The Dirty Little Secret that Hartford Doesn’t Want you to Know about Juan Mendez, Dr. Mark Burns and Dr. Michael Ratter

Long term disability carriers, like Hartford Life Insurance Company routinely see claims like fibromyalgia syndrome which cause persistent and debilitating pain. For example, in Klehforf vs. Hartford Life and Accident insurance Company, 201.WL.260066018 (N.D. Ind., June 22, 2010), Mr. Klehforf was employed as Vice President and Senior Fiduciary Officer at JP Morgan Chase from 1976 until September 2007. Unfortunately Mr. Klehforf, had suffered from fibromyalgia and was unable to continue to work at Chase.

Hartford review the medical evidence and concluded, mysteriously, that the “medical evidence didn’t support” the claim. This, of course is a common Hartford defense and one that you will see after they request an attending physicians statement despite how your voluminous medical records in your file.

Mr. Klehforf’s medical records, including those from Mayo Clinic, confirmed that he was suffering from debilitating pain and cognitive problems. The court held that a “strange credulity when Hartford states that it denied Klehforf’s LTD claim based on their own nurses conclusions that Klehforf’s was no longer disabled and the conclusions of Dr. Ratter, a board certified psychiatrist, and Dr. Burns, a board certified physician of internal medicine (neither who examined or treated Klehforf), that Klehforf was not suffering from any condition that would prevent him from resuming his full time employment.”

These two physicians, and Juan Mendez, an “employee in Hartford’s appeals unit” were all employed or retained by Hartford.

The court noted that Hartford’s appeal unit is supposed to be a “separate unit charged with the task of conducting a full, fair… de novo review of claims that have denied by the long term disability claim department on its initial review”.

What the court found “troubling” about the scenario is that Hartford “failed to adequately explained by ruling its medical evidence including an exclusive diagnosis by a physicians whose expertise Hartford does not challenge- suddenly lost all its apparent significance by the time that… Mendez and Dr. Ratter and Dr. Burns conducted their reviews and made their conclusions.”

The court also said that the “company failed to adequately explain the decision to ignore or not evaluate certain medical evidence when making the determination of whether to award benefits under ERISA plan is one basis for a court to find that the decision was arbitrary and capricious.”

It also “begged the question of whether Hartford was actively looking for a reason to deny Kleforf’s claim.”

The court held that there was a genuine issue of “material fact that the new result was only finally drawn when issues of credibility (i.e. the reasoning of those individuals involved in the denial of Kelforf’s claim for LTD benefits), can be assessed properly when the record can be fully developed beyond the state of the pending motions for summary judgment.”

Congratulations to the court and Mr. Kelforf’s attorney. Don’t let your fibromyalgia or Hartford Life claim fall into the black hole of long term disability claims denials. Contact Harford fibromyalgia long term disability attorney Nancy Cavey for assistance in your claim.