Ms. M was employed as a personal banker with JP Morgan Chase when he began experiencing debilitating diabetic symptoms, diabetic retinopathy and peripheral neuropathy. JP Morgan Chase provided its employees with group long-term disability insurance with Hartford Life and Accident Insurance Company (“Hartford”). By 2010, Mr. M’s diabetes was out of control despite his attempts to control it through medication. He experienced headaches, dizziness, fatigue and persistent visual impairment. By early 2011 he was experiencing severe fatigue, his blood sugar was running between 200-300, he was experiencing neuropathic pain in his legs and his vision continued deteriorating due to diabetic retinopathy.
As a personal banker, Mr. M was frequently standing, processing financial transactions, using the computer and interacting with customers. Unfortunately, due to his worsening conditions, Mr. M was forced to notify JP Morgan Chase and Hartford that he was having difficulty performing his occupational duties and could no longer continue in his position. After being notified, Hartford gathered medical records and employment information, and following its review approved Ms. M’s claim for long-term disability benefits.
Hartford requests field interview with claimant after conducting video surveillance
By the end of 2011, Hartford began conducting video surveillance of Mr. M. The surveillance observed Mr. M running errands, driving short distances and walking with and without a cane. He was observed using a computer and talking on his cell phone.
In early 2012, after the video surveillance was taken, Hartford contacted Mr. M to conduct a field interview with one of its “investigators”. By the time of the interview, Mr. M had gone completely blind in his left eye and was wearing an eyepatch and his right eye vision was 20/400. He reported that he was able to run errands but if he anticipated walking for any length of time he would use his cane or motorized cart if the store made them available. Mr. M said nothing to contradict any prior statements and was completely 100% honest with the investigator interviewing him.
Hartford sends claimant to two independent medical examinations
Hartford was not satisfied with the video surveillance and field interview that confirmed that Mr. M was totally disabled. It now wanted to subject Mr. M to not one but two independent medical examinations with a physical pain and rehabilitation physician and a forensic psychiatrist, due to Mr. M’s reports of depression and anxiety resulting from his deteriorating physical condition. By this time, Mr. M. had applied and been awarded social security disability benefits and, in turn, Hartford was receiving the financial benefit of reducing Mr. M’s monthly benefit by the amount he was receiving from social security disability. In addition to the two independent medical examinations, Hartford selected an ophthalmologist to conduct a peer review of his medical records, however, the peer review physician never examined Mr. M’s vision or eyes personally.
Hartford and its team of physicians concluded that there was not enough medical evidence to support Mr. M’s claims of loss of visual functional capacity and that based on the totality of the medical records and the video surveillance benefits should be discontinued.
Mr. M contacted Attorneys Dell & Schaefer and retained Attorney Cesar Gavidia to represent him with his appeal of benefits. Attorney Gavidia and his team began by gathering all of Ms. M’s medical records and requesting the extensive Hartford claim file, as well as copies of all video surveillance and investigative reports. Attorney Gavidia contacted and spoke with Mr. M’s physicians, who expressed shock that Mr. M’s disability claim was denied and reaffirmed their support for Mr. M by completing customized attending physician statements.
Soon after receiving the appeal and the exhibits of evidence, Hartford contacted Attorney Gavidia and informed him that it was reversing its decision and would be reinstating Mr. M’s long-term disability benefits.
Mr. M is currently on claim and receiving long-term disability benefits from Hartford. Attorney Gavidia and his team at Dell & Schaefer monitor Hartford’s actions and ensure that all requests for medical documentation and claimant updates are addressed promptly and accurately.
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