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.
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.