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ANOTHER LONG-TERM DISABILITY TERMINATION REVERSAL

March 6, 2012

. . .

We recently received a favorable decision from Hartford overturning a termination of our client’s (let’s call her Ms. B) ERISA long-term disability benefits. Ms. B left her former job as a retail sales manager due to her lower back condition. She had previously undergone lumbar fusion, and had been diagnosed with chronic pain syndrome, lumbar degenerative disc disease, sacroiliitis, lumbosacral spondylosis and lumbar radiculopathy. Due to her constant pain, she was prescribed several narcotic medications (including morphine and valium) which affected her cognition and mood. These conditions and medications rendered her unable to work.

Hartford originally agreed Ms. B was unable to perform her prior occupation, and paid her benefits for two years. As we regularly see, Hartford re-evaluated the claim at the end of the initial 24-month benefit period, as the policy definitions change at that time. As described elsewhere on this cite, most group insurance policies provide benefits throughout the first two years if an individual demonstrates an inability to perform his or her “own occupation.” After two years, the definition typically changes, and an individual must demonstrate an inability to perform “any occupation.” A large majority of the denials we see occur with this “change in definition.”

When Ms. B’s policy definition changed, Hartford promptly terminated her long-term disability benefit. Before doing so, they requested her physician complete an “attending physician statement,” setting forth restrictions and limitations. Her treating physician clearly responded that she could sit no more than four hours per day, which is inconsistent with full-time sedentary work. He also noted that her pain interfered with daily tasks, including concentration. Hartford claimed to base its decision on this physician’s opinions, yet completely disregarded these portions of his statement, which were not helpful to its position.

After receiving Hartford’s termination, Ms. B contacted our office seeking assistance with her appeal submission. Attorney Heather Petitmermet immediately requested Hartford’s claim file and made several recommendations to our client. Ms. B underwent a thorough functional capacity evaluation to further establish her restrictions and limitations. Ms. Petitmermet also discussed the case with Ms. B’s treating physician, and obtained clarification of his opinion in a narrative letter. With the help of paralegal Emily Fourcroy, we ultimately submitted a lengthy appeal, including extensive medical and other evidence which undoubtedly established Ms. B’s disability and Hartford’s erroneous claims practices. After reviewing the extensive appeal submission, which established its denial was unsubstantiated, Hartford reinstated Ms. B’s LTD benefit.

Hartford’s tactics in the way they handled Ms. B’s claim are, unfortunately, quite typical. If Hartford or any other insurance company has terminated your long-term disability claim, give us a call or email to discuss your legal options. The Law Office of Shawn E. McDermott will provide a free consultation regarding your long-term disability termination or denial.

Categories: Disability, ERISA Claims

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