Leif v. Hartford – LTD Claim For Collections Rep With COPD And Cardiac Impairments

A collections representative with serious cardiac conditions and COPD lost her long-term disability (LTD) lawsuit against Hartford after the court found the insurer’s denial was reasonable and supported by substantial evidence. Despite her argument that the stress of debt collection work would aggravate her heart condition, the court found Hartford had not ignored that evidence — it simply wasn’t persuaded by it.

Lisa Leif filed suit against Hartford Life and Accident Insurance Company under ERISA after it denied her long-term disability claim. She had been employed by W.B. Mason Company, Inc. as a Collections Representative until her cardiac conditions and COPD made it impossible to continue working.

During its claim review, Hartford obtained a vocational analysis and an independent medical review from Dr. Paul Medrek, an occupational medicine specialist, who concluded there was insufficient documentation to support a finding of complete impairment. Dr. Medrek attempted to confer with Leif’s treating physicians but was only able to reach one of them. Based on that review, Hartford denied the claim, concluding the medical evidence did not demonstrate she was unable to perform the essential duties of her occupation.

Hartford denied Leif’s long-term disability claim. Hartford concluded the medical evidence provided purportedly did not demonstrate that Lisa Leif was unable to perform the essential duties of her occupation due to her disabilities.

Ms. Leif appealed Hartford’s denial, arguing that “Hartford’s decision failed to properly address how the stressful nature of her position would exacerbate her underlying cardiac issues, most notably, her high blood pressure and unstable angina.”

During the internal appeal process, Hartford obtained additional peer reviews from a panel of physicians selected by the Exam Coordinators Network. Hartford also reviewed additional hospital records and a Cardiac Medical Source Statement supplied by the claimant.

Hartford sent these independent medical reviews to Ms. Leif’s counsel, who argued that they “did not contemplate how the stress of working as a debt collector would exacerbate her condition, and thus dodged the main issue presented within her appeal.”

However, Hartford maintained its decision to deny the claim, concluding that “the medical evidence does not support that [Ms. Leif’s ongoing] symptoms are of such severity that she would be precluded from performing her own occupation through and beyond the Elimination Period as required by the Policy.”

RELATED VIDEO: Cardiac Impairments or Heart Problems in Long-Term Disability Claims

The plaintiff then brought this action against Hartford Life and Accident Insurance Company. She argued that Hartford wrongfully denied her long-term disability benefits, contending that her medical condition prevented her from performing her job.

In response, Hartford maintained that the medical evidence submitted by the plaintiff did not conclusively prove her inability to perform the essential duties of her occupation, justifying their decision to deny the claim based on the terms of the policy and the evidence available.

The Court’s decision was based on a deferential review standard, meaning the Court looked for whether Hartford’s decision was made arbitrarily and capriciously, given the evidence they had.

The Court ruled in favor of Hartford, concluding that Hartford’s decision to deny long-term disability benefits to Lisa Leif was reasonable and supported by substantial evidence. The Court determined that the medical information provided did not adequately establish that Ms. Leif could not perform the essential duties of her occupation.

Regarding the plaintiff’s argument that Hartford had “discount[ed] the impact occupational stress and risk of harm had on her cardiac health,” the Court “do[es] not read the denial of benefits to have ignored significant material evidence submitted by [Ms. Leif].”