physicians can describe a patient’s decline from personal, firsthand comparison.
Cognitive decline after bypass surgery performed with a heart-lung machine is sometimes called “pump head.” The pulmonologist linked our client’s encephalopathy (a general term for impaired brain function) and mental status changes to that phenomenon. A five-year study of bypass patients published in the New England Journal of Medicine found cognitive decline in 42% of patients five years after surgery.
The pulmonologist also noted continuing word loss, a new facial twitch, poor balance, and dependence on a walker or cane, then gave his opinion:
“Personally, I believe that the patient cannot hold down a steady job, let alone critical care nursing or any healthcare related occupation whether it is part-time or full-time work due to his underlying medical comorbidities.”
Objective findings that contradicted the paper review
The appeal also pointed The Hartford to findings already in its file that no sedentary work assessment could ignore:
- Brain MRI: minimal chronic atrophy and microangiopathic disease, meaning loss of brain tissue and damage to the brain’s small blood vessels, both associated with slowed thinking and memory problems
- Neurology: repeated opinions that he could not lift 10 pounds and could not stand or walk without a cane, walker, or crutches
- Neurological exams: weakness in the arms and legs, decreased sensation, truncal ataxia (trouble keeping the upper body steady), and a positive Romberg test, a sign the body cannot hold its balance without visual cues
- Pulmonary exams: diminished air movement with wheezing and a continuing need for supplemental oxygen
A man who cannot lift 10 pounds cannot perform work defined by lifting up to 10 pounds. That is the difference between The Hartford’s paper review and reality.
The Hartford Reinstates His Benefits
About five weeks after we filed the appeal, Appeals Specialist Anastasiia Briggs notified our office that The Hartford had overturned its decision. The letter stated that our client’s disability “remained medically supported” from the date benefits stopped “through the present and beyond.”
Benefits were reinstated back to the termination date, covering roughly seven months of withheld payments, and the claim returned to The Hartford’s claims team for ongoing benefits under the any-occupation definition.
This did not happen by accident. Had The Hartford upheld the termination, our client’s next step would have been a lawsuit in federal court under ERISA’s civil enforcement provision, and the appeal record we built was designed to win there too. Attorney Palamara has secured results like this before, including an Unum appeal for a claimant with severe coronary disease, a termination he also reversed.
Speak With One of Our Disability Insurance Lawyers Today
As attorney Palamara wrote in the appeal, “Hartford cannot reasonably terminate benefits based on a review that admits the very testing needed to determine function was not performed.”
If The Hartford has cut off your benefits at the any-occupation change, or any disability insurance company has denied your claim based on a paper review or a disputed neuropsychological exam, the clock is already running. Federal ERISA regulations give disability insurance claimants at least 180 days after a denial to file an appeal, and the evidence you submit in that window may be the only evidence a court ever sees.
Our firm has represented disability insurance claimants since 1979, helping tens of thousands of people nationwide recover more than $2 billion in benefits. Contact our office for a free consultation with one of our long-term disability insurance lawyers. There is no fee unless we recover benefits for you.
