by Steve Fields | July 27th, 2022
June 21, 2022 – U.S. Court of Appeals – 2nd Circuit – Unpublished Opinion
Wallace was paid the first 24 months of benefits under her Long Term Disability policy. She sought additional benefits based on fibromyalgia, undifferentiated connective tissue disorder and obsessive-compulsive disorder (OCD). Hartford denied her claim for additional benefits beyond the initial 24-months. Wallace filed suit, and the claim was remanded to Hartford to determine if she was entitled to be benefits for her obsessive-compulsive disorder. Hartford reviewed the claim for OCD and for physical conditions and denied the claim. Wallace filed suit, arguing she was not afforded a full and fair review and that Hartford abused its discretion in denying the claim.
The Court found that Hartford’s hired doctor was not required to opine on every document in the record, and that their failure to address an Independent Medical Examination report from Wallace was not error. The appeals specialist for Hartford relied on four separate medical opinions to deny Wallace’s claim. Hartford retained full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the benefits policy. The Court determined that Hartford’s decision was based on substantial evidence, even though Wallace disagreed.
Many policies contain language that grants the insurance company the discretion and authority to make decisions on your claim. This can result in a heightened burden on the claimant to prove their case, and it creates an unfair advantage in favor of the insurance company reviewing and ultimately denying your claim for Long Term Disability benefits. Our attorneys routinely work against this unfair standard of review and know how to give you the best chance to overcome this unlevel playing field. The sooner we come on board to help with your claim, the more helpful we can be.
