Hartford’s refusal to provide entire claim file did not prejudice claimant’s ability to dispute her denial of disability benefits
Citation: DiGregorio v. Hartford Comprehensive Employee Benefit Serv. Co., No. 04-2219, No. 04-2252, 2005 U.S. App. LEXIS 19380, (1st Cir. Sept. 8, 2005).
Angela DiGregorio, a secretary for Coopers & Lybrand was insured under the company’s group long-term disability plan. In July 1995, carpal tunnel syndrome forced Ms. DiGregorio to stop working and apply for long-term disability benefits with Hartford Comprehensive Employee Benefit Company (hereinafter “Hartford”) who approved Ms. DiGregorio’s claim for benefits. Pursuant to the terms of her disability plan, she was entitled to receive total disability benefits if she was unable to perform the substantial and material duties of her own occupation. After two years, the policy required that in order to be deemed totally disabled Ms. DiGregorio had to show that she was unable to perform any duty pertaining to any occupation for which she was qualified.
During the review of Ms. DiGregorio’s claim file, Hartford found that Ms. DiGregorio no longer satisfied the policy’s definition of disabled and subsequently terminated her benefits. Hartford based its decision on medical records from Ms. DiGregorio’s orthopedic surgeon, an employability analysis and telephone conversations with Ms. DiGregorio.
Following receipt of Hartford’s termination of benefits, Ms. DiGregorio notified Hartford of her intent to appeal and requested a copy of her entire claim file, including reports and documents reviewed by its medical department or outside consultants. In response, Hartford produced the employability analysis and Dr. Howard’s medical records, but did not produce the entire claim file. Despite numerous requests to obtain the entire claim file, Ms. DiGregorio was unsuccessful.
Ms. DiGregorio submitted an appeal of the denial to Hartford and the decision was upheld. Thus, Ms. DiGregorio files a lawsuit against Hartford. Ms. DiGregorio argued that her claim was not given a full and fair review required under the requirements of The Employee Retirement Income Security Act of 1974 (“ERISA”) because Hartford did not disclose the entire claim file to her prior litigation, despite request for same.
The court held that despite Ms. DiGregorio’s inability to obtain her entire claim file, she was not denied a full and fair review because she was unable to show that Hartford’s failure to produce her complete file prevented her from submitting evidence necessary to dispute the denial of her claim for benefits or absence of the entire claim file impacted her ability to prepare an informed response to Hartford’s denial.