Hartford Financial's mental nervous disorder limitation clause in disability insurance policy held ambiguous

The United States Court of Appeals for the Ninth Circuit recently ordered a lower court to reconsider its decision that had affirmed Hartford Financial Insurance Company’s denial of a woman’s claim for disability benefits. Although the claimant has not yet been awarded her requested disability benefits, the Appeals Court’s decision leaves her one step closer to achieving this goal.

The Appeals Court remanded the case of Janice Parker back to the lower court for two reasons:

  1. The lower court reviewed Hartford’s disability benefit denial with the wrong standard of review; and
  2. The lower court failed to consider the policy’s mental nervous disorder limitation.

De Novo Review Ordered:

In ERISA cases, the default standard of review is “de novo” unless the governing disability policy grants discretion to the insurance carrier. When the insurance carrier is given discretion by the policy to interpret the policy and to decide whether benefits should be awarded, the court’s hands are tied in deciding only whether the insurance carrier abused this discretion. Although there may be sufficient evidence to support a finding of disability, if discretion lies with the carrier and there is a reasonable explanation for the administrator’s decision denying benefits, then the decision must be upheld by the court.

Conversely, when the policy does not grant discretion to the carrier, the appropriate review conducted be the court is the “de novo” standard. This standard allows the court to look at a disability plan administrator’s decision with a more critical eye. The court has the right to look at the evidence and evaluate whether the plan administrator’s decision was right, not just reasonable. Disability claimants would prefer the court to review the carrier’s decision under the de novo standard.

In the case of Janice Parker, the lower court conducted a review of Hartford’s decision under the abuse of discretion standard rather than conducting a de novo review. The Court of Appeals found that the lower court used the incorrect standard because the language in the disability policy only stated that the claimants were entitled to “a full and fair review” of their claims. The Court noted that this language did not mention nor grant discretion, and as such, the lower court should have use the de novo standard of review.

Ambiguous Mental Disorder Limitation in Hartford Disability Policy:

Janice Parker’s policy stated that the carrier would “not cover any loss caused by or resulting from a disability beyond 24 months after the elimination period if it is due to mental or emotional disorder of any type.” Because Janice Parker had been on claim for more than 24 months, the lower court felt that her benefits for mental and emotional disorders were exhausted and thus the mental disorder limitation was not implicated. The Court of Appeals disagreed.

The Court of Appeals found that the mental disorder limitation was implicated when Hartford refused to consider Parker’s previously acknowledged mental disabilities because of the limitation. Furthermore, the Court of Appeals found the limitation language in this specific disability policy to be ambiguous because it was not clear whether a disability was to be classified as “mental” by looking to the cause of the disability or to its symptoms or whether a disability resulting from a combination of physical and mental factors is included in the limitation. The Court stated that because ambiguities in the policy language are always construed against the drafter (here, as in most insurance cases, the carrier), Janice Parker’s illness would not fall under the limitation language if a physical illness contributed to, or was a cause or symptom of, the mental disorder. In other words, if Janice Parker’s depression caused her physical symptoms or if her physical problems contributed to her depression, she would still be entitled to benefits.

Because the lower court used the incorrect standard of review and failed to consider the mental disorder limitation or apply the correct definition of that limitation, the Court of Appeals remanded the case back to the lower court for a new review. Hopefully this disability claimant will receive long term disability benefits beyond 24 months.


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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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