The Texas disability lawyers at Marc Whitehead & Associates recently filed suit on behalf of a 59 year old male who became severely disabled while covered under a long term disability insurance policy issued and administered by The Hartford.
Founded in 1810, The Hartford is one of America’s oldest and largest insurance companies, taking billions of dollars in revenue each year. The Hartford leads the industry in fully insured disability sales and are the second largest providers of life and disability insurance in the U.S. market. Other insurance companies with a large share of the disability market include Standard Insurance, SunLife, MetLife and Liberty Mutual, Provident, CNA, John Hancock, Colonial, AXA Equitable, New York Life, Guardian, Penn Mutual.
Like many other insurance companies, The Hartford often makes it difficult for policyholders to get their claims for long term benefits approved.
The SSA Agreed Our Client Was Disabled; The Hartford Did Not
Our client, formerly employed as a Registered Nurse, became disabled and unable to work due to a C5-C6 cervical radiculopathy, degenerative disc disease, osteoarthrosis, cervicalgia, hyperlipidemia, and failed back syndrome.
Our client’s initial claim for disability benefits had been denied, despite the fact that the Social Security Administration had issued a fully favorable decision for our client’s claim for Social Security disability benefits under Title II and Title XVI of the Social Security Act, finding that he was disabled and unable to work any job during the relevant time period.
On December 14, 2009, the insurance company informed our client that he had exhausted all administrative remedies and they would consider no further claims or evidence.
In their final denial, the Hartford dismissed the opinions of our client’s treating physicians, among others, and the documented limitations from the severe impairments he suffers and their effects on his ability to engage in work activities.
Where Do You File an ERISA Disability Benefits Denial Lawsuit?
Since our client had now exhausted all available administrative appeals, we were forced to file suit in Federal Court to obtain the long term disability insurance benefits, to which he is entitled under a disability insurance policy underwritten and administered by The Hartford.
Our client’s policy, like almost all long term disability plans offered by a private employer, is governed by the Employee Retirement Income Security Act of 1974, or ERISA. It’s a federal law that regulates the handling of Employee Benefit Plans and the remedies of the beneficiaries of these Plans. Among other things, ERISA provides policyholders with the right to file a lawsuit in Federal Court to appeal a denial of benefits by an insurance company.
A plaintiff’s choice of venue is given great deference by the courts. ERISA states that you may file your lawsuit in one of four places:
- Where the Plan is administered
- Where the breach occurred
- Where the defendant resides
- Where a defendant may be found
In cases of benefit denial, the courts generally conclude that the breach of contract occurs where the benefits are to be received. Practically speaking, this means you may file your lawsuit where you live or expect your benefit checks to be delivered. You may file an ERISA case in either state or federal court, but invariably the defendant will remove (transfer) your case to federal court based on federal issue jurisdiction.
ERISA Lawsuit Filed in Federal Court
Since our client lived and received benefits in Texas, suit was filed in federal court in Texas pursuant to 28 U.S.C. § 1331 (“The district courts shall have original jurisdiction of all civil actions arising under the Constitution, laws, or treaties of the United States”) to our client’s rights under the ERISA, as allowed by:
- 29 U.S.C. §§ 1132 (“A civil action may be brought… by a participant or beneficiary to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan”),
- 29 U.S.C. §§ 1133 (“Every employee benefit plan shall…afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim”), and
- 29 U.S.C. §§ 1140 (“It shall be unlawful for any person to discharge, fine, suspend, expel, discipline, or discriminate against a participant or beneficiary for exercising any right to which he is entitled under the provisions of an employee benefit plan”).
In the end, the judge agreed with our client that the Hartford had wrongfully denied his claim.
Don’t Wait Until Your Claim Has Been Denied To Speak With Marc Whitehead & Associates
Disability Insurance claims are governed by ERISA’s complex set of laws and procedures. A single mistake is all it can take for you to lose out on the benefits you need. Disability Insurance companies such as Unum, Cigna, Aetna and Prudential take advantage of ERISA’s rules and regulations to delay and deny a claim decision. Most people make the mistake of thinking they can handle the administrative appeal themselves and then hire a lawyer if they lose and have to file a lawsuit. This is totally backwards thinking.
Don’t wait until your claim has been denied to speak with an experienced disability benefits attorney. Marc Whitehead & Associates have been helping disabled workers and veterans obtain the benefits they deserve for over 25 years. We understand the process as well as the insurance company – the only difference is we use the rules and regulations of ERISA to protect our clients’ rights and cut through all the insurance company’s attempts to discourage, delay and deny your claim.
If your claim for LTD benefits has been turned down by The Hartford or another insurance company, contact Marc Whitehead & Associates 866-365-7898. We would be happy to schedule a consultation to meet with you to discuss your case and legal options.
You can also download our free ebook “Disability Insurance Policies-How to Unravel the Mystery and Prove Your Claim” for more information.