Hartford Disability Lawsuit and Appeal of A Disability Insurance Denial

Hi, I'm attorney Gregory Dell and today I'm here with attorney Cesar Gavidia. And today we're going to discuss a recent case out of New York against Hartford Disability Insurance Company. Cesar and I, we cannot stop talking about the Hartford because there seems to be so many denials lately coming from Hartford. This case recently that you just brought to my attention, which wasn't from our law firm but it was still out of a district court of New York, and I thought it was something that would be helpful for disability claimants around the country to be aware of. And this case was extremely disturbing when you brought it to my attention and I right away wanted to get on video and let everyone know about it because of the fact that Hartford won this case when in fact it looked like there was a lot of evidence in favor of the claimant. So, can you talk to everyone for a few minutes about this case and then let's finish by some things that maybe could have been done for this claimant so that the claimant didn't end up in a denied position. Sure, Greg. I mean, this case is just proof of how difficult ERISA disability cases are to win, how much you have to battle even in federal court with these insurance companies. In this particular case out of New York, the claimant was a payroll supervisor for a professional consulting firm. She filed a disability claim in 2005 due to chronic migraines and depression. Like most disability policies, it contained a two-year own occupation period, which was the first two years of her claim. And then after that, it changed into an any gainful occupation definition, basically any gainful occupation which was trained by education, training, and experience. Hartford initially accepted her claim. They paid for the first two years of her claim. Following that, they denied it. They stopped paying her. She appealed, as is required under ERISA. Before you get to the appeal, what did they rely upon to deny her claim initially? Well, initially they looked at what she had provided as far as medical records are concerned, what her doctors had put into the record. They went ahead and actually had all of that reviewed by two physicians, third-party physicians which they obtained through read review services. These physicians were a psychologist and an internist. Mind you, she had a neurologist, an internist, and a psychologist. So she had three doctors. She had three doctors, including a specialist in chronic migraines. The Hartford basically denied this lady's claim, relying on the opinions of paper reviews of these two physicians. They found basically she could go back to do some sort of sedentary or light occupation job, which begs the question, how is that really much different from what she was doing as a payroll supervisor, a job that required her to sit at her desk, a job that required her to pay close attention to detail, I'm sure meet with staff and supervisors and managers and people in her job. Okay, so she filed an appeal with Hartford. So she files her appeal with Hartford. They uphold the denial. This time they go back to two more physicians, two separate physicians, two doctors that they didn't actually consult with in the first appeal. So now they have four doctors who all support that she could go ahead and do some sort of sedentary or light occupation. So following that, she filed a lawsuit in federal court in the US District of New York. The federal judge reviewed all the opinions of these four independent, so-called independent physicians. He reviewed all the medical records that she'd submitted from the neurologist, including opinion letters, attending physician forms, claim forms, and all that, and even reviewed the social security disability file, which found that she was, the findings in that file were that she was permanently disabled according to social security standards. Now I remember you told me about that earlier, that during, at some point during the pendency of her claim with Hartford, she got approved for social security disability, and you told me it was done through lawyers that Hartford helped her hire. Not only did she get approved by social security disability and get awarded all these benefits, but the Hartford assisted her by issuing her a credit and obtaining a law firm for her to help her file for social security disability. And as you know, the guidelines for social security disability are actually very similar to that any gainful occupation definition. So the federal judge reviews all this information, and he still finds that the Hartford did not abuse their discretion, and that they gave her a full and fair review. So it just goes to show you how difficult these cases are, that it's so important to make sure that you have all your support lined up in your appeal, that you not only, you know, gather the information and documentation from your doctors and letters of support from your doctors, but you maybe even have to go and find other independent physicians on your own to conduct examinations, to conduct tests for you. You may have to go and get letters of support from your family, your friends, your former co-workers, anything and everything you possibly obtain to support you, because you're going to battle with these companies. You're going to war with them, and you need to have that ammunition. It seems like this claimant really had her hands tied, because Hartford went out and hired four doctors, and it seems like she was damned any which way she went. But is there anything you think about that maybe could have been done differently at some point during the appeal or the litigation? It's hard to say, because I'm not sure exactly of every piece of information that she provided. But if she hadn't provided support from her family, friends, co-workers, letters of support, those things, people that could offer eyewitness testimony to see the struggles that she goes through daily with her disability and how it affects her, those chronic migraines and depression. Because a lot of those things, you talk about migraines, you talk about depression, a lot of these problems are subjective. In other words, there's no objective test or examination that's going to say, oh, this is what's wrong with you. This is the problem that you're having. So people that see you in that depressed state or people that are there and actively seeing an episode of having a chronic migraine and how often that happens to you in a particular day, that's very strong. So if that wasn't there, that should have been provided. Well, I think from everything you've said in this case, that this Hartford claimant really got screwed because of ERISA. Because ERISA is a bad law. Whether the judge agreed or disagreed with Hartford's outcome, the judge basically said, look, I think the company acted reasonably. And since they did a reasonable review, there's really nothing here that I can do to overturn their decision. Right. The judge is basically there. His hands are in a way almost tied by ERISA and this very difficult standard to overcome, this arbitrary and capricious standard, which basically even if you show that, yes, you're disabled, that you have all these problems, that you indeed can't perform your occupational duties, the judge then has to determine, well, did this insurance company act unreasonably? Well, this insurance company went and hired four doctors who offered opinions. So in his view of the world, they acted reasonably. Right. You know, Cesar, this is just another one of those cases that calls for the laws to be changed. And hopefully, you know, people will talk about a case like this. Legislators will find out about a case like this and will continue to fight to get ERISA changed to make the laws better for the claimants. If you have a claim with Hartford, whether it's a denial or a lawsuit, feel free to call us at any time to discuss your claim. We're happy to offer you a free consultation, answer your questions, and to discuss what your possible options will be.