Most Hartford insurance claims for long-term disability (LTD) benefits are group disability claims. The Hartford sells LTD coverage to employers who in turn offer it as an employee benefit.
Disputes and complaints regarding group disability claims are governed by the federal law known as ERISA, which stands for the Employee Retirement Security Act. If your Hartford disability coverage was offered through your workplace or directly provided to you by your employer, your claim and legal rights to Hartford benefits may well be controlled by ERISA.
This can impact your claim in every way, from filing an initial claim for disability benefits to how you can fight a wrongful denial of benefits.
Under ERISA’s rigid rules, your insurance company has far more protections than you do as a claimant. Insurers face no real penalties for denying valid disability claims and are thereby often incentivized to deny benefits.
When this leads to a wrongful denial, you are in a very vulnerable situation. Being too sick or hurt to work, you should not deal with The Hartford on your own. You need legal support.
In this article, we explain why an experienced ERISA attorney can be your greatest legal ally and strength. At Marc Whitehead & Associates, we have that experience.
Five Legal Reasons Why Hartford Insurance Claims Can Be Difficult to Win
1) Mandatory Appeals Process
Before you can go after your benefits in a lawsuit, ERISA law requires that you “exhaust” all administrative remedies stated in The Hartford’s (or any other insurance carrier’s) policy documents. This is known as the administrative appeal. The procedure you should follow and deadlines you must meet should be defined in the policy itself and your denial letter.
Essentially you must submit a mandatory appeal to The Hartford – the same company that denied your claim to begin with. Failure to appeal under the Plan’s requirements will cause dismissal of any lawsuit you may bring.
The appeal must present well-thought-out arguments with documentation that will prove your claim and stand up in federal court, should The Hartford deny your appeal.
The appeal should be handled not just by an attorney, but by a seasoned ERISA attorney. The unusual degree of difficulty associated with ERISA claims can often be overcome when (1) the attorney is knowledgeable about ERISA’s procedures and (2) experienced with The Hartford’s insurance claims handling tactics.
As you can see, the administrative appeal becomes the most important part of your claim and will be the basis of legal arguments later in your case.
2) What if The Hartford denies your claim on appeal?
If your appeal is denied and you file a lawsuit, you cannot add any new evidence to support your case. Your administrative record upon appeal may be theonly evidence you willhave to rely onlater in court.
3) You have no right to pursue your claim in state court
ERISA does not allow you to bring state causes of action for bad faith and usually does not allow for consequential or punitive damages in the event of The Hartford’s breach of fiduciary duty.
4) In ERISA there are no jury trials
The court will decide your case based on legal briefs, or in some cases, the court will conduct a bench trial with the judge sitting without a jury.
5) The standard of review in ERISA-based Hartford insurance claims: abuse of discretion
When litigation becomes involved in ERISA claims, most cases are not about proving whether you are disabled, but that the insurance company “abused its discretion” by denying benefits. Simply put, the judge will only consider whether The Hartford’s decision-making process was reasonable.
To decide whether you should be entitled to Hartford benefits, the court will consider both parties’ briefs, arguments, and the administrative record. If the judge finds The Hartford’s decision-making process was reasonable, the judge cannot reverse the decision. Even if the judge agrees you qualify for disability benefits, the court will find in favor of the insurer.
Why Are Hartford Insurance Claims for Disability Benefits Denied?
Claimants who expect to collect long-term disability benefits on their Hartford insurance claims are often stunned by this company’s aggressive denial measures. The Hartford is a billion-dollar enterprise that often takes a rigorous approach to claim denial.
Also, in 2018 The Hartford acquired AETNA’s group disability business. All AETNA disability policies are now handled by The Hartford insurance claims disability operation.
We are prepared for all tactics used by The Hartford to delay and deny benefits, such as:
- Field interviews. The Hartford will often send a representative for a face-to-face interview with you, asking many questions in hopes of learning any information they can use to deny your claim.
- Surveillance. The Hartford may use video surveillance or social media monitoring to “catch” you doing what appears to be activities you claimed you could not do.
- Relentless requests for documentation: By making repeated demands for medical records, The Hartford delays the whole claims process. This can go on for months, frustrating and wearing claimants down.
- They say you are not disabled: The company may allege you are not disabled from working at any occupation, or that you can still do sedentary work despite your condition.
- Malingering: They may allege you are malingering (faking disability).
- Rely on DOT occupation definition: The Hartford may misstate what your own occupation truly entails in terms of daily tasks, and instead apply the general occupation description from the Department of Labor’s Dictionary of Occupational Titles (DOT) of how your general occupation is done in the national economy.
- Ignore the award of Social Security Disability Insurance (SSDI) benefits. Although Social Security’s criteria for disability are strict and thorough, an award of SSDI does not mean you will be awarded long-term disability benefits.
- Ignore your treating physician’s statements. The Hartford often will not fairly consider your own doctor’s medical evaluation, findings, and opinions, and rely instead on paid third-party or in-house medical examiners.
- Ignore medication side effects: The Hartford fails to give adequate consideration to the side effects of medications when this has been clearly stated in the claim.
Are All Hartford Insurance Claims Governed by ERISA?
The majority of Hartford insurance claims for disability coverage concern group disability benefits plans provided by employers. This is important because the laws governing your potential claim are vastly different, depending on whether your employer pays for any of the coverage.
The Hartford offers disability plans with a variety of payment options, from 100 percent employer-paid to options where the employee contributes a percentage of the payments. For example, your workplace may offer employees the ability to pay 30 percent of the premium through payroll deductions, and the employer pays 70 percent. With various options, it is difficult to know what laws may govern a case. Never guess about the laws governing your claim. Always consult with an experienced ERISA disability attorney. Also, be aware of tax ramifications on any Hartford benefits won if you have contributed towards coverage.
Disability Case Studies – The Hartford Insurance Claims
disability settlements, and lawsuits regarding Hartford insurance claims.
If you’d like more information about The Hartford, please download our free ebook:
Your Battle Plan for Winning Disability Insurance Benefits
The Hartford Insurance Claims Denial:
Situation: Our client, a dentist, suffered severe back and spinal issues, lumbar spondylolisthesis, and a total shoulder replacement. In addition, her medications drastically affected her problem-solving skills, which further damaged her competence as a dental professional. The applicable law, in this case, was ERISA.
The Hartford Denied Benefits: Musculoskeletal disorders are very common in medical and dental professions. Insurance companies find doctors and dentists to be a lucrative group to market policies to, only to deny claims when benefits are truly needed.
In this case, The Hartford denied our client’s initial claim by alleging there was not enough medical evidence to prove disability. The Hartford selectively ignored our client’s full medical records and denied benefits by (1) misapplying our client’s physician’s statement that she could occasionally lift 20 pounds, (2) relying on The Hartford’s hired third-party’s medical opinion and vocational analysis, and (3) ignoring the cognitive impact of our client’s required medications.
Result: We appealed the denial and The Hartford reversed its decision. By meticulously answering each issue of denial, our law firm showed that our client was entitled to disability benefits.
Situation: Our client suffered from relapsing-remitting MS, where symptoms fluctuate over time. Our client had been receiving disability benefits from The Hartford for three years, and then The Hartford decided to terminate benefits saying she was no longer disabled.
The Hartford Terminated Benefits: The company denied our client’s claim in 3 ways:
- Ignored the award of disability benefits by Social Security
- Did not consider our client’s pertinent medical evidence regarding MS
- Unreasonably relied on surveillance video
Result: Marc Whitehead & Associates filed an ERISA lawsuit on our client’s behalf. The judge found that The Hartford had abused its discretion in denying our client’s benefits. The court awarded our client benefits and attorney’s fees, with judgment withheld until the amount of benefits due was determined.
Situation: Our client suffered from trigeminal neuralgia, a chronic pain condition that affects the face. Our client had already been awarded SSDI.
The Hartford Denied the Claim and the Appeal: The insurer was aware of SSDI’s benefit award, and yet denied our client benefits on the initial application and again on appeal. Our client had exhausted all available administrative remedies and was forced to file a lawsuit to obtain his disability benefits.
Result: We filed an ERISA lawsuit in federal court in Arizona. The Judge agreed that our client’s claim was unfairly denied and ordered The Hartford to pay the disability benefits he was entitled to under his policy.
Our Experienced Hartford Insurance Claims Attorneys Are Ready to Help
Do not give up hope. The truth is The Hartford and other insurance companies routinely deny long-term disability claims. When LTD benefits are your lifeline, Marc Whitehead & Associates will fight for the benefits you need and deserve.Our law firm handles Hartford insurance claims with ERISA’s many difficulties in mind. We have extensive experience with The Hartford’s disability insurance practices. We can help you in any location in the U.S., at any stage of your claim—from filing your initial claim to litigation.