Hartford’s decision to deny long-term disability benefits to a plant operator is upheld

(Group / ERISA Disability Policy) Robert Hulet, a plant operator, stopped working July 28, 2002, due to chronic left shoulder problems, which resulted in several surgeries. Mr. Hulet was covered for long-term disability benefits under a group disability policy issued by Hartford Life and Accident Insurance Company (hereinafter referred to as “Hartford”). Hartford paid Mr. Hulet long-term disability benefits for two years in accordance with the “own-occupation” definition of total disability in his policy. After two years, Mr. Hulet’s definition of total disability changed to “any-occupation” which is defined as:

During the Elimination Period and for the next 24 months you are prevented by:

  1. accidental bodily injury;
  2. sickness;
  3. Mental Illness;
  4. Substance Abuse; or
  5. pregnancy,

from performing one or more of the Essential Duties of Your Occupation, and as a result your Current Monthly Earnings are no more than 80% of your In-dexed Pre-disability Earnings.

After that, you must be so prevented from performing one or more of the Essential Duties of Any Occupation.

Your failure to pass a physical examination required to maintain a license to perform the duties of Your Occupation does not alone mean that you are Disabled.

In order to determine Mr. Hulet’s continued eligibility for disability benefits, Hartford took the following actions:

  1. Prepared an Employability Analysis Report;
  2. Contacted Mr. Hulet’s treating physicians;
  3. Hired an independent Orthopedic Surgeon to review Mr. Hulet’s medical records;
  4. Had a medical doctor review all of the medical records after Mr. Hulet submitted additional medical documentation to Hartford; and
  5. Consulted with a Rehabilitation Clinical Case Manager.

Based upon the review of the evidence in the administrative record, the US District Court for the Western District of Michigan concluded that Hartford’s decision to deny benefits under the policy’s “any-occupation” definition of disability was supported by substantial evidence and based upon a reasoned explanation. The court also noted that the Social Security Administration’s findings that Hulet was disabled fails to demonstrate that Hartford acted improperly in denying disability benefits to Mr. Hulet.

See Hulet v. Hartford Life & Accident Ins. Co., 2007 U.S. Dist. Lexis 75411 (W.D. Mich. Sept. 28, 2007).

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