The Hartford Denies, Delays, and Terminates Disability Claims
Hartford Financial Services Group, Inc., better known as Hartford, provides both Short Term Disability (STD) and Long Term Disability (LTD) insurance coverage to millions of people across the United States. Each disability insurance policy is intended to replace part of an employee’s income in the event that the employee is unable to work because of a disabling injury or illness.
Unfortunately, Hartford disability denials are common. It’s much more likely that you will receive a Hartford disability denial letter than an approval. Hartford collects premiums each month, but it does not always honor its end of the deal. Claims are often denied, delayed, or terminated.
Long Term Disability Insurance Claim Denials
You may wonder how the insurance company justified the decision to close your claim while you are suffering from a disability. The fact of the matter is, the insurance company was never on your side – Hartford prioritizes their own profits overpaying claims.
ABC’s Good Morning America has aired news reports on Hartford’s treatment of disabled individuals. Chris Cuomo reports on how Hartford wrongfully terminated a disability claim by Jack “Rocky” Whitten based on surveillance video. The “GMA” story on insurance company surveillance led to other mistreated disability policyholders contacting Good Morning America to share more allegations of abuse and stories of having their disability benefits terminated. In 2010, Good Morning America aired a follow-up segment titled: ‘GMA Gets Answers’: Disabled Claimants Fight Back.
If your claim has been wrongfully denied or terminated it is important to hire a disability attorney who has experience in dealing with Hartford to help you fight the benefits you deserve.
Reasons for a Hartford Long Term Disability Claim Denial
A Hartford long term disability claim will be denied if the insurance company finds that you do not meet the definition of disability as defined by your disability insurance policy. Here is the definition used in a Hartford denial letter dated March 5, 2021:
From the date that you first became disabled until monthly benefits are payable for 24 months you meet the test of disability on any day that:
You cannot perform the material duties of your own occupation solely because of an illness, injury or disabling pregnancy-related condition; and
Your earnings are 80% or less of your adjusted predisability earnings.
After the first 24 months of your disability that monthly benefits are payable, you meet the plan’s test of disability on any day you are unable to work at any reasonable occupation solely because of an illness, injury or disabling pregnancy-related condition.
As you can see, the definition changes after the first 24 months that monthly benefits are payable. It is very common for claimants that were originally approved to receive a long term disability denial when the definition transitions from “own occupation” to “any occupation”.
Another common reason for denial is a pre-existing condition limitation. Most insurance companies include a statement that excludes long term disability insurance claims for a pre-existing condition. Disability insurance companies are known to incorrectly apply this limitation to eligible claims. The exact definition of a pre-existing condition will vary between different disability insurance policies, but here is a sample from one of our recent cases with Hartford:
A pre-existing condition is an illness, injury or pregnancy-related condition for which, during the 3 months before your coverage became effective:
You received medical treatment for the illness, injury, or pregnancy-related condition; or you took drugs or medicine prescribed or recommended by a physician for the illness, injury, or pregnancy-related condition.
No benefits are payable for any disability that is caused by or substantially contributed to by a pre-existing condition or medical or surgical treatment or pre-existing condition and starts before the end of the first 12 months following your effective date of coverage.”
How to Avoid a Long Term Disability Claim Denial
Meet Hartford’s Definition of Disability
You must meet the definition of disability in order to receive benefits. Although each disability policy is different, the definition of disability below was sourced directly from the policy of another one of our cases against Hartford Financial Services Group Inc.
“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 Pre-disability Earnings; and
3) after that, Any Occupation.”
The definition of disability for your policy may be different from the definition above, so be sure to request a copy of your policy and review it carefully.
Submit All of Hartford’s Claim Forms
Hartford’s LTD application is made up of 5 sections:
- Employer’s Statement: This section must be completed by the employer’s authorized representative;
- Information for Group Life Premium Waiver Benefits: This section must be completed by the employer’s authorized representative if the employer also has a Group Life Insurance premium policy with the Hartford that includes a Premium Waiver benefit;
- Employee’s Statement: This section must be completed by the employee who is applying for benefits. Be sure to include:
- Your health care provider’s (doctor or hospital) name, specialty, address, telephone number, and fax number;
- Your medications, the date they were prescribed, the condition they were prescribed for, and the name of the prescriber; and
- You should also attach a copy of your driver’s license.
- Authorization to Obtain Information: You obviously have a right to privacy in your medical records. This form allows Hartford permission to access your medical records; and
- Attending Physician’s Statement of Disability: The Hartford will want to obtain an opinion from your doctor that identifies your physical and/or mental limitations. Your doctor should specifically identify your diagnoses, your resulting impairments, and how the impairments affect your daily activities. It is useless for your doctor to write a note that makes simple, conclusory statements like, “This patient is disabled. Please give him/her all appropriate accommodations”. It is not necessary for your doctor to state that he or she thinks you’re “disabled.” It is more important for your doctor to identify your level of impairment. If your doctor is not willing to help with your case, you should seriously consider finding a new one who is willing to help.
These forms collectively make up the application for long term disability benefits. Hartford may also request an updated authorization and/or an updated Attending Physician’s Statement of Disability during the appeal review process. If you do not submit all of the necessary forms for your claim the Hartford may deny or terminate the claim due to noncompliance.
How We Can Help Get the Long Term Disability Benefits You Deserve
At the Ortiz Law Firm, we believe that disability insurance companies should honor the long term disability insurance contract you purchased when you’ve upheld your end of the bargain by paying your premiums.
Hartford denies even “strong” disability claims that seem to have plenty of evidence to support the claim. If Hartford denies your claim you should not give up. A long term disability denial is not the end of the claim process, however.
Many Hartford disability insurance policyholders have contacted us regarding challenges to their claims for benefits after receiving a Hartford disability denial or termination. We primarily represent claimants whose applications for LTD benefits were wrongfully denied and claimants who were being paid benefits that were suddenly terminated, so our legal team has experience preparing a comprehensive Hartford appeal. We work closely with our clients and offer legal advice at step each in the claims process. The assistance of a disability lawyer can dramatically improve your chances of having your appeal approved. A disability lawyer will assist you by:
- Helping you understand the reason for your denial;
- Gathering necessary evidence for the appeal, including medical records, medical bills, job descriptions, bank statements, and pay stubs;
- Obtaining doctors’ opinions as to your limitations due to your medical condition(s);
- Understanding the requirements of your policy, and helping you gather the documents necessary to satisfy your “proof of loss”;
- Documenting your claim file in the manner that offers the best chance of approval;
- Completing the appeals paperwork; and
- Filing your disability appeal within the allotted time frame.
With over a decade of experience in handling insurance claims, our Hartford disability appeal attorneys have the knowledge and skill needed to help you obtain or hold onto the benefits you deserve under your long term disability plan with Hartford.
The Hartford Disability Appeal Process
Understand Your Denial Letter
You should receive a denial letter from Hartford shortly after your claim is closed. Your denial letter should specify why your claim was denied and how to file an appeal. Pay close attention to the reasons given for the denial so you can determine how you proceed with your appeal. For example, if you were denied because the insurance company stated your claim file lacks “objective documentation”, you would want to submit additional CT-Scans, x-rays, or MRIs.
Another example is if you were denied because “the medical records received from all providers noted above does not support that your physical and/or psychiatric conditions prevented you from performing your occupation”, you would want to submit any new records detailing why you are unable to work, a written statement from your physician, or even a Residual Functional Capacity (RFC) form. We offer free RFC forms for both physical impairments and mental impairments).
If you still aren’t sure why your claim was denied an experienced Hartford disability appeal attorney can help you interpret and understand the denial letter.
Request Your Claim File
One of the first things you should do after you receive a disability denial letter from the insurance company is to request a copy of your claim file in writing from your LTD insurance company. In accordance with federal law, the insurance company is required to provide you with a free copy of your entire claim file if your claim has been denied or terminated.
You’ll need to review your claim file to see if all your medical evidence has been added to the file, and if not, you have an opportunity to submit additional evidence with your appeal. If you file a lawsuit against the insurance company in federal court, the judge will be limited to considering only the evidence that was in your claim file at the time the claims handler issued his or her final decision. That means you should “pack” or “stack” the record with favorable evidence during the administrative appeals process.
Obtain and Submit Medical Records
The reason for denial, as stated in your Hartford disability denial letter, will help you determine what specific evidence you need to submit with your appeal, but it is always a good idea to submit any new medical evidence (such as visit notes from recent doctor appointments) that supports your claim. Although Hartford may have had you sign an Authorization to Obtain Information form, it is still your responsibility to obtain and submit any medical evidence that is relevant to your claim. There is usually a time limit to submit proof of loss or proof of claim, and if Hartford does not receive your medical records within a certain amount of time your appeal will be denied.
It is best to hire an attorney as early in the appeal process as possible, but for those of you who are looking to file your own appeal, we have even more detailed information about how to appeal an LTD denial.
Where to Submit Your Appeal Letter
Each disability policy is unique, so it is important that you review your denial letter for the most accurate instructions on how to submit an appeal to Hartford. The most recent denial letter that we received from Hartford states that the appeal letter must be sent to:
P.O. Box 14087
Lexington, KY 40512-4087
Can I File a Lawsuit If I Receive a Hartford Disability Denial?
In most cases, the claimant must exhaust their administrative appeals before they can sue Hartford. In the event that your appeal is also denied, we also assist clients in:
- Filing a lawsuit under federal ERISA regulations; and
- Preparing your case for review by a federal judge during the ERISA lawsuit.
An experienced long term disability attorney will be able to advise you whether you must appeal the decision through an internal administrative review process with Hartford or by filing an ERISA lawsuit to have your case reviewed by a federal judge.
Work With an Experienced Long Term Disability Attorney
If your illness or injury makes it impossible for you to work and you have been denied your long term disability benefits, the legal team at Ortiz Law Firm can help. We represent claimants anywhere in the United States and we offer a free consultation if your claim has been wrongfully denied or terminated. Give us a call today at (888) 321-8131 to request a free consultation.