UnitedHealth Group Clinical Review Coordinator With Persistent Post-Concussion Syndrome Wins Florida Hartford Long-Term Disability Insurance Appeal
Hartford denied long-term disability benefits to a registered nurse with a traumatic brain injury — a Hartford long-term disability denial built on the claim that there was no evidence of cognitive impairment, even though Hartford never required or obtained neuropsychological testing. Our client, a Clinical Review Coordinator at UnitedHealth Group in Florida, was left without income after a second concussion made it impossible for her to sustain the computer-intensive, cognitively demanding work her role required.
This is a pattern we have seen from Hartford repeatedly — denying claims for conditions like cognitive limitations disability claimants experience after brain injuries by leaning on paper reviews, ignoring treating provider opinions, and mischaracterizing the record to manufacture the appearance of agreement. Attorney Alexander Palamara built an appeal that exposed every flaw in Hartford’s denial, obtained new specialty-appropriate evidence, and forced Hartford to confront what it had been avoiding.
Hartford reversed its denial in full. Below, we break down how this appeal was structured and why the strategy matters for anyone facing a similar fight. If Hartford or any other disability insurance company has denied your claim, speak with one of our long-term disability insurance lawyers for a free consultation. We represent claimants nationwide, and we never charge a fee unless your benefits are paid.
Table Of Contents
- 1. Why this case matters for every Hartford claimant
- 2. Hartford’s denial: a paper review, mischaracterized opinions, and no cognitive testing
- 3. The provider Hartford cited had no basis to opine on brain injury
- 4. What the medical record actually showed — and Hartford ignored
- 5. Neuropsychological testing delivers the objective proof Hartford claimed was missing
- 6. The appeal: dismantling Hartford’s foundation
- 7. Hartford reverses its denial in full
Why This Case Matters for Every Hartford Claimant
An insurer cannot rely on unqualified providers to validate a denial. Hartford pointed to a chiropractor and a physician assistant as providers who “agreed” with its peer reviewer’s conclusion that our client had no restrictions or limitations. Neither was qualified to assess traumatic brain injury or post-concussion syndrome. When a provider’s scope of practice does not extend to the disabling condition at issue, their opinion carries no weight — and claimants facing a Hartford long-term disability denial should scrutinize which providers the insurer is relying on and whether those providers are actually qualified to render the opinions attributed to them.
Normal brain imaging does not mean normal brain function. Hartford’s peer reviewer emphasized clean CT scans and a negative MRI to justify denying ongoing restrictions. Post-concussion syndrome (ICD-10: F07.81) is a condition in which patients experience disabling cognitive, vestibular, and visual symptoms despite normal structural imaging. Approximately 15 percent of individuals who sustain a mild traumatic brain injury will develop persistent post-concussion syndrome, and those with a history of prior concussions face elevated risk. Hartford’s equation of “normal imaging” with “full functionality” is a fundamental misunderstanding of the condition — and one we see disability insurance companies exploit regularly.
When an insurer says there is no objective evidence of cognitive impairment, the answer is to create it. Hartford’s denial hinged on the absence of formalized cognitive testing in the claim file. Rather than accept that gap as a dead end, we obtained a comprehensive neuropsychological evaluation that produced exactly the objective, quantified evidence Hartford claimed was missing. The evaluation confirmed deficits in processing speed, executive function, visual memory, and response inhibition — all critical to our client’s cognitively demanding occupation.
Failed return-to-work attempts are objective evidence of functional limitation. Our client did not simply stop working and file a claim. She tried to return — first at four hours per day, five days per week, then three days, then two. Each attempt worsened her symptoms. By the time she transitioned to long-term disability leave, she could not tolerate more than two four-hour days per week. A claimant who progressively reduces hours and ultimately cannot sustain even that minimal schedule is demonstrating, in real time, that the demands of the job exceed her functional capacity. That pattern is itself evidence Hartford chose to disregard.
A paper review that ignores occupational demands is not a valid basis for denial. Hartford’s peer reviewer, Dr. Vivian Suarez, opined that there was “insufficient evidence” to support restrictions beyond one week after the injury. That opinion never analyzed whether our client’s documented symptoms — dizziness, photosensitivity, blurred and double vision, inability to read a screen for more than 45 minutes, debilitating fatigue after cognitive exertion — were compatible with the specific demands of her job: sustained computer use, complex medical record analysis, and uninterrupted concentration for a full workday. A peer review that does not connect symptoms to occupational requirements is incomplete at best and misleading at worst.
Hartford’s Denial: A Paper Review, Mischaracterized Opinions, and No Cognitive Testing
Our client sustained a traumatic brain injury after a fall at home, striking the left side of her face on the floor. She was taken to the emergency department, where CT imaging confirmed a facial contusion with a 3 cm hematoma at the left buccal space (the inner cheek) and significant periorbital edema (swelling around the eye). She was diagnosed with a concussion. This was her second head injury — she had sustained a prior traumatic brain injury approximately five years earlier in a motor vehicle accident, from which recovery took months of therapy.
Before the injury, our client worked remotely as a Clinical Review Coordinator — a role that required an active RN license and demanded sustained computer use, review of complex clinical information, application of medical criteria, coordination with providers, and compliance with benefit policies. It was, in every sense, a cognitively intensive, screen-based job. She had worked for UnitedHealth Group for nearly a decade and excelled in the position.
Hartford denied her claim for long-term disability benefits, issuing denial letters stating that the medical evidence did not support restrictions or limitations beyond a brief injury-recovery window. Under the policy, our client was in the “own occupation” period — the initial phase of a long-term disability policy in which the claimant must prove she is unable to perform one or more of the essential duties of her specific job, not any job in the general economy. Hartford’s denial rested on three pillars — all of which were flawed.
The Paper Review by Dr. Vivian Suarez
Hartford retained Dr. Vivian Suarez, a neurologist, to conduct a paper review — a file-only assessment in which the reviewer never examines, speaks with, or observes the claimant. A paper review, sometimes called a file review, is a claims evaluation method in which a physician retained by the insurance company reviews medical records and renders an opinion on functionality without ever meeting the patient. Dr. Suarez concluded that restrictions and limitations were supported only for one week following the injury and that from that point forward, there was “insufficient evidence” to justify ongoing limitations.
Dr. Suarez acknowledged that our client had been diagnosed with a concussion and post-concussion syndrome, and that she continued to report dizziness, blurred vision, headaches, fatigue, nausea, vertigo, and photosensitivity. Yet despite this, Dr. Suarez emphasized normal neurological examination findings — intact cranial nerves, normal gait, and 5/5 muscle strength — as justification for denying ongoing restrictions. This reasoning reflects a fundamental misunderstanding of persistent post-concussion syndrome: the very nature of the condition is that patients experience disabling cognitive, visual, and vestibular symptoms despite normal objective neurological findings and negative imaging. As the CDC has noted, a brain scan is not needed to identify a mild traumatic brain injury — and a clean scan does not rule one out.
The Mischaracterized Provider “Agreement”
Hartford’s denial letter claimed that two of our client’s treating providers had “responded in agreement” with the peer review’s conclusions. This assertion was either a misunderstanding of the record or a deliberate mischaracterization of it. The two providers Hartford cited were a chiropractor and a physician assistant — neither of whom specialized in neurology or brain injury medicine, and neither of whom was qualified to assess the cognitive, visual, or vestibular impairments at the core of our client’s disability.
Meanwhile, the providers who were qualified — her treating neurologist and neurology APRN — explicitly rejected the peer review’s conclusions. In a letter to Hartford, they confirmed that our client’s post-concussion symptoms were ongoing, variable, and significantly impairing her ability to perform her job duties. They recommended that, at minimum, she be maintained on a restricted part-time schedule, and if that was not sustainable for her employer, she should continue on long-term disability. Hartford’s denial letter did not mention this letter.
No Analysis of Occupational Demands
Perhaps the most glaring omission in Hartford’s denial was the complete failure to analyze whether our client’s documented symptoms prevented her from performing the essential duties of her specific occupation. Her role as a Clinical Review Coordinator required sustained concentration, complex medical record analysis, application of clinical criteria, provider communication, and regulatory compliance — all conducted through extended computer use. Hartford’s assumption that she could perform this work on a full-time basis was never tested against the reality of what the job actually demanded.
The Provider Hartford Cited Had No Basis to Opine on Brain Injury
One of the first issues attorney Alexander Palamara identified was Hartford’s reliance on the treating chiropractor’s “agreement” with the peer review. Hartford’s Medical Claims Manager, Stacy Peraze, RN, had sent the peer review report to our client’s providers and asked them to sign off. The chiropractor — who treated our client for musculoskeletal complaints including neck and back pain — had responded without additional comment, which Hartford interpreted as agreement with Dr. Suarez’s conclusion that our client had no ongoing restrictions.
Attorney Palamara contacted the chiropractor directly and obtained a written clarification that dismantled Hartford’s position. In a signed letter, the chiropractor confirmed:
- Determinations regarding traumatic brain injury and persistent post-concussion syndrome symptoms — including dizziness, headaches, nausea, fatigue, and cognitive impairment — are outside the scope of chiropractic practice.
- Opinions regarding those symptoms are more appropriately provided by our client’s neurology specialists.
- Our client had ongoing symptoms and greater pain following her second concussion.
This clarification eliminated any ambiguity in the record. Hartford had attempted to use a chiropractor’s non-response as evidence that the peer review was supported by treating providers. The chiropractor’s own words confirmed that she had never been in a position to agree or disagree with conclusions about brain injury — because assessing traumatic brain injury was not within her professional competence. The only providers qualified to evaluate the disabling effects of our client’s post-concussion syndrome were her neurology team, and they had consistently documented that she could not sustain the cognitive, visual, and stamina demands of her occupation.
What the Medical Record Actually Showed — and Hartford Ignored
Hartford’s denial portrayed a claimant whose symptoms should have resolved within days. The medical record told a completely different story — one of persistent, documented impairment across multiple specialties over more than a year.
Objective Neurological Findings That Never Resolved
From the initial chiropractic evaluation days after the injury through neurology follow-ups more than a year later, our client’s providers consistently documented abnormal findings:
- Bilateral acrocyanosis (bluish discoloration of the extremities) and pedal edema (swelling of the feet) on lower extremity examination
- Oculomotor abnormalities — bilateral pupillary constriction on cranial nerve III testing
- Impaired tandem gait and a positive Romberg sign, indicating balance dysfunction. A positive Romberg sign means a patient cannot maintain balance when standing with eyes closed, which signals impaired proprioception or vestibular function.
- Tenderness on palpation of the cervical spine with multiple trigger points in the cervical region
- Restricted cervical range of motion documented repeatedly across chiropractic, physical therapy, and neurology evaluations
- Early cognitive screening showing immediate memory reduced to 10/30, delayed word recall at 4/10, and digit span at 1 of 4
These findings were not isolated to one visit or one specialty. They appeared across emergency medicine, chiropractic therapy, physical therapy, and neurology, and they persisted throughout the entire period Hartford claimed our client was fully functional. Neurology evaluations in the months following the denial continued to document the same pattern: impaired tandem walking, positive Romberg sign, oculomotor abnormalities, and cervical trigger points.
A Failed Return to Work That Hartford Dismissed
Our client did not simply stop working and file a claim. After 12 weeks off work, she attempted a gradual return under her neurologist’s supervision — initially approved for four hours per day, up to five days per week. The result was devastating. Within days of returning to her computer, she experienced severe nausea, blurred and double vision, debilitating headaches, and fatigue so profound she slept more than 10 hours a night. Her productivity plummeted.
Her treating neurology team progressively reduced her schedule. By late in the year, two four-hour days per week was manageable, but three was intolerable. She reported that the first couple of hours went well, but after that, her decline was rapid. Even that minimal schedule triggered vertigo, diplopia (double vision), and headaches. Her physical therapist documented that after returning to work, our client reported regression to the symptom level she experienced just weeks after the concussion. By early the following year, she could not continue. Her employer confirmed she was not medically cleared for full-time return and separated her from employment.
These failed work attempts — documented by multiple providers in real time — are themselves objective evidence of functional limitation. No individual capable of full-time sedentary work — defined by the Department of Labor as work performed primarily while sitting, with occasional lifting up to 10 pounds, and frequent handling, fingering, and arm extension at desk level — would be compelled to step down from full-time hours to 12 hours per week, and ultimately to zero. Hartford dismissed this evidence entirely.
The Treating Neurology Team’s Consistent Position
Our client’s treating neurologist and neurology APRN provided consistent, well-documented support for ongoing disability throughout the claim. Their positions were clear:
- Post-concussion syndrome symptoms can persist for extended periods and are exacerbated by stress, screen time, blue light exposure, and environmental factors.
- While the symptoms may be considered subjective, they have a significant impact on a patient’s ability to perform job duties, activities of daily living (ADLs), and instrumental activities of daily living (IADLs).
- Our client’s symptoms were “indeed having a significant impact on her ability to perform her job functions.”
- At minimum, she should be maintained on a restricted part-time schedule. If that was not sustainable for her employer, she should continue on long-term disability.
Hartford elevated the opinion of a non-examining peer reviewer over this treating team — the providers who had examined and treated our client over the course of more than a year. Courts have long recognized that subjective symptoms cannot be disregarded simply because they are difficult to measure, yet Hartford’s denial did exactly that.
Neuropsychological Testing Delivers the Objective Proof Hartford Claimed Was Missing
Hartford’s denial centered on the claim that there was insufficient evidence of cognitive impairment. Rather than accept that framing, we addressed it head-on. Our client underwent a comprehensive neuropsychological evaluation — a battery of standardized, validated cognitive tests administered by a board-certified neuropsychologist. A neuropsychological evaluation is a detailed assessment of cognitive functioning across multiple domains, including memory, attention, processing speed, executive function, and motor coordination. When performed with proper validity measures, it produces objective, quantifiable data that either confirms or rules out cognitive dysfunction.
The evaluation confirmed that our client’s estimated premorbid cognitive functioning was in the average to high-average range, based on her educational background and reading ability. Her current testing revealed a different picture — her ability to think quickly, stay focused, manage competing tasks, and remember visual information had all declined significantly from her estimated baseline. For a Clinical Review Coordinator who spent her workday analyzing complex medical records on dual computer screens, these deficits made sustained work impossible.
Where Deficits Emerged
The neuropsychological results documented impairment across several domains critical to our client’s occupation:
- Executive function: Response inhibition — the ability to suppress automatic responses and exercise cognitive control — fell in the exceptionally low range. Divided attention, complex alternating sequencing, and the ability to form abstract concepts and maintain mental set were below average. Auditory attention and working memory were low average. For a Clinical Review Coordinator who must analyze complex medical records, apply clinical criteria, and make accurate determinations under time pressure, these deficits are disabling.
- Processing speed: Visual-motor speed and associative learning were below average. Visual scanning and speed of information processing were low average. These scores mean our client processes information more slowly than expected for her age and education — a direct barrier to performing a job that demands rapid, sustained computer-based analysis.
- Visual memory: Immediate recall and recognition of complex visual information were below average. Delayed visual memory was low average. These deficits are particularly significant for a role requiring extended reading and review of clinical documentation on screen.
- Motor coordination: Eye-hand coordination and motor speed were exceptionally low in both the dominant and non-dominant hands — scores consistent with known effects of post-concussion syndrome and compounded by her arthritis.
- Language: Letter fluency — the ability to generate words under timed conditions — was below average, reflecting reduced verbal processing efficiency.
Verbal memory, by contrast, was intact — a pattern consistent with the heterogeneity seen in chronic mild traumatic brain injury, where some cognitive domains are preserved while others are significantly impaired.
Validity Was Not in Question
Critically, the evaluation included multiple performance validity measures — tests specifically designed to detect whether a patient is giving genuine effort. Our client passed all of them. The Test of Memory Malingering (TOMM) scores were 48 and 49 out of 50. The Rey 15-Item Test was 15 out of 15. Embedded validity measures were also adequate. There was no indication of suboptimal effort, and the evaluator concluded that the results were, in all likelihood, an adequate measure of current abilities.
Diagnosis: Mild Neurocognitive Disorder From Cumulative Brain Injuries
The neuropsychologist diagnosed mild neurocognitive disorder due to multiple etiologies (ICD-10: F06.8), generalized anxiety disorder (F41.1), and major depressive disorder, recurrent, moderate (F33.1), with persistent post-concussive syndrome documented by history. Mild neurocognitive disorder is a clinical diagnosis indicating a measurable decline in cognitive functioning — such as memory, attention, or executive function — from a person’s previous baseline, significant enough to interfere with daily activities but not severe enough to prevent independent living. The likely cause of our client’s cognitive impairment was multifactorial — including the cumulative effects of two mild traumatic brain injuries, vascular and metabolic risk factors, chronic pain, and mood disorder.
The evaluator’s conclusion was direct: our client’s deficits in processing speed and executive function “may compromise the ability to manage complex clinical information, maintain vigilance, and prevent errors — skills that are essential for nurse practitioners and other healthcare professionals in safety-sensitive roles.” The prognosis for substantial improvement was guarded, given the duration of symptoms, comorbidity burden, and our client’s age.
This evaluation gave the appeal something Hartford’s denial said did not exist: objective, validated, quantifiable evidence of cognitive dysfunction tied directly to the demands of our client’s occupation. It transformed the appeal from a dispute over subjective symptoms into a confrontation with data Hartford could not dismiss.
The Appeal: Dismantling Hartford’s Foundation
Attorney Alexander Palamara filed a comprehensive ERISA administrative appeal under 29 U.S.C. §1133 that attacked Hartford’s denial on every front. For anyone wondering whether they can appeal a Hartford disability denial for post-concussion syndrome — or any condition where the insurer claims there is no objective evidence — this case demonstrates what a well-built appeal looks like. An ERISA administrative appeal is the mandatory internal review process that a claimant must complete before filing a federal lawsuit under the Employee Retirement Income Security Act — and it is often the claimant’s last opportunity to build the record that a court will later review.
The appeal was built around four pillars:
- The chiropractor’s clarification letter, which confirmed that assessments of traumatic brain injury and post-concussion syndrome were outside the scope of chiropractic practice, eliminating any suggestion that Hartford’s peer review was supported by treating providers.
- The neuropsychological evaluation, which provided objective, validated evidence of cognitive deficits in the very domains Hartford’s peer reviewer claimed showed no impairment — executive function, processing speed, visual memory, and response inhibition.
- Updated medical records from the treating neurology team, documenting continued abnormal findings — impaired tandem gait, positive Romberg sign, oculomotor abnormalities, and cervical trigger points — months after the denial.
- A detailed analysis of occupational demands, connecting our client’s documented functional limitations to the specific essential duties of her role as a Clinical Review Coordinator–RN, which Hartford’s peer review had never attempted.
The appeal also highlighted the pattern in Hartford’s handling of this claim: relying on non-specialist providers to validate a denial, dismissing treating provider opinions that contradicted the peer review, failing to consider the significance of failed return-to-work attempts, and equating normal imaging with normal functioning in a condition known to produce disabling symptoms without structural abnormalities. We have seen Hartford use these same tactics in other cases — including a Hartford LTD appeal we won for an SAP advisor whose denial was driven by an internal paper review and a Hartford appeal we reversed for a computer systems administrator with chronic back pain.
Hartford Reverses Its Denial in Full
Hartford completed its appeal review and issued a written decision reversing the denial. Hartford advised that the decision to deny long-term disability benefits was overturned from the date of disability through the present, and that our client met the policy’s definition of disability. Benefits were approved and all back benefits owed were to be paid.
The reversal came less than a year after the original denial — a timeline that underscores how quickly a well-built appeal can resolve what might otherwise have required federal litigation. For our client, it meant the difference between an indefinite legal battle and the financial security she needed to continue treatment and focus on her health.
Post-concussion syndrome is real, disabling, and often invisible on routine imaging. When an insurer denies a claim by pointing to clean scans and normal neurological exams, it is exploiting a gap in the record — not reflecting the medical reality. As attorney Alexander Palamara argued in the appeal, Hartford’s assumption that our client could continue performing this cognitively demanding, computer-based role on a full-time basis “flies in the face of both medical reality and occupational requirements.”
If Hartford or any other disability insurance company has denied your long-term disability claim — whether for chronic headaches and migraines, cognitive impairment, post-concussion syndrome, or any other condition — speak with one of our disability insurance attorneys. We have represented tens of thousands of claimants nationwide since 1979 and have collected more than $2 billion in disability insurance benefits. We handle every stage of the claim process, from initial applications through appeals and federal litigation, and we never charge a fee unless your benefits are paid. Contact our office for a free consultation. Appeal deadlines are strict under ERISA — do not wait.
