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When Disability Insurance Companies Don’t Play Fair

Osterhout Berger Disability Law > Long Term Disability > When Disability Insurance Companies Don’t Play Fair

One of the ways we at OBL ensure that we are offering excellent representation to folks whose claim for long-term disability benefits has been denied is to continuously watch federal court decisions being issued in appeals of insurance companies’ denials of these cases. This helps in two ways: (1) to guide us in making sure that our clients’ cases are being developed in the best possible way in light of current court decisions, and (2) to give us insight into the kinds of mistakes (and, frankly, bad behavior) committed by certain insurance companies. Sometimes, we see a trend, and unfortunately, we are definitely spotting one with respect to The Hartford and Aetna’s mismanagement of long-term disability cases, resulting in unsupported and unfair denials.

To step back a moment, a long-term disability case only ends up in federal court when the insurance company denied the initial application and any appeals that were available under the insurance policy. A federal court appeal is the “last chance” of overturning the decision; these cases are not easy to win, mainly because in most cases whatever record was developed while the insurance company was considering it is the only record that can be considered by the federal court in the appeal. In short, if evidence was not submitted, or if mistakes were made by the claimant in the application process, this can almost never be fixed at the federal court level. This is why we advise those who are even thinking of applying for long-term disability benefits to consult with an experienced law firm who handles these cases or, if the application has already been filed and denied, that the client contact a lawyer immediately so that any mistakes or missing evidence can still be addressed before the insurance company’s denial of long-term disability benefits becomes final.

What we have noticed in our recent review of federal court decisions is that The Hartford and Aetna in particular seem to have had their claims decisions overturned a lot lately. And, the reasons why these cases were overturned are not only helpful to us at OBL in offering the best representation to our clients, it also frankly says a lot about The Hartford and Aetna. This brief list (it could be a lot longer) will give an idea of the trend of unfair decisions issued by these companies.

The Hartford originally granted the claimant benefits based on his well-documented heart condition, orthostatic hypotension and vertigo. However, after paying benefits for two years, it suddenly decided that the claimant’s understandable anxiety about his long-term health problems was the real reason why he was disabled and terminated benefits based on a two-year limitation in the insurance policy for mental health impairments. This, in the face of evidence from his treating physician, an independent occupational medicine specialist, and The Hartford’s own reviewing physician. 

Aetna failed, in a claim involving a claimant who had represented herself, to (1) fulfill its duty to effectively communicate with her about her appeal rights; (2) failed to pursue medical evidence, despite her having provided the information to Aetna, about one of the main medical conditions in her case; (3) failed to consider the well-documented severe narcotic side effects of her medications; and, (4) failed to provide the claimant with copies of reviews performed by its in-house physician.

The Hartford “forgot” to include the attachments to a vocational report, it relied upon to find that, even though the claimant could not perform his past job, there were other similar jobs he could perform. Once on appeal, the attorney representing the claimant in the appeal demonstrated that the attachment was inconsistent with the report in several critical ways that undermined the decision to deny long-term disability benefits.

Aetna found, contrary to the evidence, that the claimant had no functional limitations, which was refuted by at least some evidence in the case. Its decision, therefore, to not include its own vocational expert’s report that considered some of those limitations was “procedurally irregular.”

We could go on and on. These are just examples which we see repeated in other federal court decisions which awarded the claimant another opportunity to appeal the denial of their long-term disability benefits.

However, the real story is that the attorneys who represented these claimants at the federal court level did an amazing job. As mentioned above, a federal court will only make a long-term disability company like The Hartford or Aetna reconsider denials under very limited circumstances and federal court decisions are not consistent across the country; a much longer article could be written detailing federal court denials of appeals, sometimes in cases with facts remarkably like the cases we described above. In short, no claimant (or attorney) should ever assume that problems in the case or mistakes made by the insurance company can easily be “fixed” at the federal court level – in fact, this is usually not the case.

The lesson here is that if you are filing a claim for long-term disability benefits, whether it involves The Hartford or Aetna or any other insurance company, you need experienced, aggressive and unrelenting representation in your case while the insurance company is still deciding your case or your appeal. We at OBL smoke out all the above “mistakes” these companies make, and many others, all the time because of our commitment to holding your insurance company’s feet to the fire and leaving no stone unturned to ensure that you are awarded the benefits you worked hard for and deserve. In fact, just by coincidence, some of our most recent settled cases are cases involving The Hartford or Aetna, cases we were able to resolve without the need to deal with a lengthy federal court action by making sure that they paid our client NOW.

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Learn More

Learn more about long term disability insurance, as well as appealing denials and how an attorney can help. These five articles will cover the basics: