In the recent case of Alexander vs. Hartford Life: An Accident Insurance Company, the United States Court Appeals for the 5th Circuit, dealt with Hartford policy that provided that a person was “disabled” if “he or she is prevented from performing one or more the Essential Duties of Your Occupation.” The Hartford policy “your occupation” as “your occupation as is recognized in the general workplace, bracket, not the specific job that you are performing for a specific employer at the specific location.” The policy also defined “Essential Duty” as a duty that is “substantial, not incidental… not supplemental or inherent to the occupation, and… cannot be easily omitted or changed. To be at work for the number of hours in your regularly scheduled work week is also an essential duty.”
Ms. Alexander was a transplant coordinator who was seeking Long Term Disability benefits. Whether she was disabled and entitled to these benefits depended on whether she was capable of filling the essential duties of her job on a full time basis.
In denying the claim, the carrier relied on a functional capacity evaluation (FCE) that concluded that she could lift 17 pounds occasionally and 9 pounds frequently. Lifts over five times per day would place her at significant medical risk. The FCE concluded that she was unable to return to work.
Hartford denied Ms. Alexander’s claim relying on the report of a Dr. Elizabeth Raof, a peer review provider. In the final denial letter states that Dr. Raof had reviewed the functional capacity evaluation that indicated that Ms. Alexander could function in a light capacity. The court held that this statement in the letter was factually incorrect because Dr. Raof’s report didn’t even mention the results of the FCE and in fact the FCE indicated that she was unable to work.
The court concluded that Hartford abused its discretion in denying this claim because there was no rational connection “between the information that Hartford relied and the conclusion it reached.”
One of the key issues in evaluating Long Term Disability claims is the definition of disability. Before you file your claim for Long Term Disability benefits, consult with a Florida Long Term Disability lawyer like Nancy Cavey who can help you understand what the definition of “disability”, “essential job duties” and “your occupation” means before you make a mistake in your disability claim.Google+