Hartford Reinstates Long Term Disability Benefits on Appeal to Computer Systems Administrator Suffering with Chronic Back Pain
Author: Attorney Stephen Jessup
Prior to filing for disability benefits with Hartford our client worked as a Senior Database Administrator and had been in the computer industry since 1978. Needless to say his entire work history and all of his skills and occupational training revolved around computers. Over those 33 years working, as he continued to excel in his career, so did his congenital form of cervical spine disease, which resulted in multiple levels of severe disc degeneration, cervical kyphosis and stenosis. Despite his best efforts to continue to work, eventually the pain and discomfort became too great a burden to bear. He experienced increased difficulty concentrating through the pain or the ability to perform the physical requirements of his job. With a work product that was declining as rapidly as his health our client filed for disability benefits under his employer provided disability policy with Hartford.
Approved… but not for long
Hartford initially approved our client’s claim for benefits. At first it seemed as if he would have no problems with Hartford – his claim for benefits with Social Security was approved and Hartford was not contacting him frequently with requests for information. However, review of the denial letter and claim file indicates that Hartford began investigating his claim shortly after he returned his Social Security overpayment. True to form, Hartford employed its usual process to deny benefits: video surveillance, field interview, and peer review. What made this case a little different than most was the fact that our client’s claim was being investigated under the “own occupation” definition of disability as opposed to the transitional period leading up to the change in definition to the much more liberal standard, “any occupation” definition of disability.
With less than a year on claim, no documented improvements in his medical condition, continued support from his treating physicians and an award for benefits from the Social Security Administration, Hartford determined that there was nothing that would prevent our cleint from returning to his former occupation. With that his claim was denied.
Prior to contacting our office, our client was represented by a different attorney who advised him that he would no longer represent him against Hartford. As such he contacted Dell & Schaefer with less than a month left in which to file his appeal within the 180 day deadline. He felt hopeless, defeated and willing to walk away from his policy. Attorney Stephen Jessup worked with him to secure a brief extension of time with which to file the appeal to ensure a copy of the claim file could be received, reviewed and undermined. With time of the utmost essence, Attorney Jessup coordinated additional functional testing for our client, consulted with his treatment providers to issue responses to Hartford’s medical review, and poured over the claim file finding numerous inconsistencies and holes in the video surveillance, vocational review and medical review to attack.
With all the updated information needed to counter Hartford’s reasons for denying the claim, Attorney Jessup submitted our client’s appeal. In less than the 45 days allowed under ERISA to render a decision, Hartford informed our office that it was overturning its decision to terminate the claim, reinstating the benefit and forwarding all benefits owed.
Has Hartford denied your claim for benefits under the “Own Occupation” definition of disability?
We are seeing increased denials of benefits by Hartford during the own occupation period of disability. We believe this to be a tactic by Hartford to allow them to set the tone for another denial at the “any occupation” period of disability. The reason being that if Hartford denies the benefit under your “own occupation” any subsequent appeal review will be with respect to the “own occupation” definition. In effect, Hartford could reinstate the claim for the remainder of the own occupation period and then enter denial under the any occupation period, prompting another appeal. It is presumed that Hartford hopes this will deter people from wanting to continue to fight for the benefits they are entitled to.
If you have any questions or concerns regarding a claim with your disability insurance carrier, please feel free to contact Attorneys Dell & Schaefer at 1-800-828-7583.