Hartford is notorious for using video surveillance and probably utilizes it more than any other disability insurance company. A recent decision rendered by the U.S. District court in the Western District of New York in Theresa Williams v. Hartford Life and Accident Insurance Company highlights the merit the Court is willing to give video surveillance when a long-term disability plan administrator uses it as evidence to deny or terminate long-term disability benefits. In order to consider the reason why the video surveillance proved an insurmountable obstacle to the restoration of William’s long-term disability benefits, we must first consider the background behind her lawsuit. Watch our video to learn more about Hartford and their claim handling techniques.
Williams had been an employee of Entergy Corporation’s Arkansas Power & Light Company and a participant in Entergy Corporation’s Long-Term Disability Plan for over 14 years when she developed chest pain in January 1994. She was diagnosed with costochondritis and stopped working on June 27, 1994 because of the chest pain. She applied for long-term disability benefits from Hartford in October of that year. Her application was denied initially, but after several appeals, Hartford reversed its decision and began paying long-term disability benefits.
This continued until August 11, 2004. Hartford notified Williams by letter that her qualifications for continuing benefits were going to be reviewed. Williams was asked to provide updated medical information by the first of September, or Hartford would use the information it currently had on file to evaluate her claim for long-term disability benefits.
Williams signed and completed the “Authorization to Obtain and Release Information” included with the letter as well as the updated medical records by the deadline. She was notified over nine months later, on May 17, 2005, that she no longer met the definition of “total disability” in the policy. The letter served as her notice that her disability benefits had been terminated.
Hartford listed more than 22 pieces of evidence to support its claim that she was no longer totally disabled. Among the most incriminating in the disability insurance plan’s estimation was the disability video surveillance which showed Williams driving, walking rapidly and other common activities without displaying any signs of discomfort.
Other pieces of evidence included a Social Security Administration Determination Letter from October 30, 1998 that awarded benefits but noted the fact that Williams had “the residual functional capacity to perform the requirements of work” with the exception that she could not lift or carry more than five pounds, or sit and stand more than two hours in an eight-hour work day, and had some limitations with bending, reaching, pushing, and pulling.
A November 14, 2004 interview with a Hartford representative indicated that Williams was taking several college courses in hopes of working in an administrative position. Add the fact that Williams was not under active treatment or therapy, didn’t need assistance ambulating or caring for herself and had only seen her primary care physician in the last 12 months, Hartford reached the conclusion that Williams was no longer disabled.
Before issuing its decision to terminate Williams’ benefits, Hartford sent her medical information for an independent medical record review. The doctor performing the review contacted William’s physician. He reported in his April 17, 2005 report that William’s doctor had stated on April 13 that her chronic obstructive pulmonary disease did not cause any physical problems or limitations. He also stated that a stress test performed on November 30, 2004 could be read in the normal range. This information confirmed the finding that Williams’ costochondritis and chest pain were documented by her subjective complaints rather than clinical evidence. The doctor also noted that costochondritis, an inflammation of the cartilage that connects the ribs to the sternum, is rarely a chronic condition.
Hartford also ordered an employability analysis. The April 27 report found that there were a number of available jobs that fit Williams’ medical needs as well as her work and educational background.
Williams asked for an extension in which to file her appeal. Hartford gave her until February 17, 2006. She then sent a letter on this date, formally stating that she wanted to “re-activate [her] claim.” She asked for an explanation of the appeals process. Hartford responded by informing Williams that she had until April 3 to submit additional information. The disability insurance plan recommended copies of medical records and letters from any physicians she was seeing.
Once again, Williams just met the deadline, faxing three documents. Two reflected notes from medical consultations and one showed the results form a CT scan of Williams’ chest. Hartford did not find the evidence compelling. The disability insurance plan issued its final denial on April 4, 2006. This final denial reviewed the reasons given in the first denial as well as explaining why the new evidence failed to prove Williams was totally disabled. One document in particular proved injurious to her claims. Her physician had stated that Williams was able to perform light to moderate household tasks. Hartford found that this supported its conclusion that Williams should be able to perform the non-strenuous jobs listed in the vocational analysis.
Disability attorney files instant lawsuit alleging wrongful termination of benefits.
Williams’ disability attorney sought to recover her rightful benefits pursuant to ERISA. This meant the Court first had to determine the appropriate standards under which to review Hartford’s decision. Hartford had applied for summary judgment. This meant the Court had to evaluate whether a reasonable jury would return a verdict in favor of Hartford. In order to do this, the Court would have to look at the evidence in a way that gave the benefit of the doubt to Hartford.
Then, under ERISA, the Court had to determine whether Hartford’s decision should be reviewed de novo or under the arbitrary and capricious standard. Because the plan did not give Hartford discretion, the Court chose the de novo standard. This left one more step. The Court needed to determine whether the administrative record was sufficient or whether it should allow Williams to add information to the record. The Court found there wasn’t sufficient evidence to suggest a need to add to the record. It would base its analysis of the record on the administrative record alone.
Attorney and disability plan agree that de novo standard applies.
When the Court reviewed the record, it found no evidence that Hartford had reached an incorrect conclusion when it chose to terminate Williams’ long-term disability benefits. The evidence clearly suggested that Williams was not “totally disabled” by plan definition.
Using the same medical evidence that Hartford did, the Court reached the same conclusion. The fact that costochondritis is usually a short course disease, plus a stress test result showing that her echocardiogram was within the normal limits suggested that Hartford’s evaluation of her medical condition was a reasonable one.
Attorney claims Social Security award of benefits was ignored.
The Court upheld previous rulings that disability benefit plans are not bound by the decision reached by Social Security. It also found that a decision rendered in 1998, failed to provide insight into Williams’ current disability status. Hartford was within its rights to not consider the Social Security Disability decision applicable evidence of Williams’ disability.
Attorney claims video evidence is tainted.
The disability attorney argued that Hartford’s medical evaluation should have included an independent medical evaluation. He also claimed the doctor conducting the evaluation failed to ask about medications that Williams was taking and failed to consider the effects of an automobile accident on his client’s condition. He also argued that the video evidence given to the doctor showing Williams pursuing activities she claimed her condition prevented her from engaging in as proof that she was no longer “totally disabled” was “tainted.”
The Court found these arguments unpersuasive. Hartford’s physician had interviewed Williams’ treating physician, and based on the information gathered reached his opinion. The video evidence had barely factored into his opinion.
The Court rejects claim that video evidence is tainted.
The video evidence demonstrated that Williams was capable of considerable activity. She was taped walking at a fast pace without assistance. She entered and left her vehicle without apparent difficulty. She seemed to be able to lift her arms above her shoulders and to cross them across her chest without discomfort.
The Court recognized that video surveillance is an acceptable method for confirming whether disability exists or not. The Court also found that while the video surveillance supported Hartford’s conclusion that Williams was no longer “totally disabled,” it was not the primary basis for the decision to terminate Williams’ benefits. The Court found, as had Hartford, that the medical evidence did not support her claim.
The fact that she was also taking courses at the local community college in accounting, blueprint reading and criminal justice suggested that she would be able to work in a sedentary position. Hartford pointed to four specific occupations for which Williams’ was suited due to her training, education, and experience which accommodated her specific limitations. The Court validated Hartford’s conclusion that Williams was not prevented by her medical condition “from doing any occupation or work for which [she is] or could become qualified by training, education, or experience.”
The Court granted summary judgment to Hartford. While in this case, video evidence supplemented the lack of medical evidence to prove the claimant’s continuing total disability, it is important to realize that video evidence is a factor that cannot be overlooked. To learn more about the use of video surveillance by disability insurance companies take a look at Disability insurance companies love video surveillance.