Hartford abused its discretion by relying on video surveillance and ignoring medical evidence

Here is an other example of case against Hartford Insurance Company which shows that you can never let your guard down when it comes to protecting your payment of long term disability benefits. Prior to going on disability, Michael O. was a heavy equipment operator in Virginia. In 2004 he was involved in an automobile accident, which resulted in having to undergo neck surgery. Despite the seriousness of his injury he was able to return to work. However, his condition deteriorated and he continued to experience a great deal of pain and in 2006 he was required to undergo a second neck surgery.

Following his second surgery he filed for long term disability benefits under his employer’s ERISA governed long term disability policy with Hartford. His claim for benefits was approved by Hartford, effective October 2006. For two years Hartford paid his benefits under the “own occupation” definition of disability contained in his policy.

Hartford’s “Any Occupation” Review

Like the overwhelming majority of employer provided ERISA long term disability policies, Mr. Osborne’s policy contained a change in definition from “own occupation” to “any occupation” after 24 months of benefits. In Mr. O’s case, and maybe the saving grace of his claim, the language of his policy seemed to indicate that to satisfy the terms and conditions of benefits under the “any occupation” definition there would have to be a showing that he be able to perform an occupation at a medium physical demand level as defined by the Department of Labor.

In 2008, Hartford began its review of Mr. O’s entitlement to benefits under the “any occupation” definition of disability. After reviewing all of the medical evidence presented by Mr. O’s treatment providers, he was deemed to be disabled from “any occupation” beyond the October 2008 change in definition of disability.

The Notorious Hartford “Milestone” Interview Request

In many disability claims, one of the most likely times for a denial of benefits is at the “any occupation” stage. Surviving this review would normally indicate that one’s claim is fairly secure. However, as with all long term disability benefits, continued monthly benefits is never guaranteed and as Mr. O discovered, an insurance company can change its position very quickly.

In April of 2009, approximately six months after finding Mr. O was disabled from performing the material and substantial duties of “any occupation,” Hartford wanted to conduct what the Court refers to in its opinion as a “milestone” interview. It is never made clear what the “milestone” was that prompted Hartford to want to conduct an interview. After several unsuccessful attempts were made to contact Mr. O, Hartford decided to place Mr. O under video surveillance.

Video Surveillance Conducted By Hartford

In June of 2009, Hartford hired an investigator to conduct two days of surveillance. On the first day of scheduled surveillance Mr. O was not observed. However, on the second day he was videoed performing two hours of yard work. During the course of the surveillance he was observed, “[U]sing a gas-powered weed trimmer, lifting a wheelbarrow out of the bed of his truck, shoveling mulch from a trailer into the wheelbarrow…” appearing to perform all of the physical activities without restriction or limitation.

Hartford Field Interview

In September of 2009, Hartford met with Mr. O to conduct a field interview. It should be noted that many denials of disability benefits by Hartford usually involve a two prong attack by way of video surveillance and a subsequent field interview with a Hartford representative. See our videos regarding the Hartford field interview process. During the course of the interview Mr. O was shown the video surveillance to which he indicated that he had performed the work to help a friend prepare for a graduation party and that he experienced a high level of pain the following day as a result of overexerting himself.

Medical Review

Following the field interview, Hartford’s medical case manager contacted Mr. O’s treating physicians to discuss his medical condition as well as providing the video surveillance for their review. Despite the contents of the surveillance Mr. O’s doctor remained convinced that he was unable to perform the level of physical activity required for gainful employment and recommended that Hartford conduct a functional capacity evaluation (FCE) to properly document Mr. O’s physical restrictions and limitations.

Instead of sending Mr. Osborne for an FCE, Hartford forwarded his medical records to a Neurologist to conduct a review of the file. Mr. O was never physically examined by any of Hartford’s medical professionals. Hartford’s reviewing neurologist determined that based upon the medical records and information available, with specific attention to the video surveillance, that Mr. O would be able to work on a full time basis. In turn, on January 12, 2010, Hartford denied his claim for benefits.

Mr. Osborne’s Appeal

As required under the policy, Mr. O appealed Hartford’s decision. As additional evidence of disability, Mr. Os underwent an eight and a half hour Functional Capacity Evaluation. In the results of the examination it was noted that he had put forth his best effort and that based on his performance hid doctor described his overall condition as, “[S]imply a mess with a guarded prognosis for returning to work in the competitive labor market.” He argued that he was not able to work a consistent 8 hour work day on a full time basis and that Hartford had improperly relied on the surveillance video. His doctors continued to adamantly voice their opinion that he was not physically able to return to full time work.

Upon submitting his appeal, Hartford again chose to have his medical records and information reviewed as opposed to having him physically examined. Hartford turned the file over to the University Disability Consortium to be reviewed by a Dr. Beatrice Engstrand. Dr. Engstrand determined that Mr. O was capable of working “full-time, consistently, with restrictions of no more than medium level work.” Based upon Dr. Engstrand’s opinion, Hartford upheld its denial of Mr. Osborne’s claim.

Long Term Disability Lawsuit Filed Against Hartford

Following the denial, Mr. O brought suit in Federal Court in the Western District of Virginia. Following review of all of the documentation in Mr. O’s claim file, the Judge found that Hartford had abused its discretion for failing to conduct a meaningful analysis of the evidence submitted by Mr. O and for the inordinate amount of emphasis Hartford placed on the video surveillance. Specifically the Court notes that even though Hartford’s reviewing doctor, Dr. Engstrand claims to have reviewed all the information presented to her that she almost exclusively focused on the surveillance, giving no weight to the FCE performed which indicated Mr. O’s inability to work. The Court acknowledged that the, “[T]wo hour segment of surveillance footage reveals some discrepancies between O’s claimed and observed functionality, it does not provide substantial evidence that O is capable of performing medium-level work on a full time basis.” The Court found that Hartford’s “failure to seriously engage in a discussion” of Mr. O’s favorable evidence served as further support of its ruling that Hartford abused its discretion in terminating benefits, stating:

On this record, the court is simply unable to conclude that Hartford followed a reasoned decision making process or that it presented substantial evidence to support its determination that Mr. O is capable of performing unrestricted medium work on a full-time basis.

The Court ultimately remanded the claim back to Hartford for further review of the material in accordance with the Judge’s order.

What Can We Learn From This Case?

The Federal Court for the Western District of Virginia provides some insight as to the factors it will consider to determine if an insurance company abused its discretion in denying a claim. Specifically, it provides additional argument against the over reliance of video surveillance in light of medical documentation and opinions. What cannot be overlooked is the fact that Mr. Osborne’s claim was denied in January of 2010, and that it wasn’t until September of 2012 that a Judge ruled in his favor. However, it is equally important to realize that by remanding the claim back to Hartford, the Judge did not award any back benefits. The Judge only ruled that Hartford had to conduct another review of the material. There is no guarantee that Hartford will ultimately change its decision or that Mr. Osborne will receive any benefits. This case serves as another example that winning the battle doesn’t mean you’ll win the war.

Attorneys Dell and Schaefer did not represent Mr. Osborne or have any involvement in his case, but has represented many claimants in actions against Hartford with similar fact patterns. Contact us for a free consultation.


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Hartford

Hartford Stopped Payments

Reviewed by Fed up in PA on April 13th 2023   Verified Policyholder | January 2023 date of disability
Worst company ever. Their analysts will go against your treating provider every single time. Horrible experience, just horrible.
Hartford

Hartford never paid me

Reviewed by Nanette M. on April 26th 2020   Verified Policyholder
I went on disability March 25, 2019 until Dec. 23, 2019 from my job FedEx. The Hartford insurance company didn’t pay me my disability check after the end of July. I appe... read more >
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Sent on April 26th 2020 by Attorney Gregory Dell

Nanette, we are sorry to hear that your claim for benefits for the period of July through December was denied. Please feel free to contact us for a free consultation.read more >

Hartford

Hartford rep felt so guilty over how the company treated me that she quit

Reviewed by Delton on April 8th 2020   Verified Policyholder
It’s been since 1998 but they really screwed me over big time and caused my family and I much distress ~ first they required me to go to a psychiatric doctor before they... read more >
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Sent on April 8th 2020 by Attorney Rachel Alters

Delton, I’m sorry to hear about the experience you had with Hartford. Unfortunately since your claim dates back to 1998 it would be too late to file suit as the statu... read more >

Hartford

Hartford ajuster won't return my calls. I might have to move back to California

Reviewed by Jesse on March 17th 2020   Verified Policyholder
I was awarded medical for life, for my back injuries at work by the court of Los Angeles in California years ago. I moved to Colorado two years ago and for the past few mo... read more >
Hartford

Hartford keeps saying they haven’t gotten my paperwork

Reviewed by David C. on March 3rd 2020   Verified Policyholder
I have a short term disability claim through the Hartford through my job. I was approved to go back to work on March 9th. The Hartford keeps telling me they did not get my... read more >
Reply
Sent on March 3rd 2020 by Attorney Stephen Jessup

David, I would recommend you try to get a fax confirmation from your doctor, or better yet secure the information needed from your doctor and send to them. I have seen ... read more >

Hartford

I'm going bankrupt after Hartford rejected all my medical tests/records

Reviewed by JNC on February 26th 2020   Verified Policyholder
In January, I collapsed in a cross walk while crossing the street. I sustained injuries to my left knee and spine and have been chronic testing to determine the cause of m... read more >
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Sent on February 26th 2020 by Attorney Jay Symonds

JNC: I suggest you contact our office and speak with one of the attorneys to address the specific questions you have regarding your situation as well as your options on... read more >

Hartford

Hartford has denying claims down to an artform

Reviewed by Judy P. on February 26th 2020   Verified Policyholder
I have been denied by the Hartford for LTD through my company. I can already tell they have this down to an artform.
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Sent on February 26th 2020 by Attorney Jay Symonds

Judy: If this is the first denial you have the right to file an appeal but the deadline is time sensitive. Unless you plan to file your own appeal, I suggest you contac... read more >

Hartford

Hartford Insurance Company is a bunch of unpassionate people

Reviewed by Daniel B. on February 15th 2020   Verified Policyholder
Why is the Hartford Insurance Company a bunch of unpassionate people?
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Q: Do I have to sign the overly broad "AUTHORIZATION TO OBTAIN AND DISCLOSE INFORMATION" form from The Hartford LTD insurance company?

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Q: Can a chiropractor fill out the APS for The Hartford LTD claim?

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Q: Before I present my appeal, can I acquire exams and conduct an IME on my own (to avoid bribery/bias from Hartford)?

Answered on November 7th 2019 by Attorney Stephen Jessup
A: Michael, yes. In the course of an appeal you want to get as much beneficial information as possible, to includ... Read More >

Q: Can I get a lawyer to get the back pay Hartford still owes me?

Answered on August 28th 2019 by Attorney Rachel Alters
A: Laren, you could hire an attorney but it may cost you more than what you are owed for the STD back pay. I woul... Read More >

Q: How many IMEs can Hartford make you go through?

Answered on August 24th 2019 by Attorney Jay Symonds
A: DWT, most group policies allow the carrier to request that you be examined as frequently as they deem reasonab... Read More >
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In the recent case of Ferrin v. Aetna Life Ins. Co. a federal judge from the Northern District of Illinois determined that Aetna improperly te... Read More >

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