ERISA APPEAL AGAINST THE HARTFORD REINSTATES BENEFITS FOR COLORADO RESIDENT
Tuesday, April 13th, 2010
Disability benefits were being paid to our client, a 51 year old man who was a high performing, high income insurance agent from Colorado. Working in the insurance business is no guarantee that a disability insurance policy claim will go smoothly – there’s no ‘professional courtesy’ in this business.
Our client had a host of serious diseases: angina, coronary artery disease, myocardial infarction history, atherosclerosis, neutropenia hypertension, hypercholesterolemia, diverticulitis, thoracic outlet syndrome, cervical spine bulging discs, presyncope episodes, and thrombocytopenia. In layman’s terms, heart disease was the leading cause of his being disabled, but in addition to heart disease, he also suffered from serious gastrointestinal and orthopedic problems.
The Hartford paid his benefits for a period of time, and then in June 2009 denied his claim following a medical records review and an employability assessment. But what Hartford considers a medical records review is not what you might expect. The medical review was not by a cardiologist, a gastroenterologist or even an orthopedist. It was a medical case manager, who only reviewed medical records from two of his eight physicians.
The employability assessment was less than a full paragraph – hardly enough to review a well-paid, high performing insurance professional.
We are certain that the real reason for the sudden cut off was the level of benefits: Hartford had been paying him $5375 a month. He was 51 when he could no longer work. That’s an expensive claim.
Our ERSIA appeal made a very thorough and aggressive attack on their vocational analysis, which failed to review the specific tasks of his position and was poorly done. The same aggressive attack of the medical records made it clear that Hartford’s denial of his benefits was outrageous.
We succeeded in having Hartford overturn their own termination, and our client’s benefits have been reinstated.
The insurance company’s decision to delay, deny or terminate claims should never be accepted as a final decision by anyone who has a disability and cannot work. Time and time again we see individuals like our client who are facing enormous health challenges and are cut off by the insurance company. If you have a similar situation, call us – we can help.