Disability Claim Denial: 3 Lessons To Learn From The Hartford Lawsuit
The Second Circuit of the United States (U.S.) Court of Appeal recently affirmed a decision of the district court in favor of Hartford Financial Services Group, Inc. The case involved a claim by a person insured by Hartford. The plaintiff submitted a claim for long-term disability benefits under her policy. She attached the Attending Physician’s Statement which advised that she had been diagnosed with fibromyalgia.
The Second Circuit affirmed the denial. It said that the physician retained by Hartford expressed doubt about the diagnosis given to the claimant because she didn’t undergo a test that was required for the claim. It also said the claimant had the opportunity to undergo the test and present it as evidence but didn’t do so. You can check this or other similar sites if you think you might have to file a Hartford Suit. There are lessons that can be learned from this denial. Here are some of them.
- Meet Hartford’s Definition Of Liability
The lesson learned here is that you have to be disabled within the meaning of Hartford’s definition of disability so you can qualify for and receive your benefits. For instance, you should undergo required tests for the knee pain therapy if you’re going through it to prove your disability.
Although the policy signed by each person is different from those of others, Hartford has a standard definition of what liability means for them and their clients. This definition is always stated in the policy that they issue to their clients. This is an example of the definition of liability:
Disability or Disabled is defined as prevention from performing the Essential Duties of:
- Your Job during the Elimination Period;
- Your Job, for the 24 month(s) following the Elimination Period, and as a result Your Current Monthly Earnings are less than 80% of Your Pre-disability Earnings; and
- After that, Any Occupation.
But it’s entirely possible that Hartford may have put a different definition in your policy. You should make sure that you have a copy of your policy, and read it carefully.
- Submit All Claim Forms, Comply With Request Form Updates
Make sure that you correctly fill out and submit all of Hartford’s Claim Forms. The long-term disability application form of Hartford consists of five parts. As a reference, here’s a video of the do’s and don’ts when filing an appeal:
Here are those important sections which you should carefully read and fill-out.
- Employer’s Statement: This section has to be completed by your employer or any of their authorized representatives.
- Information for Group Life Premium Waiver Benefits: This section applies to you only if your employer also has a Group Life Insurance premium policy with Hartford. The policy should contain a Premium Waiver benefit for this section to be applicable. Your employer’s authorized representative has to complete this section if it’s applicable.
- Employee’s Statement: You’re the one who should complete this section. Make sure that you provide complete and specific information about the following:
- The complete name of your healthcare provider. This could be your physician or hospital. Their specialty, address, office phone number, and fax number.
- The medications prescribed to you and the date when they were prescribed. You should also say what conditions they were prescribed for, and include the name of the physician who prescribed them.
- Make sure you attach a copy of your driver’s license.
- Authorization to Obtain Information: This form is to give Hartford the permission to request access to your medical records from wherever they need to get them such as hospitals where you were previously confined.
- Attending Physician’s Statement of Disability: This is one of the most important sections of your application. Hartford will inquire about the basis of your disability claim. They’re going to ask for your doctor’s opinion that clearly says the physical and mental limitations you have.
Your doctor has to provide specific information about your diagnoses, the impairments you’re suffering from, and in what way these limitations or impairments affect the things that you have to do every day.
Your physician has to provide more than just vague statements, and instead specify the level of impairment that you’re suffering. If your doctor can’t give you a specific statement, then you might have to see another physician.
If you appealed the denial of your claim, Hartford may request for updated versions of your authorization and your attending Physician’s Statement of Disability while the review process is going on. You’ll have to comply if they request for these updated forms. Otherwise, they may deny or terminate your claim on the ground that you didn’t comply or submit all the necessary forms.
You should submit all forms and comply if they ask for updated ones since you have to exhaust all administrative remedies and take part in the administrative appeal in good faith.
- Request Your Claim File And Pack With Favorable Evidence
You should send a written request for your claim file as soon as you receive a letter denying your disability claim from Hartford or the insurance company which issued your long-term disability policy. They’re obligated under federal law to give you a copy of your claim file for free if they denied or terminated your claim.
You should go over your entire claim file. Check if they included all the evidence of your medical condition in your file. If they didn’t, this is your opportunity to include additional evidence of your physical and mental limitations when you submit your appeal. This is crucial when the time comes that you might have to file a lawsuit against Hartford or your insurance company.
Keep in mind that the judge can only consider the evidence that’s in your claim file at the time that the claims handler gave their final decision on your long-term disability (LTD) claim. The lesson from this is that you should have the foresight to pack your claim file with evidence that is favorable to you. You should do this as early as the administrative appeal process stage of your LTD claim.
Consult A Lawyer
You know that you’re facing a host of potential complex legal issues when you receive a letter of denial of your LTD claim. It’s possible your claim might be denied with finality down the road.
But there are things you have to do and keep in mind as early as the administrative appeal process such as packing your claim file with evidence that favors you. A lawyer can help you make sure all the helpful evidence will be included in your file. You should consider consulting a lawyer for help even before you think you need to sue.