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:

  1. Your occupation during the Elimination Period;
  2. Your occupation, for the 24 month(s) following the Elimination Period, and as a result Your Current Monthly Earnings are less than 80% of Your Indexed Pre-Disability Earnings; and
  3. After that, Any Occupation.

In terminating the benefits, Hartford failed to adequately evaluate Plaintiff’s physical impairments that include chronic daily headaches, chronic kidney disease, obstructive sleep apnea, cognitive impairment, fibromyalgia and how these conditions prevented her from performing her own occupation or the material duties of any occupation for which she is or may reasonably become qualified.

In support of its denial of benefits, Hartford relied upon the opinion of a contracted physician hired by Hartford to review Plaintiff’s medical records.  Hartford’s doctor had never met or examined Plaintiff, yet he reviewed Plaintiff’s medical records and contended that, “The medical documentation failed to support any neurological impairment affecting your ability to physically function without restrictions up to 40 hours a week.”  Hartford failed to take several statements from Plaintiff’s treating physicians into account when denying her benefits. Plaintiff’s treating physician submitted repeated attending physician statements outlining her disability and her inability to return work.

After filing the lawsuit, both parties agreed to attend a mediation in South Bend with a trained mediator.  The parties were able to reach a compromise and were able to settle the case.  The case has now been dismissed against Hartford.

If you have a disability claim which has been denied or terminated by Hartford Insurance company, contact the O’Ryan Law Firm as soon as possible to discuss your options in pursuing the benefits you are entitled to under the terms of the Hartford policy.