A New York Federal Judge has reversed a determination made by Hartford Insurance Company to terminate benefits to a woman suffering from Multiple Sclerosis. The Court determined that Hartford had abused its discretion in terminating the claim, where it based its decision upon its typical claimant approach — “finding” inconsistencies in the record, assigning the file to its Special Investigations Unit, conducting surveillance, and having a field representative interview the claimant, coupled with a paper only physician review by a well known insurance pandering doctor.
The Court found that the various bases upon which Hartford relied upon for its claim determination were lacking, and determined that the claimant was entitled to her long term disability insurance benefits. Hartford relied upon results of surveillance, which revealed the claimant walking her new baby, and running an errand, as well as the results of the filed visit, where the claimant was shown the surveillance and acknowledged that this represented her usual level of activity.
Following this activity, Hartford obtained a medical review from Dr. Bruce LeForce, a doctor well known in the industry and providing insurance favorable reports on a myriad of medical conditions. The claimant had also secured Social Security disability benefits, which permitted Hartford to reap a financial benefit of reducing its obligations to the claimant.
The Court was troubled by several aspects of Hartford’s claim handling. First, the Court did not accept Hartford’s short shrift of the Social Security award and finding. Next, the Court was bothered by the incomplete medical review undertaken by Hartford’s paid reviewers, and third, the Court did not believe the surveillance constituted substantial evidence to dispute her ongoing claim.
Thus, the Court granted benefits to the claimant and reversed Hartford’s decision.
Ingravallo v. Hartford Life