Hartford Reversed Decision To Terminate Claimant’s LTD Benefits After Submitting an Appeal
Author: Attorney Rachel Alters
Attorney Rachel Alters was successful in convincing Hartford to overturn its decision to terminate her client’s LTD benefits after submitting an extensive appeal on her behalf. The claimant in this matter, due to physical limitations resulting from lumbar radiculopathy, failed back syndrome, sciatica, disc bulges L4-5 and L5-S1 and degenerative disc disease of the thoracic spine, was unable to perform even sedentary work due to severe pain and discomfort.
As insurance companies typically do, Hartford dismissed the overwhelming volume of objective evidence supporting her claim for total disability such as; significant abnormal findings on objective diagnostic testing, the claimant’s credible complaints of pain and clear observed limitations by her board certified physicians and specialists. It could not be disputed that the claimant in fact, had significant objective findings that evidenced that she indeed had medically supported restrictions and limitations which prevented her from working in any gainful occupation.
After reviewing the claim file, Attorney Alters determined that Hartford’s denial of her client’s claim was based heavily on surveillance video obtained by Hartford.
It is very important to be aware, that once you file a disability claim you are most likely going to be followed by the insurance company’s private investigator in an attempt to catch you doing activities that you claimed in your application or filed interview that you were unable to do. But sometimes, even though you are caught on video performing activity, it does not necessarily mean that you are capable of working in a full-time job 8 hours a day 5 days a week.
In the instant case Hartford conducted surveillance of the claimant on day one for the entire day and no activity was observed. A second attempt was made on day 2 and again she was not observed. On day 3, she was finally observed leaving her home. The surveillance report indicates that the investigator arrived at her residence at 6:57 a.m. No activity was observed until 4:08 p.m. She departed from her house and drove to a Dollar General Market store. She arrived 2 minutes later at 4:11p.m. She was observed inside of the store from 4:14 P.M. until 4:25 P.M. – she shopped for a total of 11 minutes. While shopping, she was observed purchasing a gallon of milk, 3 soda 12-packs, a case of water bottles, and several other small items. She is observed holding onto the cart for support as she squatted down to retrieve the packs of soda from the bottom shelf, she scoots them to the bottom rack of the shopping cart and then slowly, using the shelves for support, returns back to a standing position, with apparent difficulty. The entire time she is shopping, she is holding onto the shopping cart with both hands. Based on this video surveillance, Hartford terminated her benefits.
This is a prime example of how an insurance company can utilize a few minutes of video, take it completely out of context, and base the denial of benefits on the claimant’s ability to perform physical activity. In a three day period, she was only active for a total of 15-20 minutes. The 35 remaining hours, she was most likely at home lying down experiencing pain. However, according to Hartford, this 15-20 minutes of video was all it needed to show that she was perfectly capable of working in a full-time sedentary capacity. Seems ridiculous, but insurance companies often base the denial of benefits on video surveillance depicting the claimant performing some sort of physical activity for a short period of time and base the decision to terminate the claim on the fact that the claimant was capable of going to the store for 20 minutes and shop for their family.
When taken out of context, as surveillance video almost always is, it appears at first glance that the claimant is performing activities which she purportedly claims to not be able to do. However, when it is put back into the context of her life and what she claims to be able and to not be able to do physically, and when viewed with careful scrutiny, it is clear that Hartford has misrepresented the significance of this tiny clip of video surveillance. The video, in fact, depicts the claimant performing some physical activities. However, it shows her doing so with difficulty and with careful consideration to her obvious back condition.
More importantly is what is not able to be seen on the surveillance video. For instance, it is not known what the claimant had been doing prior to going out to the store, from 6:57 a.m. until 4:08 p.m. She could have been lying in bed or in her recliner resting for a majority of the day. It is also not known what medications she had already taken prior to going to the store. It is possible that her last dose of opiate pain medications had just taken effect and that time period, from 4:00-4:30 p.m., was the optimal time of her day for doing any activity such as running small errands. The surveillance video does not depict whether anyone helped her bring the groceries into the house after she returned home. Nor does the video show if she was completely worn out and incapacitated AFTER her shopping trip. She very well could have spent the remainder of her evening once again laid up in bed or in her reclining chair, with an exacerbation of pain after performing those small activities. These are all the arguments that were made to help overturn Hartford’s decision to terminate her benefits.
It is very important to be cognizant of the physical activity you perform once you leave your home making sure you are not doing anything that contradicts what you told the insurance company you were not able to do as a result of your disability. At any point in time you could be videotaped and even if you were having a good day, your claim can be terminated based solely on the video obtained.