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.
Hartford Terminates the Long Term Disability Benefits
In the claim file, it appears that Hartford actively sought to dig up information in order to terminate the claim. They attempted 4 days of surveillance, sitting outside Ms. Miller’s home for 4 days, 8 hours a day. The surveillance showed no activity by Ms. Miller for these 4 days. Ms. Miller’s primary care physician continued to be very supportive of the disability claim and reported to Hartford that she was unable to return to work due to the severity of her fibromyalgia and arthritis. Despite no improvement in her condition, on April 30, 2015, Hartford terminated the Plaintiff’s long-term disability benefits based on a record review by a physician that had never examined Ms. Miller. Most egregiously, Hartford reported that Ms. Miller’s rheumatologist had reported to Hartford that she could return to “light” duty work. When contacted, the rheumatologist denied having ever said this to Hartford. Hartford refused to reverse their position.
The Plaintiff Files a Lawsuit against Hartford
Given that the medical records and the Plaintiff’s primary care physician support the continued payment of her disability benefits, the O’Ryan Law Firm filed a lawsuit against Hartford seeking to have the court order Hartford to reinstate the benefits. During the litigation, it became apparent that Hartford’s file was missing a critical element of the Plaintiff’s claim—an Attending Physician Statement that was sent to Hartford during the internal appeal process. It appears that Hartford never bothered to review the appeal or the exhibits attached to the appeal; otherwise, they would have immediately noticed that they did not have the most important document in Ms. Miller’s appeal. Hartford’s failure to provide Ms. Miller with a full and fair review of her claim is a violation of ERISA and therefore constitutes an abuse of discretion.