How The Hartford Denies Disability Claims

First, Hartford conducts hidden video surveillance of the claimant’s activities. Next, a Hartford investigator interviews the claimant (who is unaware of the surveillance) to obtain statements from the claimant about his or her normal daily or weekly activities. Finally, Hartford sends the surveillance, claimant statements and medical records to one of the outside companies it regularly uses for a review. The idea, of course, is to “catch” the claimant performing activities that the claimant disavows, which Hartford offers both as proof of the claimant’s ability to perform more strenuous activity and to impeach the claimant’s overall credibility.

Video can be powerful evidence and Hartford not only uses it for its own medical reviews, but also frequently sends the video to a claimant’s treating physician to try to change opinions that support the claim. Hartford has enjoyed a great deal of success in obtaining court approval of decisions to not only deny new claims, but also to terminate payments on claims that it has already approved through this process. Not surprisingly, however, Hartford routinely abuses this process to further its own economic interests.

Federal Courts Often Labor Under the False Notion That Insurance Companies Will Act Impartially

Perhaps the insurer’s greatest advantage in defending a claim under a long term disability policy governed by ERISA is the policy language that invariably reserves to the insurer discretion to make determinations of benefits under the policy. Federal courts enforce that language by giving deference to the insurer’s decision and will overturn that decision only where it is found to be arbitrary and capricious.

A limited exception to that standard applies where the insurer’s financial conflict of interest in both insuring the payments of claims and deciding whether to pay those claims has an effect on its decision-making process. Of course it does.

However, courts continue to labor under a false notion that an insurance company can somehow ignore its conflict and act impartially. Hartford routinely offers affidavits from management that tout purported steps it takes to insulate the decision-makers from the obvious influences of this conflict.

Hartford Claim Handlers Are Well Aware of the Benefit of Denying Claims

In the mid 1990s, internal Hartford documents showed that Hartford routinely evaluated and incentivized its claims handlers based on their performance in areas such as the numbers of claimants they could return to work “RTW” and the frequency with which they procured opinions from claimants’ treating physicians of the claimants’ “functionality” thereby moving the claimants off claim and saving the company money. Documents uncovered in more recent cases show that Hartford’s claim handlers are still very much aware of the financial impact that their decisions have for the company.

In Hertz v. Hartford Life and Accident Ins. Co., the court was persuaded by internal Hartford documentation showing that Hartford continued to evaluate its claim handlers on the frequency with which they referred claimants to its SIU unit for surveillance, which Hartford referred to as a “cost containment program,” and based on the number of claims the evaluator “closes.”

That court was also troubled by Hartford’s close relationship with the MLS Group, the company that routinely provides the physicians who review surveillance videos and medical records for Hartford. The court noted that a sampling of the 752 medical reviews MLS had conducted for Hartford from January 2010 and November 6, 2012 revealed that approximately 95% of the time, the physician reviewing the file for Hartford found that the claimant could perform some work. When facts like these are proven, it becomes more clear that Hartford’s purported role as a plan fiduciary gives way to its own conflict of interest in these claims.

Bad Faith Denials in Long Term Disability Claims

Insurance companies such as Hartford have a fiduciary responsibility to act in the best interests of their policyholders. However, that responsibility is in direct conflict with their profit margin. If an insurance company can find any reason to deny your claim, they will do it whether it’s in your best interests or not. In cases where they do this capriciously, you can turn around and claim that they have acted in bad faith and failed their duty of care to their policyholder. You can, in fact, sue them on that basis and recover damages related to any losses you incurred due to their denial. You can also appeal. To learn more about appeals, read our article Should I Handle My Own Appeal?

In some cases, insurance companies won’t deny your claim outright but ask for bad faith extensions. Since these policies need to be processed on a time table, they manufacture extensions with repeated requests for more information. Red flags include:

• Requests for examinations from doctors in an unrelated specialty;
• Requests for information that they already have; or
• Failing to make a prompt decision or requesting more time.

Additionally, Hartford claims adjusters may deny an otherwise valid claim for specious reasons.

Talk to a Hartford Disability Denial Attorney

Applying for disability coverage can be an enervating process to begin with. Repeated requests for information and seemingly endless doctors examinations are meant to exhaust you. Making the process as difficult as they possibly can ensures that only those who really need the disability payments are paid in the end. But don’t think for one second they will give their money away freely and easily. Nonetheless, they’ve been collecting that money from you or your employer for decades. You are entitled to receive the benefits of that policy when you need it. At Robinson & Warncke, we can help take the burden off your shoulders and file the claim for you. Contact us today to learn more.