In a recent court decision from Washington state, Reetz v. The Hartford Life and Accident Ins. Co., 2018 WL 934627 (W.D. Wash. Feb. 16, 2018), a federal court ruled that The Hartford improperly terminated Ms. Kristen Reetz’s long-term disability (“LTD”) benefits. The court found that Ms. Reetz was disabled from her own, and any occupation, and was entitled to benefits.
The case highlighted a number of issues that regularly occur in disability insurance disputes. The court’s handling of these issues is informative for claimants in similar situations.
Chronic Pain/ Fibromyalgia
Insurance companies commonly deny claims for chronic pain and fibromyalgia because pain is difficult to prove. But, the court in Ms. Reetz’s case found that her disability based on fibromyalgia and chronic lumbar pain was well supported by her treating physicians. The court found no issue with her credibility and did not insist on objective evidence as proof of her disability.
Treating Physician v. Consultant Reviewer
Very commonly in disability cases, the claimant’s treating physician supports the claim for disability benefits, but the insurance company’s consultant physician disagrees.
In Ms. Reetz’s case, her treating physicians all filled out forms concluding that she could not continue working full-time. The Hartford’s physicians reviewed Ms. Reetz’s records and disagreed, naming few, if any, restrictions on her ability to work.
The court determined that Ms. Reetz’s treating physicians’ opinions should be given more weight than The Hartford’s physicians for multiple reasons. First, the Hartford’s physicians never examined Ms. Reetz. Therefore, they could not observe the effects of illness on Ms. Reetz or assess her credibility. Second, The Hartford’s physicians identified restrictions and limitations that were different from Ms. Reetz’s treating physicians’ restrictions and limitations without identifying why. The court found this “troubling.”
Though treating physicians’ opinions do not automatically get more weight from a reviewing court, common sense arguments such as those identified by the court in Reetz can often be made.
Social Security Disability Decision
Another issue that commonly arises in disability insurance disputes is the effect of a favorable decision from the Social Security Administration (“SSA”) for disability benefits. In Reetz, The Hartford argued the favorable decision from the SSA did not mean Ms. Reetz was also entitled to LTD benefits under her insurance policy. The Reetz court agreed, but nonetheless determined that the SSA judge’s determination that Ms. Reetz was disabled should have been given more weight.
Evidence of Improvement
Finally, the Reetz court found it informative that The Hartford had approved Ms. Reetz’s LTD claim for approximately 23 months before terminating her benefits. The court noted that after a period of paying benefits, one would expect to see some evidence of improvement in the medical records leading up to the termination. In Ms. Reetz’s case, the medical records showed the opposite – a worsening of her condition prior to The Hartford’s termination.
The court in Ms. Reetz’s case considered a number of issues that commonly appear in long-term disability insurance disputes. Our firm has the expertise to spot these issues and argue successfully on your behalf. If your benefits have been denied or delayed, or you would like assistance filing your claim, call us for a no-cost case review and consultation.