Jessica Ortiz had been on disability insurance benefits for two years. At that point, The Hartford Insurance Company was reviewing her claim for the change in the definition of disability from own occupation to any occupation. The Hartford terminated her disability benefits finding she could work and Ms. Ortiz appealed.
During the appeal, as is typical of insurer’s, The Hartford hired “independent medical examiners” to conduct a paper review of Ms. Ortiz’s claim. The three reviewers determined the medical evidence in the file did not support a disability from any occupation. It also conducted a vocational review wherein it found various occupations in which Ms. Ortiz could work. The Hartford then denied the appeal.
The Court’s job in this type of lawsuit is to determine whether the insurer acted arbitrarily and capricious in denying or terminating benefits. In other words, did the insurer make a reasonable decision based on the evidence before them?
The Court determined the Hartford did make a reasonable decision. It conducted medical reviews based on the evidence in the file. It conducted a vocational review based on the evidence in the file. Both found Ms. Ortiz was not disabled from any occupation.
The Court specifically noted that it does not have to consider her Social Security disability approval because it was not part of the claim file. The Court’s review was limited to the claim file.
Typically, in ERISA disability insurance cases, once the final appeal is denied the claim file closes. At that point, no new information can be introduced. This is why the appeal stage is so important for disabled claimants. As disability insurance attorneys, we get creative with the files. Our goal is to make our client’s case as strong as possible. After reviewing the evidence and the medical condition, we use various tools to work up the file. Some examples include:
- Independent medical examinations
- Functional capacity evaluations
- Peer reviews
- Personal statements from the claimant, and their co-workers, family, and/or friends
- Sworn statements from treating providers
- Vocational reviews
Help from a Lawyer with Expertise in Disability Insurance
Disability insurance law is complex. Hiring an experienced disability attorney is important. Because all disability lawyers at this law firm focus on disability insurance claims, we have expertise in disability insurance law.
That means have:
- Experience with every major disability insurance company;
- A proven track record of success by winning major disability lawsuits;
- Recovered millions of dollars in disability benefits for clients;
And, we never charge fees or costs unless our clients get paid.
The firm can help at any stage of your disability insurance claim, including:
- 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.
Because federal law applies to most disability insurance claims, our lawyers are able to represent clients across the country.
Call to speak with an experienced disability attorney. Consultations are free.