Hartford Long Term Disability Denial and Appeal Tips

Hi, I'm Greg Dell with Dell Disability Lawyers here with attorney Alexander Palomara, and we're going to discuss some frequently asked questions specifically about Hartford Disability Appeals. We do these Ask Our Lawyer Questions segments all the time. Today, when we talk about Hartford, I'm trying to think about some of the common questions that we get from the people that call us all the time for the free consultations and then obviously the clients, the hundreds if not thousands of Hartford specific clients that we've represented over the years. One of the biggest things I always get, and I like to think of these situations of being in the shoes of a claimant who's just been denied and now needs to go about an appeal. First question that always comes up really is like, look, I've been denied. How long is this going to take before we get some kind of resolution? I want people to be back on claim as soon as possible because their income is stopped. They have no money coming in unless they're on Social Security. If they are, great. At least they have some money coming in, but the great majority of their money has now stopped cold turkey, and I want them to get back on claim as soon as possible, but things have to be done before you file an appeal because with Hartford, you only get one bite at the apple. If they deny your appeal, then you have to file a lawsuit, and that can take up to 12 months, 18 months to get a resolution from a judge, so you can't rush an appeal. The reason why you can't rush an appeal is because an appeal has to be well thought out with argument, and it has to include as much medical documentation as possible because you need to prove your claim. Obviously, they don't think you have enough proof here, so you need to prove your claim or reprove your claim, so you can't rush it. You need to get all your ducks in a row. You need to get all your medical records. You need to get more support from your treating providers, maybe additional testing done. You need to have a chance to review the claim file that Hartford has to send you, that you or your attorney or representative has to request, and it takes time to get everything in line before you can actually review everything and put together a proper appeal. So it can't be rushed, but when we take on a case, as soon as somebody signs up the next day or maybe even that day, depending on the time of day it is, we have a letter of representation sent out to the insurance company at Hartford letting them know that we're representing this person and requesting all the files they have to give us under the law, so we request a copy of the entire administrator records, the entire claim file, and they have 30 days to get to us. But while we're even waiting for the claim file, we're still working on the case, ordering those updated medical records, reaching out to the treating providers to get more support, but it just takes time, and I know the quick answer is, you know, it takes probably at least 45 days, sometimes a whole 180 days to get an appeal out. It's not a timely process, but we work as quickly as possible, but my point is, do not rush an appeal. And then the 180 days, which the law provides you for the appeal, so someone, most people call already that the clock has been running, and we can get an appeal done in whatever time frame it is, we'll do the best we can, the more time we have, the better. But then from when you submit the appeal, like, I wanted a global answer from you, what's an expectation, because if I'm denied, I'm sitting at home going, I don't have money coming in, so what is, what should I be budgeting and planning? Right, the worst part is, once we file the appeal, the ERISA laws give the insurance company 45 days to give an answer on the appeal, however, the laws also give them an additional 45 days under certain circumstances, which they, you know, they have to have a, pretty much, a lame excuse can get them the additional 45 days, so they have a total of 90 days, so even once we file the appeal, they have 90 additional, it's three months, so you really do have to budget yourself and maybe talk to friends and family, because if you have no income coming in, no social security coming in, you really have to figure things out. Yes, you know, some of my clients ask me, hey, can I do something part-time, you know, I really can't, but maybe I can fight through it or have some money coming in, because I'm going to be on the streets, and I always tell them, you need to, whatever you need to do to survive, you do it, I'll figure it out later on, I'll make the arguments to the insurance company saying, you pushed that person to this, you know, they can't work, you know, they have a lot of credibility, because they went above and beyond, they broke their back to get back to work, have some income coming in, either that or they're going to be on the streets, so it's not representative that they're able to work, but they did so in this circumstances because it's either the streets or trying to gut it out and work part-time or whatever it is they decide to do, so I tell my clients, if you need to do it, you can do it, I prefer that you don't, because it could technically hurt your disability insurance claim, but I'll figure out whatever I can do to get their claim approved, and without any excuse or any argument I need to make that the insurance company does not take that against them, but the best thing the person can do is budget as best as they can, because it could be a few skinny months with no or limited income coming in. So would you go as far as to say, on average, that if you're doing an appeal, that you should be planning on 9 months from the date you got denied until potentially there's a reinstatement of benefits? Yes. Unfortunately, that's probably a good answer, is 9 months, somewhere between 6 and 9 months. We hope to get it done quicker, and we hope to get an answer quicker, but sometimes I file the appeals and I have an answer within 20 days, on average it's 45 to 60 days. I wish it was quicker, but again, we don't sit back and do nothing for the first 90 days of someone hiring us. We have a team of people that are actively working on your case. Not only the attorney, we have an assistant whose sole job is gathering medical records. Another assistant whose sole job is reaching out to the providers to get updated attending physician statements completed, setting up appointments for us to speak to the doctors and treating providers. So we have a team of people that are working on all of these cases so that we can get everything together as quickly as possible, get this appeal out as quickly as possible, but we don't like to sacrifice quality for time. You can't rush an appeal, because again, if you rush an appeal and the file is not complete, all your medical records are not in there, if they issue a denial of your appeal, then your claim file is closed, you cannot get any further information in under these group ERISA policies. Once they deny your appeal, the claim file closes. So if there was a medical record or a letter of support from a doctor that you wanted to get in, but now they've denied your claim and the appeal is denied, that will never be considered by the judge. You cannot rush an appeal. All right. I know you've handled thousands of Hartford appeals specifically, and every time you handle a claimant's file, you request the claim file and you tear that apart, and usually it could be a couple hundred pages to 10,000 pages, extensive. But from your experience, and again, we're going to talk in a generality. If I had to say to you, Alex, tell me the two most important things that you think you have to do on every disability appeal with Hartford to be successful. You need to get that claim file and go through it. There's a few documents that you need in there, but the most important documents you need are the reviews that Hartford relied upon to deny your claim. You'll see in the denial letter, they'll reference either, sometimes they summarize the different people that reviewed your claim. They'll say, you know, the appeals or the benefit specialist, but they always include maybe an internal doctor, what they call a medical director. Sometimes they use an outside doctor, which is an independent physician consultant, and you need to find those reviews. That's what they're hanging their hat on to deny your claim because they're not going to have a normal benefit specialist deny the claim. They're not trained in any medical field. So most times the insurance company will use in-house nurses or in-house doctors or outside doctors to perform a review of your medical records. Sometimes they'll send people to independent medical examinations, but for the most part, they just do these reviews. You need to find these reviews because if you're disabled and you know you're disabled and the insurance company is saying that you're not disabled and the reviews they're relying upon is saying they're using to deny your claim, they're saying that you're not disabled, there has to be holes in those reviews. So you need to find those reviews and what we do is we find those reviews and we poke holes in them. We say, we look at the entire thing. It's like, where did the doctor mess up? Where are they misconstruing what the medical records say? So we poke holes in those reviews. We fill those holes with updated medical records. We fill those holes with updated support from your treating providers and we put together an appeal to challenge the decision. But the most important thing is getting your hand on those reviews and the claim file. The most important thing and the other thing that's important for the sake of getting an appeal together is getting updated support from your treating providers. That's in the form of medical records and even having your doctors fill out attending physician statements, like additional ones that we often draft ourselves. So we formulate what I like to call APSs for our specific client's claim. The insurance companies use the same form for no matter what the claim is. They have one for behavioral health and one for physical and they think it's like one size fits all. It doesn't. So we formulate our own and we ask our doctors specific questions that are relevant to our specific client's conditions and diagnosis and whatnot. And we send those out to the doctors. We talk to the doctors and make sure they fill that correctly. If there's something that I think can be misconstrued, we ask them to edit it to make sure that it's clear what they're trying to say. And then we make sure that we have as much support for our client as we possibly can before and after we file that appeal. So I try to explain to clients that 80% of the work that we're going to do on their appeal and the best work we do is done before we even draft the appeal letter to send it in because we're all about obtaining the best evidence possible. And the reason we do that and the way in which we go about it and which you touched on recently is kind of like, I don't want to call it our secret sauce, but that's our strategy because we're not just thinking about what the person at Hartford's going to do. We're also thinking about if we lose the appeal, how is the court going to look at it so that we're fighting two battles at once. And so the way I always go about it, and I know that you do as well, is I've got to put together so much strong evidence during this appeal process while I'm representing this client so that when Hartford sends it to their doctor or their medical director, whoever they hire, that doctor has to look at the information that I've now put before them where I've poked holes in all of the other things they've done and say, based upon what I'm seeing here, there's no way this person can do this job or that job or any job if that's the standard of disability at that time. And that process takes time. It takes cooperation from the treating physicians. It takes pushing the treating physicians to even want to cooperate to do the right thing. It takes telling the attending physicians how they need to write these things because they don't know because they treat patients. They don't write reports for doctors and Hartford knows that. Hartford tears into the treating doctors saying, you didn't say this, this, or that because it's not something you would do in the ordinary course of treatment of a patient. The other thing is claimants don't know how to use a particular, whether it's a functional capacity expert, a vocational expert, a physical therapist expert, a neuropsychological expert, whatever expert it is that isn't necessarily a treater but knows how to document functional limitations that relate to the ability to do a job. And it's a big burden to say to a claimant, hey, go ahead and appeal because when they're asked to appeal, they just think, okay, I want an appeal, you're going to have a supervisor look at it and they're going to do something different. But we don't look at it like that. Your appeal is a fresh slate because you know under the laws a new person has to look at it. New doctors have to look at it. Everybody's new. But now when you have a lawyer advocating for you who's writing your appeal, you're able to change the dynamic and focus the direction to say, hey, you need to look at this because anybody who has this, there's no way they can work. And if you do say they can work based on this evidence, then you're insane. You're unreasonable. And that's the standard if we lose, did the person act reasonably? So I know that's how we gear everything and we try to do these videos to educate claimants so that they can know this is a very challenging and methodical process to get where you need to be to win these appeals. And in these limited videos we do, we try to educate, give the tips and share our knowledge because look, people can do this by themselves. I don't recommend it because of the challenges that come, but more so not only because obviously we would love to help them and work with them and give them the best chance to do it, but if someone does it on their own, they don't have the opportunity to do it again because when they come to you, Alex, when they're denied, which we do all the time, someone did their own appeal and we're going to file a lawsuit and we'll do the best possible job we can using the law. But the facts are the facts are the facts in that claim. We cannot add one single thing and we get that and look at that and go, I would have done 10 things differently often. Doesn't mean we still can't win their claim the way it is, but it's a different dynamic. So the person who's able to reach out, get someone beforehand to do their appeal is a hundred times ahead of the person who just says, I'm just going to do an appeal on my own. Certainly. And the one thing I tell everybody not to do is don't rush your appeal. Sometimes they get a denial letter and the insurance company says, Hey, just all you have to do is email us that you want to appeal and we'll start the appeal process. And it's crazy because you're going back to the same entity, although it's a different person now looking at your file, but going back to the same company, the person still works for Hartford and the new person still works for Hartford. And going back to them saying, Hey, reapprove me. The person below you got it wrong and they're going to do the same thing to deny you again. And I know exactly why, because you started, you know, you talked about that earlier today and that's one of your big mantras, like don't rush it because we have the, we're contacted by thousands of people every year. We only accept a certain number of cases. And the reason it's so frustrating for us is because we see a lot of poorly written, rushed appeals because that's what a, that's the normal reaction. That's what, if I didn't know any better and I got denied, I would just be like, here's my appeal because you denied me. You must've made a mistake. Let me just appeal in 30 days. This will be over. Right. But it's not, you just bury yourself into a bigger hole by not getting it done. And I feel some of the claims analysts set a trap for the people for the claimants saying, just go ahead and appeal. I'll take it right to the appeals people and we'll get an answer for you as quickly as possible. And they're trying to set a trap because they know if you don't send it, submit anything additional with your appeal, you're going to be denied and there's no way they're going to lose the lawsuit or the likelihood is that if you just write, I appeal, the odds of you winning the lawsuit are so low and the person knows that their initial denial is just going to be rubber stamped by everybody and they're going to look good for their bosses. So don't fall into the trap. At least call us first before you rush into it. I get calls all the time where people go, I already filed the appeal. I go, what did you do in the appeal? I go, I sent him an email that I'm appealing and they send me a letter saying they'll give me an answer in 45 days and I get, you might have to withdraw that as soon as possible so I can get going on this or at least give you some ideas what to do. So don't rush the appeal. Call us first. I'm happy to give you a free consultation anytime or we always give 10, 30 minutes to anybody. That's awesome. Okay. Well, if you're someone out there who has a Hartford disability claim, feel free to on our website, ask us your questions here, which we always answer, call Alex, call myself, no matter where you are in the country, we're available to assist you. And again, we'll always provide you with a free initial consultation.