Hartford's unreasonable denial of disability benefits to a hospital employee is reversed by Texas Court
Aside from the fact that many disability insurance companies already have a conflict of interest for being both the administrator of benefits and the entity that decides whether or not an employee qualifies for disability insurance, there are some cases in which it appears that insurance companies simply decide they don’t want to pay disability benefits.
Pamela Alexander began suffering with pain in 2002, when she worked as a transplant coordinator at a hospital. Having long-term disability insurance through her employer, Pamela applied and was denied in 2003, and two subsequent denials by Hartford Life occurred in March and September of 2004, after administrative appeals.
In 2003, Alexander had a Functional Capability Examination (FCE), which stated that while she was technically ‘qualified’ to lift 17 pounds occasionally and 9 pounds frequently; lifting this amount more than 5 times a day would put her at medical risk. The examining doctor clearly stated in the FCE that Alexander should be lifting no more than 13 pounds occasionally and 7 pounds frequently. The FCE also stated that the ‘Return to Work Status’ was NO.
Hartford hired Dr. Elizabeth Roaf to conduct a paper review of Alexander’s medical records. It should be noted that Dr. Roaf never personally examined Alexander. However, Hartford’s final denial for benefits letter denying Alexander’s appeal stated that Dr. Roaf “noted the results of your June 3, 2003 Functional Capacity Evaluation, which indicated that you could function in a light duty capacity.” Hartford misinterpreted the facts – as the FCE stated that Alexander “should not return to work at all”.
Therefore, the final denial for disability benefits makes no sense at all, especially since that letter stated that Alexander was ‘limited to 15 pounds pushing and pulling.’ Hartford’s occupational requirements for Alexander’s job stated she would be ‘lifting, carrying pushing, and pulling 20 lbs occasionally.’ In response to Hartford’s denial of Alexander’s disability benefits, Alexander filed a lawsuit in the United States District Court of the Northern District of Texas. The District court found in favor of Hartford, however, Alexander quickly appealed the courts decision.
Hartford’s Wrongful Denial Overturned on Appeal
The appeal court overturned the decision made by the district court, stating “that the insurer abused its discretion in denying the employee’s long-term disability claim because there was no rational connection between its conclusion that the employee was not disabled and the information on which it relied to support that conclusion.” There was a conflict of interest present which had to be considered in court as well, since Hartford was the plan insurer and administrator. The appeals court found that Hartford abused its discretion and wrongfully denied Alexander her long term disability benefits.
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I’m extremely satisfied with the experience I have had with this firm from day one. The lawyer who has handled my case, Alex, is very efficient and attentive to all my questions and concerns. They are always aware of how my case has gone and they care about my health. I feel optimistic with them because they are very attentive during the process of my claim. I would not hesitate to recommend families and friends if in any situation they need their services. Kathleen as well has been very well and assisted me with this case. I highly appreciate everything they have done for me.
It’s unfortunate when disability insurance companies come after older disabled policyholders just to help their bottom line. It can be a living nightmare the damage they can do to a family. Dell Disability Lawyers are polite, understanding and knowledgeable. They call you back and answer any question you have no matter how unimportant it can be. The amount of stress they took off of myself and family was incalculable. I recommend them highly to take care of any disability case whether it be filing for benefits or reversing a claim decision. They are outstanding.
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Without them my LTD company was dropping my plan with me still suffering from my accident, even with doctor’s statements I’m still disabled. The LTD company didn’t want to advance my policy to the next stage of years of pay. Dell Disability Lawyers saved my policy, and helped to enforce the LTD company’s own policy (for its policy holder, me) that I would be covered still under the LTD policy I had paid for at my previous job, when my accident occurred. These lawyers know what they are doing and can help you too. LTD companies will try to drop you when you still need coverage just because they don’t want to pay on your policy anymore. Don’t let them break contract with ya because they are trying to get out of it. Hit em with legal action to ensure the continuation of your policy you paid for. Dell Disability worked very well for me and continue to do so.
I was denied long term disability benefits from The Hartford after being on it for years. I found Dell Disability Lawyers after doing research online. In a matter of days they responded and explained to me everything that would be done. Dell Disability Lawyers were able to settle my suit against The Hartford very quickly and responded to me quickly. I would definitely recommend this team of lawyers for anyone that is fighting for their disability insurance.
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This law firm is the best so far. MetLife denied me two times, they appealed two times for me and they won of course. So if you are on disability and want a chance at winning your case use this firm Dell disability lawyers, kind courteous understanding and they get the job done. You won’t be disappointed.