Articles Posted in Hartford

The O’Ryan Law Firm recently represented a former employee of Trinity Health, in South Bend, in a lawsuit against Hartford Insurance Company.  Plaintiff worked for Trinity Health as a Food Service Manager for 24 years when she was forced to stop working for Trinity Health because she became disabled in July 2014 mainly due to chronic daily severe headaches.  Hartford Insurance provided disability coverage to Trinity Health employees agreeing to pay income replacement benefits to any employee who became disabled due to injury or illness.

Plaintiff applied for her disability benefits offered through Trinity Health’s employee benefit plan, and insured by Hartford. Hartford approved Plaintiff’s claim beginning in December 2014.  More than 12 months later, on January 12, 2016, a letter from Hartford informed Plaintiff that her benefits would cease on January 13, 2016. In the January 12, 2016 denial letter, Hartford stated, “We have determined that the weight of the medical evidence in your file does not substantiate functional impairment which continues to prevent you from performing Your Occupation on a full time basis. Therefore, benefits are not payable beyond January 12, 2016 and your claim has been closed effective January 13, 2016.”   The Hartford policy has the following definition of “Disability”:

Disability or Disabled means you are prevented from performing one or more of the Essential Duties of:

O’Ryan Law Firm, on behalf of Plaintiff Dee Ann Miller recently filed a federal lawsuit against The Hartford Life and Accident Insurance Company (“Hartford”) for payment of disability benefits. The Plaintiff was employed as a Senior Collector with Springleaf Finance, Inc., which made her eligible for disability benefits under the Springleaf Finance Disability Plan and Hartford policy who insures the Plan.  In Miller v .The Hartford Life and Accident Insurance Company, the Plaintiff filed a lawsuit to gain the long term disability benefits she was entitled to under the terms of the Hartford policy and promised to her by her former employer.

Facts of the Case

Ms. Miller was employed by Springleaf Finance for over 15 years until she became disabled in 2014 due to the disabling effects of Fibromyalgia, psoriatic arthritis, osteoarthritis, and chronic pain.  Ms. Miller submitted a claim to Hartford and was paid disability benefits by Hartford. from September 2014 to April 2015.  Her condition did not improve and her medical records showed that she continued to actively seek treatment for her multiple medical conditions.  The last report from her rheumatologist showed that she had 18 of 18 tender points.  She also has difficulty grasping with her hands because of her arthritis.

At the O’Ryan Law Firm, we have represented several clients who have become disabled due to the severe symptoms of Scleroderma.

According to the American College of Rheumatology:

WHAT IS SCLERODERMA?

Many of our clients suffer from depression as a result of their disabling physical conditions or they may have other disabling psychiatric conditions such as bipolar disorder. It is important to be aware that most disability policies cut-off disability benefits after 24 months of benefits if the disabling medical condition is considered a psychiatric condition otherwise known as a “mental impairment.” Each policy contains different language on this issue. For instance, the Prudential policy provides

What Disabilities Have a Limited Pay period Under Your Plan?

Disabilities which, as determined by Prudential, are due in whole or part to Mental illness also have a limited pay period during your lifetime.

The limited pay period for self-reported symptoms and mental illness combined is 24 months during your lifetime.

Mental illness means a psychiatric or psychological condition regardless of cause. Mental illness includes but is not limited to schizophrenia, depression, manic depressive or bipolar illness, anxiety, somatization, substance related disorders and/or adjustment disorders or other conditions. These conditions are usually treated by a mental health provider…using psychotherapy or psychotropic drugs.

In the case of Deal v. Prudential:

 Deal saw a host of medical professionals for both physical and psychological conditions out of a knee injury and associated pain.
 Diagnosed with Moderate Major Depressive Order  Two psychologists reports indicating Deal’s disability caused, at least in part, by mental disorders  The Court concluded–“Prudential has not shown that the mental disorder benefit limitation applies.”
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Disability insurance companies may look to more than just medical records and reports when determining whether a claimant qualifies for disability insurance benefits. Insurers have long used private investigators to perform surveillance of claimants in order to obtain additional information regarding the claimant’s restrictions and limitations. Oftentimes, the private investigators are asked to document their observations with video to provide tangible evidence of the claimant’s daily activities and abilities. Depending on the information gathered, reports from the investigators’ surveillance and the associated video evidence can lead to a denial of disability benefits. Generally, when courts review video evidence they look at whether the observations in the surveillance video are consistent with the claimant’s reported restrictions and limitations.

A common strategy for disability insurers is to schedule surveillance at a time when the claimant has a scheduled appointment with their doctor or a previously scheduled medical examination. This provides the private investigators with a known opportunity to observe the claimant outside of their home. Inevitably, this allows the surveillance team to observe the claimant driving or riding in a vehicle. In Mote v. Aetna Life Insurance Co., 502 F.3d 601 (7th Cir.2007), Aetna’s decision to deny the plaintiff’s disability benefits was upheld by the court. Aetna based their decision in part on video surveillance showing the plaintiff running errands, driving to medical appointments, and loading groceries into her car. This evidence was used to establish that the plaintiff could work in “any occupation.” However, video surveillance in Gessling v. Grp. Long Term Disability Plan for Employees of Sprint/United Mgmt. Co., 693 F. Supp. 2d 856, 864 (S.D. Ind. 2010) only showed that the claimant was capable of driving a little longer than the fifteen minutes he reported to a Hartford Life representative. The court in Gessling found that this video evidence “says nothing useful about (the claimant’s) ability to work in his own occupation.”

Similarly, the Northern District of California found that surveillance evidence depicting a plaintiff “walking, driving and doing errands … for a couple of hours … does not mean that [that p]laintiff is able to work an eight-hour a day job.” Thivierge v. Hartford Life & Accident Ins. Co., 2006 WL 823751, at *11 (N.D.Cal. March 28, 2006). The Eastern District of California reached the same conclusion in a case where Hartford procured surveillance video of the plaintiff driving to the store, visiting a friend, carrying a small bag, and sitting through an interview while taking numerous breaks. Leick v. Hartford Life & Acc. Ins. Co., 2008 WL 1882850 (E.D. Cal. Apr. 24, 2008). The court determined that the plaintiff’s documented activity on a “good day” did not contradict that the plaintiff was unable to perform a full-time sedentary job. Id. See also Hunter v. Life Ins. Co. of N. Am., 437 F. App’x 372, 378-79 (6th Cir. 2011) (surveillance of a plaintiff driving to her functional capacity evaluation, as well as other activities of daily living, did not indicate that Hunter can perform all the physical duties of her former occupation).