Our client worked as an Account Executive for many years until he suffered an accident that required him to undergo neck surgery. Harford approved his long-term disability benefits and paid him for over three years. His condition never improved, in fact it became worse after he suffered a stroke. After paying the claimant for several years, Hartford determined that he was capable of returning to work in a full-time capacity, completely disregarding his treating physician’s medical opinion that he was incapable of full-time or even part-time work.
Hartford Tricks Treating Physician Into Signing Document Stating His Patient Can Work
Disability insurance carriers are notorious for harassing claimants’ treating physicians with an overwhelming amount of paperwork hoping at some point the physicians will become fed up and stop supporting their patient’s disability. The insurance carrier will send countless letters to treating doctors asking them to fill out documentation stating their patient can return to work. Unfortunately, most physicians are extremely busy and do not have time to read through lengthy paperwork and will sign off on forms that may or may not contain the correct information.
Hartford was not satisfied with the claimant’s treating physician’s opinions which supported his inability to perform full-time sedentary work with any reasonable continuity. Therefore, Hartford sent his doctor a statement asking him to sign if he agreed that he could go back to work or provide a reason he could not work full-time sedentary work. In haste, his physician signed Hartford’s statement not realizing it did not coincide with his previous opinions. Of course Hartford was hoping this would occur and as a result, the Hartford terminated his disability claim. However, the claimant’s physician was always of the opinion that he was not capable of full-time sedentary work and would stand by his original medical opinions.
It came as a surprise to our client when he learned that the physician he had been treating with for years, who consistently supported his inability to work, and previously stated that his disability was permanent, signed a letter provided by Hartford stating that he was able to return to full-time sedentary work.
In her appeal, Attorney Rachel Alters provided an additional Attending Physician’s Statement clarifying the medical opinions of the claimant’s treating physician. The claimant’s physician did not remember signing the letter stating his patient could return to work and had always been of the opinion that he was incapable of performing the material and substantial duties of his occupation or any gainful occupation due to cervical disc disease, radiculopathy, rotator cuff injury, neck and shoulder pain, left sided weakness, bilateral carpal tunnel syndrome and lower back pain. Attorney Alters also argued that Hartford acted unreasonably by failing to consider the Social Security decision as well as failing to retain a qualified physician to review our client’s claim.
Hartford Acted Unreasonably By Failing To Hire a Physician to Review His Claim
Hartford had a duty to reasonably investigate our clients claim prior to terminating his benefits. However, Hartford did not even bother to retain a physician to review his claim and failed to have a physician’s examine him to determine whether he was disabled. Our client was clearly disabled as was confirmed by the Social Security Administration when they determined he was not capable of performing full-time sedentary work.
Hartford Upholds Decision To Deny Benefits and Claimant Files Suit In Federal Court
Hartford upheld its decision to deny our client’s benefits claiming that the medical evidence failed to support his inability to work in a full-time sedentary capacity. Dell & Schaefer filed a lawsuit in federal court on behalf of our client alleging that Hartford violated his rights under ERISA and that their decision to terminate his benefits was arbitrary and capricious. The suit was amicably resolved in a confidential settlement prior to trial.
If you would like to obtain a free consultation to discuss your disability insurance claim please contact the law firm of Dell & Schaefer.
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