Hartford Life Abused Its Discretion by Failing to Advise of Need for an FCE
Author: Attorney Victor Peña
In McKenna v. Hartford Life & Accident Insurance Co., the Minnesota federal court remanded to the Hartford plan administrator for reconsideration of its termination of McKenna’s long term disability benefits. The court held that since Hartford failed to inform McKenna, who was representing herself, of “what type of objective evidence she needed to provide with her appeal,” and she did not understand that a functional capacity evaluation (FCE) would be helpful to her case until after the denial when she obtained counsel, she had shown “good cause” for failing to obtain the FCE before Hartford closed her file. The court then remanded to Hartford with instructions to consider the FCE, “along with the rest of the administrative record, before making its final benefit determination.”
McKenna’s initial application for disability benefits was approved when Hartford agreed her fibromyalgia prevented her from performing the duties of her own occupation. After two years, the definition of disability changed, requiring McKenna to be unable to perform the duties of any occupation. Initially, Hartford granted her long term disability benefits under the new standard, but after reviewing some of her Facebook posts and conducting video surveillance, Hartford informed McKenna that it was terminating her benefits since there was “no objective clinical physical exam findings to support any restrictions or limitations.”
McKenna then retained counsel who had her undergo an FCE which was conducted by Dr. Phillip Haber (Haber Report). When her attorney attempted to submit the Haber Report, Hartford refused to accept it, saying it was untimely. She then filed this ERISA lawsuit in which she requested the court to reinstate her benefits or, at a minimum, remand to Hartford with instructions to reevaluate her entire medical record including the Haber Report.
The court noted that it is acceptable to ask a claimant who has fibromyalgia to present objective evidence as to the extent of the disability. According to Hartford, “One method of objective proof of disability is a functional capacity evaluation, a reliable and objective method of gauging the extent one can complete work-related tasks.” Prior to terminating her benefits, Hartford failed to inform her of this even though one of her treating physicians said that an FCE “was necessary to fully assess her capabilities.” The court granted McKenna’s request and remanded to Hartford with instructions to “evaluate the Haber Report and consider the expanded record before issuing its claim decision.”
This case was not handled by our office, but it may provide claimants guidance in determining evidence that can be submitted on administrative appeal in support of their long term disability claim for benefits under the “any occupation” standard. If you need assistance with a similar matter, or with any issue concerning your disability case, please contact any of our lawyers for a free consultation.