A Utah federal court found that The Hartford wrongfully terminated LTD benefits for an insurance broker who became disabled from Chronic Fatigue Syndrome, Epstein Barr Virus, Valley Fever, and Fibromyalgia . In Lalli v. Hartford, the court found that Mr. Lalli was disabled under the terms of the policy and The Hartford unreasonably relied on surveillance to terminate his benefits.
The Hartford initially approved Mr. Lalli’s LTD claim and paid benefits for over three years before its termination. According to the court, the medical evidence clearly showed Mr. Lalli was entitled to continued payment of long term disability benefits.
Mr. Lalli’s Subjective Medical Conditions
Mr. Lalli, who was in his sixties when we became disabled, worked as an insurance broker for over 30 years. He was forced to stop working in 2006 after experiencing persistent fatigue. Proving disability from conditions such as Chronic Fatigue Syndrome, Epstein Barr Virus, Valley Fever, and Fibromyalgia is difficult because the symptoms are subjective. This means that doctors depend on the patient's report of pain and fatigue to assess their ability to work. As a result, insurance companies often challenge disability claims due to subjective conditions. The Hartford was no different in Mr. Lalli’s case.
The Hartford’s Termination of Benefits
During its review, The Hartford hired three separate doctors to review Mr. Lalli’s medical records and issue an opinion. Not surprisingly, each doctor determined Mr. Lalli was not disabled. The court found that, given the subjective nature of Mr. Lalli’s condition, The Hartford’s reliance on paper-based reviews was unreasonable. Instead, the court reasoned, Mr. Lalli should have been examined in person.
The Hartford also conducted six days of video surveillance on Mr. Lalli as part of its review. On two of the days when surveillance was taken, Mr. Lalli did not leave his home. On each of the remaining four days Mr. Lalli was seen away from his home four or less hours. On one of the four days, Mr. Lalli spent four hours on the golf course. While The Hartford used this surveillance footage to claim Mr. Lalli was over reporting his limitations, the court was not impressed.
Ultimately, the court found The Hartford’s decision to terminate benefits to be unreasonable.
What does this mean for disability claimants? Simply put, disabled people should not fear leaving their house. While an insurance company may be conducting surveillance, you should continue your day-to-day life.
Help from an Attorney with Expertise in Disability Insurance
Disability insurance law is complicated. If your claim for long term disability benefits was denied or being delayed by an insurance company, it is important to get help from a lawyer with expertise in disability law.
Why Us?
Our lawyers specialize in disability insurance:- Our lawyers have experience with UNUM, CIGNA, Reliance Standard, and just about every other insurance company;
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Dabdoub Law Firm represents clients nationwide with:
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