Our client, a 62 year old former pharmaceutical sales rep, had been receiving long term disability benefits with Hartford Insurance Company for nearly six years due to chronic back pain, which had resulted in six surgeries in a span of several years, when Hartford abruptly terminated his claim for long term disability benefits.
Hartford had initially determined that our client was unable to perform the material and substantial duties of his pre-disability occupation as a pharmaceutical sales representative. Then, two years later when our client’s occupational definition switched from “own occupation” to the much more broad “any occupation” definition of disability, Hartford again determined that due to his physical limitations and documented medical conditions, that he remained disabled as defined under the terms and conditions of the policy. Additionally, the Social Security Administration had approved disability benefits due to the disabling nature of his physical conditions and upheld its decision on reassessment.
However, despite the overwhelming medical evidence supporting his claim for long term disability benefits, the length of the claim history, and his advanced age, our client was not safe from scrutiny by Hartford. As our disability lawyers have seen on most Hartford disability denials, Hartford conducted video surveillance on our client and submitted him to an in home field interview. Hartford subsequently denied our client’s claim and relied upon the video surveillance, field interview statement, and medical records from one to two years earlier. The client subsequently contacted Disability Attorneys Dell & Schaefer to assist him with the ERISA Appeal of his disability benefit denial.
Attorney Stephen Jessup, prepared and filed the ERISA mandated administrative appeal on behalf of our client. In reviewing the claim and the extensive medical history, it became clear that the ultimate issue was not the sufficiency of the medical records, but rather Hartford’s actual review and reliance upon ancillary, non medical “evidence” used to deny the claim. Specifically, Attorney Jessup attacked Hartford’s reliance on and the contents of the video surveillance, the seemingly blatant manufacturing and cherry picking of dated documents and statements used by field interviewer, and the contents of the “any occupation” vocational review conducted by Hartford. In systematically attacking and countering the arguments relied upon by Hartford in terminating our clients claim, and by furnishing additional medical information and other items in support of the claim, Attorney Jessup was successful in forcing Hartford to reverse its termination of benefits.
This claim, and the hardships endured by our client during the appeal process, serves as a reminder to those on long term disability benefits that no matter the length of time one has been on claim, or their age (in relation to actual retirement claim or potential time left on claim) long term disability benefits are not guaranteed benefits. An insurance carrier is constantly reviewing claims for long term disability on a month to month basis, and with the state of the law in relation to ERISA based group disability policies, the insurance carriers will look for any reason they find “reasonable” in denying a claim for benefits.