Our client, Mr. H, formerly worked as a CEO of an engineering services contractor. In February 2016 a number of medical issues, including Cardioembolic Stroke as well as associated cardiac and cognitive issues, forced Mr. H to stop working and submit his claim for disability benefits, first under his employer’s short-term disability (STD) policy and then continuing under its long-term disability (LTD) policy. Both benefits were funded and administered by Hartford. Mr. H’s occupation as a CEO was intellectually demanding and required high level of executive functioning. Under his employer’s disability policy, he would be considered totally disabled if he was unable to perform the essential duties of his “own occupation.”
After paying Mr. H for the maximum benefit period under the STD policy, Hartford denied LTD benefits. After receiving the denial, Mr. H contacted Dell & Schaefer and discussed his case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in Hartford’s denial letter and in the physician consultant’s medical reviews, and agreed to prepare and submit Mr. H’s ERISA appeal with the assistance of his appeal team. The appeal was successful and Hartford overturned its decision and reinstated benefits. Less than 3 months later Hartford again terminated benefits claiming Mr. H was “able to perform 8 hours/day and 40 hours/week on a sustained basis.” Because Attorney Symonds and his team continued to represent Mr. H following his reinstatement of benefits they were quickly able to prepare and submit a second appeal on his behalf.
The appeal addressed all of Hartford’s short-comings and reasons for denial, with a special focus on the review conducted by Hartford’s 3rd party medical consultant and undocumented and unnecessary interactions initiated by Hartford’s in-house nurse reviewer. In particular, despite having overturned the denial, the nurse reviewer circumvented the claims examiner and contacted the 3rd party medical consultant purported seeking “clarification” on issues that had already been resolved and asking that he apply a policy standard not applicable to Mr. H’s claim. What’s more, the 2nd denial addressed only Mr. H’s sleep apnea and failed to address Mr. H’s significant neurological/cognitive dysfunction, which was the basis for his initial claim.
Approximately 4 weeks later, and after reviewing the 2nd appeal and hundreds of pages of exhibits and medical records, Hartford again overturned its decision to terminate the claim and reinstated Mr. H’s long-term disability benefits. Attorney Symonds continues to represent our client to best ensure that Hartford will not terminate his benefit again. Feel free to call our disability attorneys for a free consultation on this or any matter relevant to your disability claim.