Hartford Overturns Denial of Disability Benefits on Appeal

Our client, a former clerk at a coal mine with severe lumbar back problems first, contacted our office and spoke with Attorney Stephen Jessup in 2015 after Hartford denied his claim for long term disability benefits following short term disability. Similar to the vast majority of people with employer provided disability insurance with Hartford, our client’s short term disability policy was ultimately payable by the employer and Hartford was only tasked with administering the policy and directing the employer to issue disability benefits. However, when the claim transitioned to long term disability the payment of benefits was the sole responsibility of Hartford.

Our client’s short term disability claim was approved and paid with little issue. Hartford had determined that the medical information provided in furtherance of the short term disability was sufficient to prove our client couldn’t work and was entitled to short term disability, but when it came to long term disability (and Hartford having to pay the benefit) the medical information miraculously no longer supported the inability to perform his “sedentary” occupation. At that time Attorney Jessup submitted and successfully won our client’s appeal. As anyone on claim with Hartford knows- being approved for benefits is by no means the end of the story.

Any Occupation Review

After 24 months of benefits were payable our client’s definition of disability transitioned from the inability to perform his pre-disability own occupation to the inability to perform one of more of the essential duties of any occupation that he was qualified for based on education, training and experience. Despite being denied by the Social Security Administration, which is a factor considered by Hartford during the “any occupation” review, Attorney Jessup was able to successfully transition our client beyond the 24 month own occupation period in 2017.

By 2017, our client’s lower back condition had worsened substantially to the point that he required surgical intervention. Unfortunately, our client was unable to have the surgery due to the fact that after years of chronic pain and the inability to move or exercise without severe pain our client had gained a significant amount of weight, which due to the risk of complication during surgery, precluded him from undergoing surgery. Attorney Jessup believed it was this fact that would ultimately set into motion the events that would lead to Hartford denying benefits again.

Denial of Benefits.

Over four years after initially securing benefits for our client and two years after transitioning him from the 24 month own occupation period into the any occupation period, Hartford again began to turn up the heat on our client. It was Attorney Jessup’s belief based upon the interactions with Hartford’s claim manager that she had it out for our client and was searching for any way to find a “reasonable” basis to deny the claim. Updated requests for medical information and a phone interview with Attorney Jessup and our client resulted in Hartford requesting our client undergo an Independent Medical Examination (IME).

Despite no improvement in our client’s medical condition and evidence actually supporting further deterioration, the IME doctor provided Hartford with what it paid for – a report and opinion that indicated our client would be able to perform full time sedentary work. The IME report was all the claim manager needed to deny the claim.

Appeal

Our client and Attorney Jessup had fought Hartford for years and were not about to give up now. Understanding that Hartford was looking down the road to litigation and was trying to establish that it had acted reasonable when it denied our client’s claim, Attorney Jessup knew that success in the appeal would be based on refuting the IME report. Attorney Jessup has questioned the opinions of countless IME doctors, but upon review of the IME report it would appear the blame laid solely on Hartford.

The IME doctor’s report initially supported our client’s disability and indicated he would be unable to perform the physical duties of a sedentary occupation on a full time basis. It was only after repeated pressure from Hartford to clarify his position did the IME doctor change his opinion to indicate our client had full time work capability.

Despite the opinions expressed by the IME doctor, there was little in the way of actual physical examination conducted that really got to the heart of our client’s restrictions and limitations. To best assess our client’s ability to sustain full time sedentary work as defined by Department of Labor criteria, Attorney Jessup had him undergo a functional capacity examination, which would entail extensive physical testing aimed at identifying physical restrictions and limitations. As expected, the testing indicated that our client would not be able to sustain full time work activities with reasonable continuity. Attorney Jessup submitted our client’s appeal and despite having performed an Independent Medical Examination, Hartford’s appeals department overturned the claim’s manager erroneous decision to terminate benefits.

Hartford is known for performing video surveillance, Independent Medical Examinations and field interviews as ways to build a case for denial. These tactics are specifically utilized with the intention of establishing for purposes of future litigation that a denial of benefits was not “arbitrary and capricious” but rather a “reasonable” basis with which to deny a claim. If Hartford has requested you undergo an IME, meet with a representative, or have sent video surveillance to your doctor for review you can rest assured that they are looking for grounds to deny your claim.

Please feel free to contact our office and speak to Attorney Jessup or one of our other disability attorneys to discuss your claim.

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FAQ

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
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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.

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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.

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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.

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