Background
Ms. Brenda Riggs worked as an insurance health specialist for Hewlett-Packard. She suffered from several conditions including neck pain, headaches from the neck pain, and spinal cord compression. Since January 2017, she has been disabled and was paid long-term disability insurance benefits by Hartford which administered her employer disability insurance plan. In July 2020, Hartford determined that she was disabled from any occupation.
In December 2021, after almost five years of disability benefits, Hartford terminated her disability insurance claim and stopped paying LTD benefits. Ms. Riggs appealed the denial to Hartford. Included with her appeal was information supporting disability from her treating provider and an independent functional capacity evaluation (“FCE”).
During the appeal review, Hartford obtained two medical reviews – paper reviews by their paid doctors which did not support disability. The appeal was denied in July 2022.
Ms. Riggs filed a lawsuit seeking her long-term disability benefits.
The Court’s Review
The court reviewed whether the decision to deny benefits was reasonable. Its review looked at the medical evidence provided by both sides, including the opinions of her treating providers, medical records, the FCE, and the reports prepared by Hartford’s doctors.
The court pointed out two important things with Hartford’s basis for denying the appeal:
- Hartford’s medical reviewer acknowledged her disabilities and noted that imaging was supportive. The reviewer opined that there was no indication that her condition would improve. Yet, the medical reviewer opined she could work full-time.
- Hartford’s reviewers did not address the FCE or Ms. Riggs’ treating provider’s reports of her conditions. Rather, these items were only mentioned in passing.
Although Hartford presented some evidence, i.e., two paper reviews, the Court found that the whole claim file supported disability.
The Court concluded that Hartford’s decision to deny benefits was unreasonable because:
- There was a lack of evidence that Ms. Riggs improved at all.
- Hartford’s reviewer’s opinions were “not substantial enough to support the about-face in this case.”
Thus, the Court determined Ms. Riggs was entitled to receive all past owed benefits and future benefits subject to changes in her condition.
Our Lawyers Specialize in Disability Insurance Claims
Because our law firm has always focused only on disability insurance, our lawyers are experts in legal representation for disability insurance benefits.
That means our disability lawyers have the following:
- Won several major disability lawsuits that helped make better laws for disability claimants;
- Experience fighting every major insurance company, such as UNUM, Hartford, MetLife, CIGNA, Prudential, and more.
- Successfully represented hundreds of clients and won millions of dollars in disability benefits.
Because federal law applies to most disability insurance claims, we can help clients across the country.
Disability insurance companies have lawyers. You should too. Call Dabdoub Law Firm to get experienced disability lawyers on your side.
We can help with:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- negotiating a lump-sum settlement; or
- Filing a lawsuit against your disability insurance company.
Call for a free consultation with a disability attorney. No fees or costs until you get paid.
