Connecticut Nurse with Meniere's Disease LTD Benefits Terminated by Hartford
A Connecticut nurse with Meniere’s disease LTD benefits were terminated by Hartford Life and Accident Insurance Company. The Court in this case found that Hartford failed to give the claimant, Ms. Hughes, a full and fair review during her appeal.
Ms. Hughes filed for disability benefits under her employer’s policy. She was initially approved and paid benefits for about five years. However, then it conducted surveillance and a medical review and determined she was no longer disabled.
Ms. Hughes timely appealed the decision. During the appeal review, Hartford sent Ms. Hughes to an Independent Medical Evaluation (“IME”). The IME doctor then provided a report to Hartford. Hartford, however, never provided a copy of the report to Ms. Hughes. Instead, it denied her appeal based on the IME report. Ms. Hughes was never given a chance to respond to the report or provide new evidence for Hartofd to consider.
The Employee Retirement Income Security Act (“ERISA”) requires an insurance company reviewing a benefit determination to provide the claimant a full and fair review. Failure to do so is a violation of ERISA.
Insurance companies can be sneaky. However, the ERISA regulations provide strict procedures and guidelines that must be followed. It is important to have someone who understands these regulations and can pinpoint when the insurance company is violating them.
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