A new case from the Fourth Circuit is timely in its theme as the U.S. Open, the modern version of one of the oldest tennis championships in the world, has recently been underway. In this recent case, the need for long-term disability claimants to maintain vigilance regarding their claims was underscored. Just as in the game of tennis, you can never take your eyes off the court. In ERISA and long-term disability claims, no claimant should rest easy and believe they shouldn't worry about another claim termination. See, Griffin v. Hartford, 2018 WL 362-4872 (4th Cir. 2018).
One game insurers play is called the game, set, match. The goal is to lure the claimant into a false sense of security, develop inconsistencies or problems with the claim unbeknownst to the claimant, and then terminate the claim. And, this game worked well in the recent Griffin case.
Facts of the Case
- Mr. Griffin worked as a medical transcriptionist until he had to stop due to pain in his arms and wrists that moved into his neck and right shoulder.
- Hartford paid his long-term disability benefits, and then continued to pay those benefits for over two years.
- Griffin developed a herniated disc and underwent surgery. Despite all of these problems, he, no doubt, that he was fairly secure in his claim, and unfortunately, he began to let things slide.
- He failed to go to his doctors regularly given the fact that his conditions appeared to be permanent. I am sure that he thought that as long as he was reasonable, Hartford would continue to pay his claim.
- Hartford, however, was busy game-planning.
Game, Set, Match.
Insurance companies like Hartford never give up on finding a reason to deny claims. Around the two-year mark, Hartford activates its game, set, match plan. They do this after two years, knowing that they will appear more reasonable to a court if they pay benefits two years before they are terminated.
- Game. Hartford hired an investigator to take some video surveillance of Mr. Griffin. The video showed Mr. Griffin walking at a quick pace and without any observable bracing or support.
- Set. Then, without informing Mr. Griffin of the video, it scheduled an in-house interview in order for the investigator to try to develop some inconsistencies or find out some juicy facts during the interview. Mr. Griffin, unaware of the set-up, volunteered much helpful information. (Of course, the surroundings of your home always yield even more information.)
- Match. The investigator did not develop any solid inconsistency from the video, as often occurs, but did learn that Griffin had not been treated by any doctor for over six months and that it had been longer for some of his other doctors. With this very helpful interview in hand, Hartford began contacting treating doctors, but since none of them had recently seen Mr. Griffin, none wanted to provide a current opinion on his restrictions and limitations. In fact, his chiropractor didn't think he had any more restrictions.
That is all Hartford needed. Game, Set, Match.
Mr. Griffin lost his benefit. He took his case to court but lost, as the court believed there was evidence that his conditions had improved. Of course, in court it was too late for Griffin to submit evidence that he still had restrictions that met the definition of disability. Mr. Griffin was stuck with the medical record as it existed before.
Long-term disability benefit claim decisions are decisions that are made month-to-month, so a claim could be terminated again at any point in time. In other words, if someone meets the plan definition of disability at age 50, and the plan is supposed to pay benefits until age 67, that person could have their claim terminated more than 17 times before reaching age 67! Don't think this won't happen! Insurance companies like Hartford are pros at game, set, match.