Long Term Disability Law Blog
No one ever expects to become disabled and unable to pay their bills. But when you need to collect Hartford disability insurance benefits you need to be prepared. In this video and article learn what every Hartford disability income policy holder needs to do when filing a claim for short-term or long-term Hartford disability income benefits.
- What documentation is needed in the Hartford general application of benefits?
- Length of time a policy holder can receive benefits
- The Hartford application process
- Understand your Hartford disability insurance policy language
Is Hartford a Company That Pays Disability Benefit Claims?
GREGORY DELL: Hi, I’m Greg Dell here with attorneys Rachel Alters and Cesar Gavidia. And we’ve been getting a lot of calls from Hartford about the Hartford Disability Insurance Company. And some questions came up on the question and answer section of our website, which basically was, is Hartford a company that pays disability claims?
And that’s a– obviously they do pay. I mean, they pay claims. But really that– the question also comes in the form, is Hartford a good company?
And so I want to talk about it from a claims handling, if it’s an appeal, if it’s an application, if it’s a denial and go through some different scenarios of what we’re seeing currently with Hartford, and then provide some general tips for people who are watching our videos about things they can do within their Hartford claim.
So I’ll start with you, Rachel. From the get go when someone calls you and they be like, hey, I have a Hartford claim, and they recently denied my claim, what’s it going to be like dealing with them?
RACHEL ALTERS: Well, when Hartford denies a claim, that means that, obviously, they’re not paying the long-term disability benefits anymore either. They had a peer review of your medical records, and their doctors disagreed with your treating doctors that you aren’t disabled, or they’re typical followed you with surveillance and caught you doing things that allegedly you claimed that you couldn’t do, and they’re going to cut you off.
And at that point, you’re going to need to appeal the denial. And they give you 180 days to appeal it. And you’re going to have to get the help from your physician as well as possibly the best thing would be to hire an attorney to help you with the appeal process.
Is Hartford a Difficult Disability Company to Deal with Compared to Other Disability Insurance Companies?
GREGORY DELL: So what’s your take, though, when it is Hartford versus, say, the handful of other companies that are out there? And you’ve reviewed hundreds if not thousands of Hartford denials. And there’s some companies we feel like, wow, this is going to be really impossible. And other companies you say, yeah, I think I can help you. Where does Hartford fall on that scale from impossible to deal with to OK to deal with?
RACHEL ALTERS: In my experience, I find Hartford to be OK to deal with in an appeals process. I do tend to win a great percentage of the appeals that I file with the Hartford. And you can get them to overturn the decisions. You just have to provide them with a very complete appeal. And you’re going to have to work with the doctors and make sure the medical records are so complete that it’s very supportive of this person’s inability to work.
So I have had a lot of luck with working with Hartford and getting the appeals overturned. But I think that without a lawyer, I think the lay person is going to have a harder time winning an appeal.
What is Different About a Hartford Disability Appeal Versus an Initial Application for Benefits?
GREGORY DELL: Cesar, touch on that since we’ve segued into the appeals and how a lawyer gets involved and goes through the claim file. What goes on in this appeal stage that’s different from what the claimant initially did on their own that allows them to have this second chance to be able to now, Hartford, you first said I’m not disabled, but guess what, through, we think you can win your appeal? What do you do to get someone to that stage?
CESAR GAVIDIA: Well, like Rachel touched on, I think the way that we approach appeals just based on our training as lawyers is very methodically. Our appeals look essentially like legal briefs to the federal courts. We put a great deal of time into them. We ensure that there’s a substantial and overwhelming amount of evidence supporting the arguments that we’re making in our appeals.
But the other thing is that there may be things outside of just your medical records that we need to seek out. When we review the claim file from Hartford or when we review your medical records, we understand that you’re disabled. We understand that you’re not able to work.
It doesn’t always necessarily mean that the medical records that you have support it. It doesn’t always mean that the insurance company has done an unconscionable thing by denying you. Your claim may just need more support. It may need more evidence to cross that threshold to an approval.
So we may need to send you to a functional capacity exam. We may need to have one of our own experts or consultants engage with you and engage in the appeals process in order to get that extra thing, extra piece of evidence, extra piece of support that we need to get your claim approved and get your appeal overturned.
GREGORY DELL: Rachel, when dealing with Hartford– and we’ll even back up to the application stage, every company has their own protocols and– I guess I call it protocols or systems that they follow. How would you describe Hartford’s system that they follow in the application process for someone who wants to know if they’re going to be able to collect benefits from Hartford?
RACHEL ALTERS: Well, as far as what Hartford requires in order to get approved?
GREGORY DELL: Yeah.
RACHEL ALTERS: Well, in the application process, you start out with first and foremost, at least when I look at a claimant’s claim to give an opinion as to whether I think they’re going to get approved, it starts with the medical records really. And you need to look at them carefully and make sure that your doctors, all the treating doctors, whether it’s one doctor who is the primary care or a specialist, is documenting in such a way that it is supportive of your inability to work. And I think that Hartford really does focus specifically on these medical records because you can’t just get a letter from your doctor stating, hey, I think this– my patient is sick, can’t work.
GREGORY DELL: Why is that not good enough?
RACHEL ALTERS: It’s not good enough because they want to see a history of a continuum of care. And they want to see that as of going back whether it’s three months ago or even going back as far as six months or a year that if you have a condition that, number one, it’s being treated properly by the proper specialist. They also want to see that the condition has progressed over time, meaning that you haven’t gotten better, that you’re actually getting worse, your symptoms are getting worse, and that your doctor’s documenting restrictions and limitations in the records stating that patient came in today in severe pain, having difficult time sitting for long periods of time, having severe fatigue.
Whatever the issue may be, it needs to be documented correctly in the medical records and can’t just be, oh, I saw this doctor one time, the doctor wrote a letter putting me out of work, and Hartford’s going to just approve the claim. Unfortunately, it doesn’t work that way. That’s why I think the medical records are really important. And it’s important that a claimant treats on a regular basis with a doctor and has conversations with the doctor asking them to please document in such a way.
GREGORY DELL: Cesar, why is it in many claims, someone calls you, they say, look, I had two or three doctors. They filled out their forms that they wanted. They documented my medical records, sent them in the Hartford. And from what I understand, their in-house doctor or nurse looked at the file and says that I can work.
How Can Hartford Deny Disability Claims Without Ever Examining the Claimant?
They never examined me. They never call me. No one’s seen me. They didn’t speak to any of my doctors. And they’re telling me they don’t want to pay me or they denied me. How– that doesn’t seem logical to me, yet we see that every day. Why does that happen?
CESAR GAVIDIA: Well, the insurance companies are insulated, especially in this employee benefits setting in these ERISA cases. The simple answer to that is they don’t have to. They don’t have to have you examined by their own doctor. They don’t have to reach out to your doctors, have a conversation with them– a sincere conversation with them about your limitations, restrictions.
Just having a discussion with them to try to see what could be done to better document the records, they’re not going to do that. They’re not going to do that with your doctors. They’re not going to do that with you because they just simply don’t have to.
So it’s your job and your advocate’s job to be your own advocates, to put all of this together unfortunately. Most people’s experiences with insurance is they go to their doctor, their doctor diagnoses them with something, they give them prescription, they submit it to their insurance company, and the insurance company pays the prescription.
But that’s not how disability insurance works. You have these critical steps and this proof of loss requirement that you have to meet in order to be eligible. So you have to basically build up all of this evidence to be able to prove that you’re not capable of working or engaging in your occupation to qualify you for these monthly benefits.
And it’s not just meeting that threshold once. It’s continuously meeting that threshold. Rachel had said “a continuum of treatment.” It’s a constant requirement to prove your claim as often and as frequently as the insurance company desires it.
Is the Support from Multiple Treating Doctors Enough to Get Disability Approved by Hartford?
GREGORY DELL: So Rachel, talking about is Hartford a good company, if three or four doctors have seen your client, and you submit the medical records and all the forms, why isn’t that enough? Why is Hartford going to a nurse or an in-house doctor? Why can’t the person that is sending the letters and saying send us a claim review that and make a decision?
RACHEL ALTERS: The truth of the matter is, Hartford looks for any reason whatsoever to deny the claim. So Hartford is hiring their nurses, their peer review doctors to look for reasons to deny a claim and not pay benefits. And if they can find that reason, they’re finding it.
So what they do is they have a peer review doctor who says, I don’t care that this claimant has seen four or five doctors, whether they’re specialists or whether they work at Harvard Medical Center. They don’t care. They say, I don’t agree that this person is unable to work. I don’t share the same opinions as the treating physicians, which you would think would be completely unfair as these peer review doctors and nurses haven’t even examined, or met, or even talked to the claimant.
So Hartford is allowed to do this, unfortunately, because the federal courts and laws allow them to hire peer review physicians to render opinions when they don’t even see or treat the patients or even have them examined. And their opinions can trump the opinions of four or five different treating doctors who have actually seen the patient over a period of years. It’s just the way the law is written. And unfortunately, they hire these people justifying reason.
So like Cesar touched on, they’ll have their peer review doctors maybe call the treating physician and ask them about the care. But in the conversations, at least from my experience, they are leading them with questions to try and get the doctors to say, hey, don’t you think this person can work?
GREGORY DELL: So it sounds like you’re saying the attitude is more is what’s missing not what’s there–
CESAR GAVIDIA: Right.
Hartford Video Surveillance and Interviews Are Used to Deny Claims
GREGORY DELL: –which is sad. But along those same lines, and in Hartford– and this is something more specific to Hartford is, their level of surveillance and their field interviews are second to none in the industry in my opinion. They are notorious– well, Cesar, you talk about the process of you get that call, and what’s going on when the Hartford person wants to come to their home. What’s usually happened already that you can explain?
CESAR GAVIDIA: They without a doubt have done conductive surveillance on you. They’ve hired out to these private investigators that have sat outside your house for three or four days taping your every movement, whether you’ve gone to the grocery store, how many times you’ve gone to the grocery store, how long you’ve spent out and about, what you’re doing in and around your front yard or within the scope of what they can see.
So they do that because then once they come to your home, and they sit down with you, and they start asking you all of these questions in this interrogation-style setting, and they ask you, are you able to do any gardening? And you say well– you think to yourself, that’s an odd question. I was just gardening last week, or I went in– I was in my front yard, or I keep a nice garden, they must– there’s those assumptions being made, it’s because they’ve seen it most likely. They’ve seen something to already lead them into this question.
And there’s been times where we’ve actually seen surveillance where they didn’t even surveil the correct person. It’s not even the claimant. And they’re engaged in activity that certainly doesn’t appear to be the activities of a disabled person. And they deny the claim on the basis of this bad– of this bad information.
GREGORY DELL: Right. Well, when they do the interviews, and then on top of the surveillance, the person comes and tries to talk to him for two or three hours, of which we help people all the time to deal with those, the bottom line is, you’ve got to tell the truth in those. And you can get through whatever it is. Just assume they know everything and just admit what it is.
The worst case scenario is trying to talk your way out of it and then have something on video that shows you doing some different. If you did it, you did it. It doesn’t meaning you can go work 40 hours a week. It’s not a big deal.
The other topic with Hartford when we talk about qualifying for benefits is there change of definition. It’s in almost every single policy. It’s more often than not that it doesn’t stay inability to do your own occupation. It switches to any gainful occupation. And usually it’s something in the national economy, whatever that particular job is. And it might be with due regard to what you used to earn, maybe 60% of what you used to earn.
But in anticipation of that, if it’s a 24-month definition, usually at about the 18-month mark, they send out this 10-page– at least 10-page questionnaire. And how important is that? And what are they looking for in that, Rachel, when a claimant gets that?
RACHEL ALTERS: It’s extremely important. Because what they’re doing is they’ll send out this questionnaire– and it usually comes with a cover letter saying your definition of disability is going to be changing as of such and such a date. Therefore, we want to find out information on what your hobbies are, what you’re able to do.
Are you able to travel? Do you drive? They want to know basically everything you do on a daily basis, what your education and training background is. And what they’re trying to do is determine– they’re going to send your claim to a vocational specialist who’s going to pick three or four jobs in the national economy that they believe that you can handle and that will pay you either 60% or 80% of your pre-disability income, whatever the policy requires.
So what they do is they find these jobs, and they ask you– in the questionnaire, they ask you anything you can possibly do. And they go, OK, well, we think that you can sit at a desk 40 hours a week. And you can be a manager, or you can be some sort of sedentary position that will pay you 60% of your job. And we’re going to now deny your benefits because we don’t think you qualify under the “any occupation” definition under the policy.
So it’s really important when you fill out these forms that you’re doing it with the help of an attorney who knows what they’re looking for. And they’re trying to trick you into saying that you can do certain things and that you’re educated to perform certain jobs. And once you put all that in writing and you hand that to them, they use it against you.
GREGORY DELL: So I think the bottom line from– and we’re just scratching the surface with Hartford. And I would suggest–
CESAR GAVIDIA: And we should also say Aetna because now it’s one company, both Aetna and Hartford. And you’ll see Hartford denials on Aetna– on Aetna policies.
GREGORY DELL: Because they acquired Aetna a couple years back. But the bottom line is being prepared. But even more so of being prepared, a person who is not in the business, who hasn’t reviewed thousands of Hartford claims, doesn’t know what it means to be prepared because they don’t know– it’s like going up to battle and they don’t know the enemy, whereas we know the enemy. We know what they want.
So you can put yourself in a better position by really being prepared and trying to avoid the things that can happen, which is why we do all these videos and offer our services to get people through applying or through an appeal, and then if you lose all that, going through a lawsuit to try to get a judge to say, hey, these people didn’t act reasonably, reverse the decision and award my benefits.
So I encourage people to watch our other videos. But most importantly, no matter what stage your claim is at, give us a call. We’re going to offer you a free initial consultation, whether it’s sending us your policy, a copy of your denial letter. Whatever stage you’re at, we will review it. We’ll let you know right away whether or not we can help you.
Our lawyers are available all over the country. Whenever you call us, you’re always going to get a lawyer to answer your call, which is something unique from our law firm. And we encourage you to subscribe to our YouTube channel because we’re regularly putting out these videos. And we hope that you find them helpful in your future claim with Hartford.
If you need to apply, appeal or file a lawsuit against Hartford to receive your disability insurance income benefits, contact any of our disability insurance lawyers for a FREE consultation to discuss how we can assist you.