Hartford Disability Appeal

Medical support is clearly the most important type of evidence that will be required if your disability claim has been denied based on a lack sufficient medical evidence to support your restrictions and limitations. The type of medical condition(s) that you believe are disabling and the number of doctors you are treating with will require a strategy to determine which doctor or doctors would be best to work with to obtain additional medical support. Our disability lawyers will work closely with you and your doctors to get the required additional medical support. We will advise you as to the exact medical information that we believe will strengthen your claim. In the many appeals that we draft we often obtain additional medical support from a medical expert that you may not have seen before.

The exact medical information that will be needed to successfully appeal a Hartford denial depends on your definition of disability and the quality of the initial claim denial letter prepared by Hartford. There are some universal items that will make or break your appeal. First and foremost is your medical documentation. Any disability claim is only as strong as the medical information that supports it. Examples of medical information that can prove invaluable to a claim include, but are not limited to:

• Medical Records from your doctors/treatment providers
• Psychotherapy Notes
• Physical Therapy or Occupational Therapy Notes
• Applicable diagnostic testing: MRI, Cat Scan, X-ray, bloodwork, EMG/Nerve Conduction studies and any other Objective Medical Testing
• Specialized testing such a neuropsychological testing or functional capacity examinations that can help verify subjective complaints
• Attending Physician's Statements
• Behavioral Health Statements

This is by no means an exhaustive list of medical based information to be submitted with an appeal. Within each of the above referenced items it is incredibly important that the content of these documents accurately reflect your condition and its impact on your ability to work. This may seem like an obvious statement, but all too often we see medical records and claim forms that contain errors (often due to standardized data entry forms in common medical record keeping systems) or that omit a patient’s complaints as to how their medical condition impacts their ability to work, or fails to establish medically supported restrictions and limitations- a standard that all insurance companies will look for in determining whether or not you should be paid. It is not enough to simply have a large quantity of supportive medical information, it must be quality information that properly documents the medical condition and establishes a connection between the condition and how it impacts your ability to work in either your occupation or any gainful occupation.

The occupational evidence presented in a disability appeal must be presented based upon the applicable definition of “disability” in your Hartford disability policy. A common phrase in the disability insurance industry is “Diagnosis does not equal disability.” Meaning, simply having the diagnosis of a medical condition is not enough for your claim to be approved. There has to be a nexus drawn between the diagnosis and how it results in an inability to work. Complicating this further is the fact that Hartford policies will have two definitions of disability- the inability to perform the duties of your own (or regular occupation) and the inability to perform the duties of any occupation based on your training, education and experience. Each of these distinct periods in your claim requires different analysis in order to get your claim approved. When submitting an Appeal we always provide in depth vocational information regarding your occupation. Our presentation goes way beyond your formal job description, as we conduct industry specific research, have you undergo functional capacity testing specific to your occupation if applicable, work with rehabilitation consulting experts to generate vocational reports, provide samples of your work when necessary, obtain statements from co-workers and supervisors, and have labor market analysis completed to analyze availability of work that Hartford thinks you can perform.

How does Hartford determine what the duties of your own occupation were, or what the duties are of an alternate “any” occupation? Hartford policies contain language that defines an occupation to mean how the job is typically performed in the national economy, and not how it is performed for your specific employer or specific location. It is known commonly as the “national economy” standard. Additionally, despite the fact many people work in excess of 40 hours a week, Hartford only has to determine the ability to work based on a 40 hour week regardless of how many hours you may work. In the any occupation definition of disability Hartford’s policy will usually define gainful occupation as a job that will pay you at least 60% of what you earned pre-disability.

In any denial of benefits, Hartford will conduct some type of vocational review that will establish what your occupational duties are based on the national economy standard or if your claim is in the “any occupation” stage, what the applicable alternate occupations are that you can perform based on your education, training and experience. This is why Hartford will send claim forms during the claims process that inquire about your work history, education, volunteer work, vocational training, etc. They are building up a reserve of information to be used against you later in the transition between the own occupation and any occupation standard of disability.

Often the vocational reviews performed are nothing more than a review and conglomeration of the descriptions for an occupation as contained in the Department of Labor Dictionary of Occupational Titles, O*Net, or some similar industry recognized vocational reference tool. The vocational expert for Hartford will not review your medical records to determine your ability to perform the noted duties, but will rather rely on the reports conducted by Hartford’s in-house doctors and nurses, outside medical reviewers, or independent medical examiners to determine what your physical restrictions and limitations are.

Why Does Hartford Ignore Your Actual Job Duties?

Although Hartford will typically define disability to mean the inability to perform the material and substantial duties of one’s regular (own) occupation; or the inability to perform the duties of any (gainful) occupation based upon training, education and experience, quite often when someone receives a denial letter Hartford does not appear to have even considered your actual occupational duties. Instead, Hartford will often state that your occupation was “sedentary” (or whatever the physical demand level is) and that in their opinion the information suggests you can perform at a sedentary demand level and as such the claim is denied.

The Physical Demand Level (PDL) of an occupation is the physical requirements of an occupation as set forth by the Department of Labor. The various levels are sedentary, light, medium, heavy and very heavy. Hartford’s determination of occupational requirements as being nothing more than the ability to perform at the PDL that one’s job is customarily performed at is inherently wrong in that it creates a standard of disability that is not found in the policy. For example, my occupation is a Lawyer, which falls into the sedentary demand level according to the Department of Labor. That being said, I do not make a living because of my ability to lift up to ten pounds, rather my job requires an extensive list of cognitive skills. By Hartford’s logic I would then be able to perform the duties of my occupation solely because I can perform at a Sedentary level. This is certainly absurd, but I can assure you it happens day in and day out to people whose claims have been denied.

The person employed by Hartford has never met you before and likely never will. This a problem because Hartford only knows you based upon the information that is written in your medical records. Character evidence gives you the opportunity to let Hartford know who you really are and how your medical condition(s) limit you. Additionally, if Hartford denies your appeal, ERISA laws do not give you the opportunity to be heard by a judge or present any additional evidence following a final appeal denial. We submit character evidence with the potential that not every appeal will be won and we want the Judge to be able to consider evidence which Hartford may ignore. With the submission of your appeal we will work with you to draft a personal statement that explains how your medical condition(s) prevent you from being able to work. We may also obtain statements from friends, co-workers, supervisors, and family members if we believe that it will be helpful. If you have a social media profile it will always be a factor in a disability claim, so it must be reviewed and explained if necessary. In some disability appeals we have submitted video statements or recorded statements so that the disability carrier has the opportunity to actually hear why you cannot work. We also use the character evidence to support the validity of your complaints.

Chances are if you have received a denial from Hartford it has come without warning. Typically it starts with not receiving your monthly disability benefit on time. When an inquiry is made it is not uncommon that you are unable to reach your claims manager to find the status of your claim. It may be some time after your monthly benefit doesn’t arrive that you receive a letter in the mail dated prior to the date your check was to be issued advising you that your claim has been denied. The courtesy of a phone call or advance warning of the denial is not common for most people who have been denied by Hartford.

In our experience representing insureds against Hartford a person’s disability claim is most likely to be denied by Hartford at one of two junctures: (1) the long term disability application stage and/or the transition period from short to long term disability and (2) at the transition from the “own occupation” to “any occupation” definition of disability. The point at which the claim is denied or terminated will often dictate how one must draft their appeal to ensure continued benefits. That being said, all disability appeals are always drafted in the context of ERISA as a body of law, which is unfortunately quite unfair for the insured. We have written and discussed numerous times throughout our website and videos as to how ERISA is an unfair body of law and having a policy governed by ERISA greatly impacts claims for disability benefits so we will not belabor the point here.

The answer is no. The biggest take away and cautionary warning when submitting an appeal to Hartford is the fact that in the event of a final denial of benefits (all appeal levels are denied) no new information can be brought into your file for a Court to consider. This means that any information that supports your claim for disability must be introduced during the appeal process. Failure to properly supplement your file could make it next to impossible to prevail in Court. Your appeal is your final shot to secure your benefits.

It is common for an insured who just found out their benefit was denied/terminated to be told by the claims manager that all they have to do to file an appeal is write a letter stating they disagree with the denial of benefits. Although this is not technically a lie, as an appeal is essentially a disagreement with Hartford’s claim denial, it is certainly not the complete truth. Your appeal is your opportunity to systematically attack Hartford’s denial of your claim. If you fail to strategically plan your attack you could be left at the mercy of a body of law that as a default favors the insurance industry. Consulting with an attorney to discuss your rights is highly recommended given that an appeal done without a disability lawyer could lacking significant evidence.

It is definitely possible to have your Hartford claim denial reversed following submission of an Appeal. We do not have official company statistics on how many Hartford disability denials are reversed, but we have historically seen a 65-75% reversal rate at the appeal level. Obviously the facts and circumstances of every case are different so naturally some cases are harder to win than others.

Under ERISA, Hartford will be allotted an initial 45 days to respond to your appeal, with the ability to request a 45 day extension prior to the expiration of the initial 45 days. The extension is supposed to be based on a showing of good cause as to why the extension is necessary, but from our experience most requests for extensions are based more on a lack of efficiency than need. It should also be noted that the 45 day timeframe can be “tolled” for multiple reasons, such as if you submit additional information after the appeal is submitted, Hartford is waiting for a response from your doctor or is waiting for you as the insured to provide requested information. Hartford will try to delay the process as long as possible, so it is important your combat the possibility of this happening. This is why we harp so strongly on making sure you have all supportive information for your appeal ready for submission at the time the appeal is filed.