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Hartford’s Claim Denial Found Arbitrary and Capricious

Tuesday, January 8th, 2013

A New York Federal Judge has determined that Hartford Insurance abused its discretion in denying a claim for long term disability insurance benefits to a claimant who worked for JP Morgan Chase. The Court reached its decision despite finding that Hartford Insurance’s structural conflict of interest was not a factor in its claim decision.

The long term disability insurance claimant had sought benefits on the basis of her inability to perform her occupation as a Product Marketing Associate, a job that required her to engage in lengthy work days (often 10-11 hours) and to be moving considerably throughout the day. Hartford reflexively determined that her occupation was simply “sedentary” without giving due regard to the employer’s description of her occupational requirements.

While the Court did not determine it was an abuse of discretion for Hartford to rely upon the Dictionary of Occupational Titles (DOT), an archaic generalized description of occupational classes, it did determine that Hartford abused its discretion in failing to properly consider the nature and degree of the claimant’s work requirements.

Thus, the Court found Hartford’s decision was to be vacated. However, and unfortunately, the Court did remand the claim back to Hartford for further consideration, which effectively permits Hartford to do a better job of insulating its claim determination of this long term disability insurance claim.

We often see courts remand determinations where it has been found that an insurer abused its discretion in deciding a long term disability insurance claim. Remand is an unfortunate result to a claimant, as it does not provide the claimant with the benefits to which they are entitled and permits the insurer to “mend the hold” in its claim adjudication.

Thomas v. Hartford

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