Court Finds Hartford Improperly Denied Plaintiff’s LTD Claim After Dismissing Both Objective Medical Evidence And Plaintiff’s Credible Subjective Symptoms

In E.L. v. Hartford Life and Accident Insurance Company, No. 22-CV-00050-PCP, 2024 WL 1336463 (N.D. Cal. Mar. 27, 2024), California Northern District Judge P. Casey Pitts granted Plaintiff’s Motion for Judgment in part finding that Plaintiff demonstrated total disability from her own occupation. The Court denied Plaintiff’s request to submit extrinsic evidence from her Social Security disability claim, finding that the circumstances did not clearly establish that additional evidence was necessary to conduct an adequate de novo review.

Plaintiff was a resident of Campbell, California and employed by Boston Scientific Corporation as a Capital Equipment Manufacturing Technician, a light duty occupation. Plaintiff applied for and received short term disability (STD) benefits from Hartford from February 17, 2020 through August 16, 2020, and thereafter sought long term disability (LTD) benefits due to, among other conditions, cervical disc herniation with myelopathy, pituitary macroadenoma and acromegaly, Sjogren’s syndrome, and major depression and anxiety — with symptoms of pain, weakness, dizziness and falls, and headaches. After initial review, Hartford denied Plaintiff’s LTD claim finding that the available information was insufficient to find her disabled from performing her own occupation and invited Plaintiff to submit additional evidence. Plaintiff submitted further clinical records, which Hartford again criticized for lack of measurable examination findings at a time during the Covid-19 pandemic when treatment was limited to tele-medicine visits. Harford also improperly evaluated Plaintiff’s occupation as “sedentary” and primarily consisting of “desk work” to again conclude that the evidence did not support disability.

Plaintiff appealed, submitting updated materials as well as a personal statement describing her experience with uncontrollable symptoms of dizziness and falls, significant neck and lower back pain, enlarged hands, feet, bones, and heart due to improper growth hormone levels, and shortness of breath. Hartford upheld its decision on appeal after its physician, Dr. Mostafa Farache (Neurology & Psychiatry), after reviewing the file materials concluded there was insufficient objective evidence to validate Plaintiff’s complaints of dizziness/imbalance, weakness, and paresthesia, and that her headaches were not of a severity to substantiate work preclusion. Plaintiff submitted additional physical therapy and progress notes, as well as a lumbar MRI report and progress notes from multiple specialists. In two addendum reports, Dr. Farache again concluded (1) there was no medical evidence to correlate with Plaintiff’s complaints, (2) Plaintiff’s reported complaints were not consistent, and (3) her neurological exams were unremarkable except for findings related to malingering, conversion disorder, and psychogenic complaints.

Under a de novo review, the Court found that Plaintiff met her burden of demonstrating that she was unable to perform the essential duties of her own occupation and was entitled to LTD benefits. The Court concluded that the weight of the medical evidence from providers who examined and treated Plaintiff over time demonstrated that she suffered from a complex but consistent array of physical and psychological symptoms that continued to prevent her from performing her non-sedentary occupation after August 16, 2020. The Court outlined that while Plaintiff’s treating providers had been unable to identify any neurological etiology for her symptoms, the evidence demonstrated persistent neck and back pain, dizziness, headaches, weakness, burning in and enlargement of her hands and feet, anxiety, depression, and related somatic symptoms likely caused by a combination of cervical disc herniation, myelopathy, and degenerative disc disease with clinically supported MRI evidence, pituitary macroadenoma causing acromegaly and acromegaly with residual disease after the removal of a tumor, and clinically indicated ongoing elevated levels of IGF-1 hormones even months after surgery. The Court further noted that Plaintiff also suffered from Major Depressive Disorder, Generalized Anxiety Disorder, and Conversion Disorder, and that the combined effect of all of Plaintiff’s symptoms created a functional impairment that prevented her from fulfilling the essential duties of her occupation.

The Court also found that Hartford’s arguments to the contrary were unavailing. The Court did not agree that Plaintiff’s claim relied solely on subjective evidence, noting that the medical file contained objective observations, assessments by treating professionals, and several MRIs. Further, while there was evidence that Plaintiff was not totally impaired in every area of her life, the Court found that this fact did not prove Plaintiff was not credible or negate otherwise compelling medical evidence. Finally, the Court found that Hartford’s errors in administering Plaintiff’s claim were substantive and not procedural, and as such, concluded that Plaintiff was provided with a “full and fair review” within the meaning of ERISA.

If Hartford or your insurer has denied your disability insurance claim, contact us for assistance.