Hartford Awards Full Long-Term Disability After Appeal
Winning Appeal Gets Long-Term Disability Benefits Reinstated in DC
Here’s the story of how a hard-working single father got Hartford to reverse their decision to terminate his long-term disability benefits after coming to us for an appeal.
Our client had a physical job, working as a machinist and welder, a job he loved and had done for years. His father taught him how to work with tools when he was a young kid, and as he got older, taught him how to weld and fabricate. He was happy to go to work every day.
A supervisor at his job didn’t follow safety protocols for grounding electricity, despite repeated warnings, or didn’t understand the importance of working with high voltage electricity. When the welder went to work, thinking the area was safe, he received an electric shock that traveled up his arm, causing pain and nerve damage.
Since he was on the job at the time of thifs injury in Washington, D.C., we were able to get him workers comp benefits for the injury, and a settlement of his DC workers comp claim because he could not return to his heavy-duty occupation.
Fortunately, his employer also had a long-term disability insurance policy that provided disability benefits for serious injuries and medical conditions.
The Long-Term Disability Application Process
Like most insurance companies, Hartford had forms to complete to get the process started. They wanted medical records and job information and had to verify with the employer that he had not returned to work.
He did the initial application on his own, like most people. He signed all the forms and paperwork. He submitted his medical records and his doctors said he could not return to work because of his injuries. But the insurance company always wanted more information, which was fine – he wasn’t trying to hide anything.
And Hartford finally approved his claim for long-term disability! Problem was, that they denied it about a week later, saying he was no longer disabled under the policy (I’m not making this up – it was that quick.
A Peer Review Doctor Who Had Never Seen the Patient Said He Could Go Back to Work.
That was the reason for the denial of benefits after they had awarded benefits – a doctor who had never seen this worker read his medical records and said he could return to his regular occupation. This happens all the time in long-term disability claims. The insurance company relies on these doctors (who charge a fortune for their service) to read a few medical records and give an opinion that a worker is not disabled, doesn’t need treatment, or his disability is caused by some other condition that is not covered by the policy.
We Filed an Appeal against Hartford’s Denial of Benefits
Since we represented him in the original injury against his company, we knew this man was legitimately injured and honest. And that he had a family to provide for.
Every appeal starts with analyzing the entire claim file the insurance company has (our request for an insurance company claims file in these cases lists approximately 30 different types of documents, media, and information) and the long-term disability insurance policy.
In this case, we attacked the peer review doctor’s opinion as incomplete (giving specific medical evidence that he had not considered in support) and we worked with this worker’s treating physicians so they expressed their opinions that he could not return to work in light of the definitions, terms, and conditions in the insurance policy (it is absolutely critical to educate the physicians on exactly how each policy defines disability).
We arranged for medical testing that his physicians could consider as support for their opinions, and which the peer review doctor had never seen or contemplated.
Naturally, our medical research professional analyzed the current state of the literature on our worker’s medical condition and the effects of the various medications he was prescribed for the problems his injury caused.
Plus we did a deep dive into the peer review doctor’s background – our extensive medical research process always includes opposition research on the insurance doctors.
We interviewed others with the same occupation to see what the real job duties were, rather than relying on a paper, corporate version of his job description – and they were quite different.
We drafted witness statements, including one from our worker describing his life, his job, his injury, his symptoms, and why he could no longer work at his heavy-duty job (a trade his father taught him as a boy – so you can imagine how powerful this was).
An Appeal of an Insurance Company Denying Long-Term Disability Benefits Has to Overwhelm the Insurance Company
Our standard appeals are 28 – 33 pages long and can contain hundreds of pages of exhibits and supplemental material.
Why do we focus on an appeal that combines medicine, law, the policy terms and conditions, new evidence and testing, witness statements, medical literature, etc.? These are difficult cases – the insurance policy always favors the insurance company – so we want to really show the disability insurance company that they were wrong, and support it every step of the way.
And if your appeal is denied under ERISA (the federal law that governs most long-term disability policies) the next step is to file a lawsuit in federal court, where a federal judge will decide whether the insurance company acted reasonably by denying your benefits, based upon the administrative record, including your appeal and evidence.
There are no chances to create evidence once you file your federal lawsuit under ERISA, which is why you need an experienced long-term disability attorney working for you early in the process.
Our case had a happy ending – the father of 4 was awarded all of his past due long-term disability benefits, about 16 months’ worth, plus ongoing monthly benefits.
Our Long-Term Disability Benefits Attorneys Can Help if You’ve Been Denied
Call us today at (202) 393 – 3320 to get started working with us. But don’t wait, under ERISA and most long-term disability benefit insurance policies, you only have 180 days to appeal – not a lot of time for the amount of work you need to do if you want to do it right.
If you received a letter denying or terminating benefits, we’ll analyze the insurance company’s position and make recommendations on your next steps for free with absolutely no obligation.
You can email the letter to us at clientexperience@dkllp.com or fax it to (202) 393 – 3324
Long-term disability claim for healthcare worker denied in DC.
I just got off of a zoom call with a nurse working at a hospital in DC. Nurses, and all healthcare workers really, have a heavy-duty, physical job. They have to lift and turn patients, move heavy medical equipment and respond to patient emergencies.
So it’s no surprise that many nurses have back and neck conditions caused by lifting and turning patients who are obese.
And these conditions often result in herniated discs in their back or neck, with pain, numbness, and tingling running down their arms or legs. When it gets really bad, they can’t work because they can’t lift or carry enough weight to perform proper patient care.
When you can’t work due to a medical condition you can apply for long-term disability benefits.
That’s exactly what this nurse did. She applied for short-term disability first because of her medical condition, and when that ran out, applied for long-term disability.
But proving you are entitled to long-term disability (and staying on long-term disability) can be difficult.
She received a bunch of forms from the hospital’s long-term disability insurance company, Hartford, and completed the forms and sent them in. Hartford wanted more information from her doctors and sent her additional forms on this.
Medically, there wasn’t much of a dispute that she couldn’t do the work, but there was a problem.
Her pain management specialist, providing her with ongoing, monthly appointments to address the pain and radiculopathy caused by her condition, would not complete the form. His office policy was to “not get involved in disability or legal claims.” The form was 1 page, with probably 7 or 8 things to fill out, that could have been copied from her medical chart.
In any disability or injury case, you really need to know how to talk to your doctor about your case – we do that for our clients, of course.
What can you do to help yourself get long-term disability benefits?
This nurse just needed some guidance to stand up to the insurance company now that she was in a long-term disability process that favors insurance companies (most cases are governed by a federal law ERISA that gives insurance companies discretion to determine eligibility for benefits – because of this, you really need an experienced long-term disability attorney to file a thorough appeal – ours are about 30 pages long plus another 50-70 pages of exhibits).
So we had her go to her primary care physician, a doctor she knew well, to review all of her medical information.
She also had a Functional Capacity Evaluation done – a physical test that measures how much you can lift, carry, walk, etc. – that indicated she had limitations on her physical activities, so the doctor could review that as well as a basis for her opinion that the nurse could not return to work.
The insurance company’s initial response was disappointing – it was clear this nurse couldn’t work and had the medical evidence to back it up – even if her pain specialist wouldn’t complete a simple form.
Get advice from a DC long-term disability lawyer
You shouldn’t have to go it alone – call us today at 202-393-3320 to get started on a plan so you can get the long-term disability benefits you need to be secure, in control, and independent.
And if you received a letter denying your long-term disability benefits, fax that letter to 202-393-3324 or email it to clientexperience@dkllp.com and we’ll contact you with a specific plan for your appeal.
Here’s What You Can Do If Your DC Workers’ Compensation Claim Is Denied By The Hartford Hartford Denied My Workers Compensation Case In DC
First, don’t panic. Hartford and other workers comp insurance companies in DC routinely deny legitimate claims for workers comp benefits after someone has been hurt at work. We see this all the time. You should receive a Notice of Controversion within 14 days of when your company knows about the injury. The Notice of Controversion Hartford files should give a reason why they are denying the claim.
There Are Several Reasons Why Your Claim Might Be Denied
Notice: A critical part of any DC workers comp case is making sure you notify your employer about your injury – you need to do that in writing, sometimes employers will have an incident or injury form, or tell your boss or supervisor that the injury happened at work. It’s not enough to tell a co-worker or just to say “my back is hurting.”
Not Enough Information: Sometimes that reason is they just don’t have enough information – maybe they haven’t gotten your medical records that relate the injury to your work and your doctor’s opinion that you cannot work. That’s another critical piece to get your case going. They are not going to go above and beyond to get the information they need. They will be looking for reasons to deny your claim, even if it is simply that they don’t have all of the information in their hands.
These issues can sometimes be resolved quickly if you get the adjuster the information they need or you get evidence of timely notice from your supervisor. But if you have a serious injury the adjuster will probably be working purposefully against you to deny your claim. If your injury is serious – you need surgery, or you’ll miss a lot of time from work – this is the time to get a DC workers comp lawyer who can help. Because once that Notice of Controversion is filed, they don’t have to pay your benefits if you can’t work or your medical treatment. At that point, it’s up to you to request a Formal Hearing so a judge can decide the case.
If You Need Serious Medical Treatment And Lost Wages, Let Our Experienced Workers Comp Lawyers Help!
Because of the way we work the case up for you, many times we can get the insurance company to start the benefits and provide the medical treatment well before the hearing – but you need that hearing in place. Do you need more info on what to do if Hartford is your worker’s comp insurance company?
Call us today at 202-393-3320 for a FREE copy of the only book on workers comp written for workers injured in the DMV (it’s the book the insurance company doesn’t want you to read) to learn what you have to do to make sure the insurance company doesn’t take advantage of you and your family after a serious injury at work. And talk to one of our staff members to see if we can help you right now.
