Employees in Chicago whose claims for long-term disability benefits have been denied often ask a common question. They ask how the insurer can disagree with all their doctors attesting to their disability, and whether that decision can be upheld. The extent to which the insurer can disagree with your doctors is largely influenced by the standard of review. For a good discussion of what the deferential standard of review means, see our prior blog post here. A recent case demonstrates how in deferential review, the insurer can disagree with your doctors, but its reasoning will be important.
In O’Connell v. Hartford Life & Accident Insurance Co., No. 21-CV-10587, 2023 WL 2633789 (D. Mass. Mar. 24, 2023), O’Connell worked as in-house counsel for a large accounting firm before claiming disability due to generalized anxiety disorder. Shea applied for and received both short-term disability and long-term disability benefits. Hartford terminated her long-term disability benefits in 2019 after its reviewing psychiatrist concluded the evidence did not support psychiatric functional impairment any longer. After O’Connell unsuccessfully appealed, she sued under ERISA § 502(a).
The United States District Court for the District of Massachusetts ruled in O’Connell’s favor, but remanded the case back to Hartford. The Court explained Hartford’s reviewing doctors did not meaningfully engage with the medical records or opinions of O’Connell’s treating doctors. Hartford therefore insufficiently explained why it credited the opinions of its reviewing doctor and dismissed the opinions of the treating physicians. The court explained Hartford’s medical reviewer’s engagement with the treating doctors’ submissions was “somewhat superficial.” The court also explained it was not outright wrong to disagree with treating physicians, but in this case Hartford did not meaningfully explain why it did so, triggering the court to remand the matter rather than award benefits.
If your claim for long-term disability benefits has been denied based on the insurer disagreeing with your treating doctors, get help from a knowledgeable ERISA long-term disability lawyer immediately.