HARTFORD REVERSES LONG TERM DISABILITY DENIAL ON A PARTIAL DISABILITY CLAIM

We were recently successful in having partial disability benefits reinstated for a client insured by the Hartford.  Ms. S was diagnosed with Parkinson’s disease.  She enjoyed her job and wanted to continue her work.  However, her disease left her incredibly fatigued and unable to perform her occupation on a full-time basis.  Her insurance policy contained a residual disability (or partial disability) provision, under which she was considered disabled if she could not perform her regularly scheduled work hours.  Hartford denied the claim, based on the report of a reviewing physician who concluded she could perform sedentary work.  The reviewing physician missed the mark all together—he failed to even discuss her fatigue and what effect that could have on her ability to work full-time. 

Ms. S contacted the Law Office of Shawn McDermott to request our assistance in preparing her ERISA long term disability appeal.  Attorney Heather Petitmermet prepared and submitted a thorough appeal to Hartford on her behalf.  Under ERISA regulations, claims administrators are required to render claims determinations within 45 days.  At the expiration of 45 days, we had not received a decision from Harford.  Ms. Petitmermet called to follow up on the status, and was unbelievably told that Hartford had failed to assign the case to an analyst upon receipt of the appeal; no one had even looked at the file yet.  Given Hartford’s clear lack of compliance with the regulations, Ms. S chose to proceed with a lawsuit. Eventually, Hartford voluntarily reversed its decision and benefits were reinstated.

People often don’t realize that they may be entitled to some disability benefits even if they are still working, if their work earnings are diminished due to their condition.  It all depends on the terms of your plan or policy.   If you need assistance with a partial disability claim, contact the Law Office of Shawn E. McDermott.  We can help you review your policy to determine if you may be entitled to partial disability benefits.

Unum Overturns Prior Denial of Benefits

Recently our firm was successful in getting long term disability benefits reinstated for a client insured by Unum Life Insurance.  Ms. S. suffered from severe osteoporosis resulting in a compound fracture of the right tibia and intertrochanteric hip fracture, each requiring surgical intervention.  She also suffered from neuropathic pain, lateral epicondylitis, Raynaud’s phenomenon, and multiple other conditions.  Unum terminated Ms. S.’s long term disability benefits, claiming she could perform sedentary work and was therefore not disabled under its policy.  In making its determination, Unum relied on a vocational evaluation from an in-house evaluator, a review from Unum’s in-house nurse reviewer, and flawed disability questionnaires from physicians Ms. S. had not seen in months.  Our firm was able to discredit the reasons behind Unum’s termination of benefits.

Ms. S. contacted our firm for assistance in preparing an ERISA long term disability appeal.  We obtained several pieces of supporting evidence in support of Ms. S.’s disability, including, among other things, an independent vocational assessment and functional capacity evaluation, demonstrating how the information Unum had relied upon was flawed.  After putting this material into a coherent appeal and submitting it to Unum, the adverse benefits determination was overturned and Ms. S.’s benefits were reinstated.

If you need assistance in submitting a thorough, well-prepared ERISA disability appeal, or require assistance with a claim under your private long term disability insurance policy, please contact the Law Office of Shawn E. McDermott.