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.

Leave a comment or ask us a question

Questions About Hiring Us

Do you help Hartford claimants nationwide?

We represent Hartford clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Hartford disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Hartford. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Hartford.

How do you help Hartford claimants?

Our lawyers help individuals that have either purchased a Hartford long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Hartford:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Alan L.

Cesar Gavidia handled my case and he was responsive to questions that I had from the very beginning until the end. I hired Dell & Schaefer to file a lawsuit after my long term disability claim was denied. I was represented by experienced professionals throughout the process and that fact was especially evident during the mediation phase. I was satisfied with the settlement they were able to obtain for me. Something that I could never have done on my own.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us