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

Ran me Around for Months

Reviewed by David on July 5th 2024   Verified Policyholder | January 2024 date of disability
Scammers. Immoral horrible people.
Reply
Sent on July 5th 2024 by Attorney Gregory Dell

David:

It’s horrible that Hartford did that to you.

Hartford

Truly Horrible and Immoral Company with No Customer Service

Reviewed by William M. on June 26th 2024   Verified Policyholder | June 2020 date of disability
My experiences with Hartford have been nothing short of cruel. They started off by claiming that having Glioblastoma, which has an expected life span of about fifteen mont... read more >
Hartford

Sent my Direct Deposit to a Strangers Bank Acct

Reviewed by Brad on May 2nd 2024   Verified Policyholder | February 2024 date of disability
I went on short term disability and The Hartford put my direct deposit into someone else’s bank account. Somehow they messed up a number or two and they are refusing to ... read more >
Hartford

Former Hartford employee has had life insurance and accidental death policy's revoked for one late premium payment

Reviewed by Becky H. THOMAS on February 12th 2024   Verified Policyholder | February 2024 date of disability
Dislike how they are constantly interrupting the lives of their disabled EE's whom are entitled to benefit which they paid into out of there pay check every pay period onl... read more >
Reply
Sent on February 12th 2024 by Attorney Gregory Dell

Thank you for your review of Hartford and we appreciate you sharing.  It’s sad they don’t take care of their own employees.

Hartford

Bad Faith

Reviewed by Dustin G on October 12th 2023   Verified Policyholder | November 2020 date of disability
They kept asking my doctor for the same information that they did not need to process my claim. He kept sending in the same information, and they kept asking for it. My do... read more >
Hartford

Denied by Hartford after 20 years of Payments

Reviewed by Mary on October 11th 2023   Verified Policyholder
Hello,I am a Multiple Sclerosis patient. I also have Lymph-edema, Asthma, Blood-clot problems, Bi-Polar 1 Depression, and Head & Neck Injuries. And now, due to MS, Spast... read more >
Hartford

This company is a scam!

Reviewed by Hana K. on July 13th 2023   Verified Policyholder | December 2022 date of disability
The Hartford does not pay claims. The Hartford only collects premiums. The Hartford doesn’t care if you are terminally ill. I’ve been employed at my employer since 201... read more >
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.
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Q: Disability company dropped my monthly benefits

Answered on February 28th 2024 by Attorney Rachel Alters
A: Since you went back to work full time you would not qualify for further benefits. You could file a new claim i... Read More >

Q: The Hartford stopped monthly benefits for repayment due to an overpayment. Once monthly benefits end do I still have to repay remaining overpayment balance?

Answered on February 28th 2024 by Attorney Rachel Alters
A: Yes, you will still be responsible for the overpayment even if your Hartford benefits end. Read More >

Q: Short term vs long term

Answered on February 14th 2024 by Attorney Jay Symonds
A: Nightwatcher, you and your treatment providers will be required to submit additional records and information a... Read More >

Q: Can I do anything to get my LTD ?

Answered on February 3rd 2024 by Attorney Gregory Dell
A: Jacqueline:You should call us to discuss your Hartford disability claim. It usually takes 60-90 days for Har... Read More >

Q: Lifetime disability policy with Hartford

Answered on January 29th 2024 by Attorney Gregory Dell
A: Deb,Thank you for your question about a Hartford lifetime disability policy. In order to support your pos... Read More >

Q: Can the Hartford reduce my long term disability payment due to a rental income?

Answered on January 25th 2024 by Attorney Cesar Gavidia
A: Usually non-work that is not described a deductible source of income the disability policy would not reduce th... Read More >

Q: Is there a specific video to help me prepare for a Hartford doctor appointment (IME)?

Answered on January 3rd 2024 by Attorney Gregory Dell
A: We have prepared a few videos on independent medical exams requested by disability insurance companies. Whethe... Read More >
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Many employer welfare benefit plans offer employees who quit their employment the option of converting their disability insurance plan to a private plan. When a claim for disability benefits is filed, there may be a dispute over whether the conversion plan is governed by ERISA. If so, then ERISA preempts any state law claims a plaintiff may have. If not, the conversion policy is a private&n... Read More >

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In October 2017 Hartford Insurance company agreed to purchase the disability and life insurance division of Aetna insurance company for 1.45 billion dollars.In this video nationwide long term disability insurance attorneys Gregory Dell and Stephen Jessup discuss what impact they believe this sale will have on Aetna long term disability policy holders.Con... Read More >

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Our client, came to us when he was unjustly denied his claim for LTD benefits by Aetna, now Hartford, asserting that his medical records did not demonstrate “a consistent inability to perform [his] sedentary occupation”.  Aetna abused its discretion in reaching this determination as its decision was not only wrong but arbitrary and capricious and was not based on a fu... Read More >

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Hartford Denies Long Term Disability Benefits After Paying for 22 Years

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 u... Read More >

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Our client, a former clerk at a coal mine with severe lumbar back problems first, contacted our office and spoke with Attorney Stephen Jessup in 2015 after Hartford denied his claim for long term disability benefits following short term disability. Similar to the vast majority of people with employer provided disability insurance with Hartford, our client’s short term disability policy was ultimately payable... Read More >

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Prior to filing for disability our client worked as a registered nurse in a hospital setting, suffering from multiple chronic medical conditions that resulted in ever worsening pain throughout her back, neck and extremities. When her conditions began to limit her ability to safely and effectively perform her occupational duties she, on her own, filed a claim for disability benefits under her employer’s group... Read More >

Hartford overturned its previous denial of LTD benefits for Illinois Account Representative

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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 terminated Ferrin’s claim for long term disability benefits and ordered Aetna to reinstate Ferrin’s claim and pay all past due benefits with interest. Prior to filing for long term disability Ferrin was an employee of Southwest Airlines. In 2008, while at work, she suf... Read More >

Hartford Admits to Improper Offset, Agrees to Reimburse 10 Years of Wrongfully Withheld Money

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Court Finds Video Surveillance Renders Claimant’s Self-Reporting Unreliable and Upholds Hartford’s Termination of LTD Benefits

In Cummings v. Hartford Life & Accident Ins. Co. (Hartford), Plaintiff was employed by the Free-Port McMoran Corporation (Plan) when he became disabled due to diagnoses of degenerative disc disease which caused him chronic debilitating pain and myofascial pain syndrome.Plaintiff was covered under his employer’s Group Long Term Disability Plan through Hartf... Read More >

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In James s. Louis v. The Hartford Life and Accident Insurance Company (Hartford), Plaintiff was a Senior Principal Product Strategist with Oracle America Inc. (Oracle) when he was fired from his job effective October 13, 2017. Between May 2017 and the date of termination, Plaintiff worked only intermittently.Oracle provided its employees with a long term disability (LTD) benef... Read More >

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