Hartford Disability Claim Tips for Dentists
Our law firm has extensive experience filing and litigating Hartford disability claims for dentists. Our attorneys understand how Hartford operates and what it takes to file a successful Hartford disability claim, and are happy to set up a free consultation to discuss your particular Hartford claim.
Below are some answers to the most common questions our attorneys receive from dentists about the disability claim process, generally, and their Hartford disability benefits, specifically.
Table of Contents
1. Do Hartford disability policies for dentists have “true” own occupation disability definitions?
4. What should I expect as a dentist filing a disability claim with Hartford?
7. Can Hartford make me undergo an IME?
8. Will Hartford recognize if I have multiple disabling conditions?
9. Do I need to hire a Hartford disability attorney to file my claim?
10. When should I contact an attorney about my dentist disability claim?
___________________________
1. Do Hartford disability policies for dentists have “true” own occupation disability definitions?
Hartford’s disability definitions can vary depending on the year the policy was issued and the coverage selected by your employer, if you have an employer-sponsored plan.
Many employer-plans define disability as “any occupation” rather than “own occupation,” or change from “own occupation” to “any occupation” after a certain number of months/years (e.g. 24 months/2 years). However, there are Hartford polices that offer own occupation coverage.
In comparison to other disability own occupation policies, which often require the inability to perform all of your material duties in order to be totally disabled, some Hartford policies contain more favorable language that defines total disability as being “prevented from performing one or more of the Essential Duties” of your occupation (emphasis added).
That being said, if you have an employer-plan, this definition may be combined with other requirements for establishing disability that are common in employer-plans, such as demonstrating that you cannot earn 80% (or more) of your pre-disability earnings.
2. I am a dentist with a Hartford disability policy. How do I start a disability claim with Hartford?
In order to file a Hartford disability claim, you must submit the proof of loss required under your Hartford policy. Most Hartford policies require this proof to be submitted in writing and within a certain time frame—typically within 20 or 30 days from the date of loss.
Hartford allows claims to be initiated online, via Hartford’s website, or by calling in to request that the initial proof of loss packet be sent to you.
If you call in, our attorneys have observed that Hartford may subject you to an impromptu interview, so you should be prepared to answer important questions impacting your claim the very first time you are on the line with them.
If you are planning on having an attorney represent you on your disability claim, it is better to consult with counsel prior to making this initial call, so that you are not subjected to questioning before securing legal representation.
If you apply online, it is important to answer each question carefully and keep a record of what you submit. The initial proof of loss forms set the foundation for your claim, and you should not finalize or submit them unless you understand the ramifications of the type of claim you are making (partial v. total, etc.) and the date of disability you have selected (which can determine eligibility for benefits, and if you are even covered at all under an employer-plan).
3. How does Hartford approach dentist disability claims? When does Hartford’s disability claim investigation begin?
Hartford will begin investigating your disability claim the moment you make them aware of your intent to file a claim (which is typically in the initial call to request the proof of loss packet, or when you submit a claim online).
Hartford’s policy provisions, many of which can seem innocuous, actually can be used to limit, deny or terminate a claim. If you are planning on calling Hartford to request a claim packet without an attorney, you could be asked questions on a recorded line that can forever affect your ability to collect disability benefits. Some questions may include:
-
- What are your symptoms, and when did they start?
- Describe all treatments/medications you’ve tried?
- How many doctors have you seen? What is their contact information?
- What are your job duties, including your duties as a practice owner, and what percentage of time do you spend on each duty?
- How much time have you taken off work? When do you plan on going back? Can you go back to work part-time or with accommodations?
- What does a typical day look like for you?
- Once you stop practicing, are you going to work somewhere else?
- When did you last work, and why did you decide to file your claim now?
- What is your income? Have you had a loss in income? Are you filing a total or partial disability claim?
Additionally, it is not uncommon for Hartford to conduct surveillance (both online, and in some cases, in-person), particularly in high-dollar dentist claims. Hartford will, naturally, not inform you if/when this is taking place, and it can begin as soon as Hartford is aware of your intent to file a disability claim.
4. What should I expect as a dentist filing a disability claim with Hartford?
After the initial proof of loss packet is submitted, Hartford assigns dentists’ disability claims to a benefit specialist (often a senior analyst), and he or she will send you a list of the additional information needed to evaluate your occupational duties and claim.
Ongoing Proof of Loss. As the claim progresses, Hartford will require ongoing proof of loss and additional paperwork to be completed by you and your doctor(s). The paperwork will include questions relevant to various policy provisions that may limit your coverage, so it is advisable to be represented by an attorney.
Records Requests. After you submit the initial claim documents, Hartford will likely send a follow-up letter requesting additional records and documents. For dentists, this usually includes financial documents (such as tax returns), CDT codes, profit and loss statements, employment agreements, and practice sale documents, among other things. Whether these requests are appropriate depends on the terms of your policy and nature of your claim, and should be reviewed by an attorney.
Interviews. In addition to periodic phone interviews, Hartford may hire a field examiner to interview you in-person. This interview typically takes place at your attorney’s office, or at your home or office if you are not represented by an attorney, and interviewers/investigators may arrive unannounced if you are not represented. Hartford may also seek to interview your co-workers and/or employers about your prior job duties, and may seek to interview your friends or family members about the impact your condition has had on your day-to-day life. Whether these types of interviews are appropriate depends on various factors, including the particular issues at play in your claim.
Disability Examinations. Almost every disability policy contains a provision that allows the company to have you examined as part of the claims investigation. However, different policies allow for different types of examinations. Older policies typically only expressly allow for “physical” examinations, while newer policies are typically much more detailed and list several different types of exams, including mental exams, vocational evaluations, rehabilitation evaluations, functional capacity evaluations, and/or neuropsychological testing, in addition to physical exams. Employer plans are typically updated periodically, so most Hartford policies will likely contain more extensive examination language. Whether an exam is appropriate depends on the particular facts of your case, and the underlying policy language.
Disability-Related Surveillance. Hartford is a company that conducts surveillance, including online and in-person surveillance. Hartford generally begins by reviewing your online presence/social media and then moves on to in-person surveillance if they feel that is warranted. If you have a partial disability claim with Hartford or keep a passive interest in your practice, Hartford will periodically review your practice’s website and social media to assess whether any posts suggest that your activity levels at the practice vary from what has been reported to Hartford.
Peer to Peer Calls. When you file your disability claim, Hartford will typically assign dentists’ disability claims to an in-house doctor and pay that doctor to review your medical records and look for any gaps or inconsistencies. Often, Hartford will then direct their doctor to call your treating doctors in what is called a “peer to peer” call. Hartford may tell you this is going to happen, but in most cases, this takes place behind the scenes without your knowledge. In these calls, Hartford’s doctors ask questions that are crafted to elicit responses that the company can use to deny or terminate your claim. The best way to prevent this from happening is to have all correspondence with your medical providers be in writing and go through a disability attorney.
This process can feel very invasive and, if you have never experienced it before, it can be hard to tell whether your insurer is taking things too far. If you are unsure whether Hartford is acting appropriately, an experienced disability insurance attorney can help you to assess/limit the scope of any overly broad or improper investigation.
5. I heard that Hartford hires private investigators to conduct in-person surveillance on dentist claims. Is that true and, if so, what should I watch out for?
There is substantial money on the line for insurers, particularly in high-dollar dentist disability claims, and disability insurance companies do not spare expense when investigating and evaluating dentist disability claims. It is not uncommon for insurance companies, including Hartford, to engage in surveillance, even after paying a claim for an extended period of time.
Insurers use surveillance in order to see if dentists are engaging in any activities that they perceive are inconsistent with the claimed disabling condition(s). It often begins with reviewing the dentist’s online presence, particularly social media accounts and postings (individual, family, and dental practice accounts). However, it can also include in-person surveillance by private investigators hired to film the policyholder over a period of several days.
All too often, this surveillance is taken out of context and used to manufacture “evidence” that is used to deny or terminate claims.
Several examples involving Hartford were the focus of a Good Morning America report that received a lot of attention in the disability industry. One highlighted example involved a claimant who filed a disability claim after breaking his neck in an accident. After years of being paid, Hartford terminated his claim after its investigators videotaped him getting into a van, reading a magazine, and going to a restaurant and dipping a taco chip into salsa. Hartford argued that this showed a capacity to work in a sedentary job and that he could go back to work, despite his pain levels, and despite the fact that “dipping a chip” is not a particularly strenuous physical activity.
In another highlighted example, a claimant with a severe back injury had his benefits terminated by Hartford after Hartford obtained video of him going to a doctor’s appointment and walking his dog. Yet another claimant with degenerative disc disease had his claim terminated after Hartford obtained video surveillance of him lifting his 2-year-old granddaughter.[1]
Hartford disability insurance court cases also reflect that Hartford uses surveillance as a tactic to deny claims. For example, Franklin v. Hartford Life Ins. Co.[2] Dr. Franklin, an osteopathic family practice physician, suffered from osteoarthritis and a herniated lumbar disc. His long-term disability insurance claim was initially approved, but later terminated after Hartford obtained video surveillance.
Specifically, the surveillance tape showed Dr. Franklin driving to take care of various errands, attending a gospel and country music graduation concert, and walking into and out of a local Christian high school where he was teaching a class, while carrying books and a “large cup.”
Hartford sent the surveillance video to Dr. Franklin’s treating doctor and asked for comment. Dr. Franklin’s treating doctor responded that the activities on the surveillance video did not compare to the “extensive demands of practicing primary care medicine 8-12 hours a day 5-7 days a week.” Dr. Franklin’s treating doctor also advised that he should not be around sick patients because he was on immunosuppressant drugs for his conditions.
In addition, Dr. Franklin also explained to Hartford that he had taken extra pain medication before attending the over three-hour graduation concert, but he had been unable to stay for the reception, and that he had needed a sleeping pill after the concert. Further, he explained that the class he taught at the high school was only an hour long, and the start time had been changed to accommodate his morning soreness and stiffness.
Despite these logical explanations, Hartford refused to reinstate benefits. Ultimately, the Court determined that the surveillance video was a “mere snapshot,” was “in fact, consistent with Plaintiff’s explanation of his limitations” and “offer[ed] no proof that he is capable of work as a family practice physician.” However, the above examples show just how far Hartford has gone to take video surveillance out of context in order to claim an insured can return to work—no matter how brief and unrelated a captured activity may be.
[1] See The Insurer Who Spied on Me: Disabled Man Sues Claiming The Hartford Unfairly Cut Off Benefits, Chris Cuomo and Gerry Wagschal, ABC News (April 7, 2010), https://abcnews.go.com/GMA/TheLaw/claims-disabled-people-hartford-stopped-insurance-benefits-surveillance/story?id=10301625.
[2] Franklin v. Hartford Life Ins. Co., No. 8:07-cv-1400-T-23MAP (M.D. Fla. Nov. 25, 2008).
6. How and when should I approach my treating doctor about my disability claim? Will my treating doctor understand the demands of dentistry/how dentist disability claims work?
Your treating physician’s support can often be critical to getting your claim approved. A hurried, uninterested physician may not have time to devote to your claim, and Hartford is a company that typically requires a significant amount of medical documentation before approving a disability claim. You will need to find a treating doctor who is willing to take the time to understand how your policy works, complete claim paperwork, and potentially answer follow-up questions from Hartford’s in-house doctors.
When the time comes to speak to your treating physician about your claim, it is also important that your doctor understands the definition of “disability” under your insurance policy—particularly if you have a “true own occupation” claim where disability is defined as the inability to practice dentistry (even if you can work in another capacity). Otherwise, if you start a new job, your doctor may assume you are no longer pursuing the disability claim and answer that you can resume working, even if your new job is unrelated to clinical dentistry.
In our experience, Hartford’s consulting physicians are reluctant to provide your treating doctor with information regarding your job duties and important policy provisions before commencing an interview. If you are represented by at attorney, measures may be taken to ensure that interviews are scheduled through counsel and are even-handed.
7. Can Hartford make me undergo an IME?
Many insurance policies, including those issued by Hartford, contain provisions that allow the insurer to undergo an Independent Medical Examination (IME), usually at the company’s expense and with a provider of their choosing. Sometimes these provisions will even explicitly state that the exam must be in-person.
But are these doctors really independent? Will they conduct a fair evaluation?
Unfortunately, the answer is not always yes. In fact, in some instances, IMEs are used to simply provide fodder for the insurance company to question your own doctor’s treatment and challenge a disability.
The case of Hughes v. Hartford[1], illustrates how IMEs can be used to deny or terminate claims. Patricia Hughes was a registered nurse who was diagnosed with Meniere’s disease after beginning to experience vertigo. Her claim with Hartford was initially approved. However, as the claim went on, Hartford used a variety of aggressive but common methods to investigate, and then terminate her claim, including interviewing her provider without her knowledge, conducting a field interview, hiring an in-house doctor to review her medical file, and conducting covert surveillance.
When Nurse Hughes challenged the denial, Hartford required an IME. The IME doctor selected by Hartford, Dr. Schiff, concluded after the examination that Ms. Hughes’s test results were normal and that her vestibular dysfunction was inconsistent with the surveillance footage that Hartford had previously taken, and Hartford upheld the denial.
In the ensuing court case, the nurse who accompanied Nurse Hughes to her examination noted that the examination was “very elementary,” “limited,” and “rushed.” Nurse Hughes’s primary treating provider also pointed out that Dr. Schiff did not even perform any of the tests that had been historically abnormal, such as a video ENG, posturography or audiogram, and further observed that Dr. Schiff was not even trained in vestibular disorders.
The Court ultimately determined that Hartford had not conducted a “full and fair review” and required that Hartford reconsider the claim denial. However, this case illustrates how IMEs may be structured in a way to look for evidence to deny claims—to the point of ignoring evidence (or even foregoing tests) that would support a treating provider’s diagnosis.
[1] Patricia Hughes v. Hartford Life and Accident Insurance Co., No. 3:17-cv-1561 (JAM) (D. Conn. March 25, 2019).
8. Will Hartford recognize if I have multiple disabling conditions?
It is not uncommon for an insured to have multiple conditions that contribute to no longer being able to work and needing to file a disability insurance claim. This can be especially true of musculoskeletal conditions, common among dentists. But will Hartford take into account all disabling conditions when considering whether an insured is eligible for disability benefits?
In Sorensen v. Hartford[1], Ms. Sorensen had a variety of diagnoses including chronic fatigue syndrome, fibromyalgia, chronic pain and dysphasia, cervical and lumbar degenerative disc disease, Hashimoto’s thyroiditis, prediabetes, irritable bowel syndrome, rheumatoid arthritis, depression, and anxiety (among others).
In spite of these conditions, documented by her treating providers (many of whom provided information supporting the claim directly to Hartford via interviews and attending physician statements), Hartford determined that Ms. Sorensen only met the definition of disability for mental illness and limited her benefits to a period of 24 months under the policy’s mental illness limitation. Hartford further concluded that any restrictions and limitations of her other medical conditions would not prevent her from working.
Upon review, the Court observed that several of the health conditions, including fibromyalgia, weren’t “susceptible to objective verification” and criticized Hartford for not conducting an in-person medical examination. The Court also found that the reviewing doctor selected by Hartford had never been given the Social Security Administration’s decision that granted Ms. Sorensen benefits. The Court also determined that Hartford’s reviewing doctor improperly cherry-picked from the medical records—looking at only a handful of visits to undercut the claim, rather than considering Ms. Sorensen’s extensive medical record in its entirety.
While it might seem that a claim would be easier with multiple conditions, this is not always the case. This is especially true if some of the medical conditions in play are mental or nervous conditions, or if they are not easily objectively verifiable.
[1] Sorensen v. Hartford Ins. Co., No. 4:21-cv-00286 (D. Idaho June 14, 2022).
9. Do I need to hire a Hartford disability attorney to file my claim?
While there are certainly claims that may not require attorney involvement—for example, a disability claim due to the loss of a limb or something very serious, such as paralysis—in our experience dentist claims are not that straightforward.
Many of our clients have more nuanced conditions, such as slowly progressive musculoskeletal conditions due to degenerative disc disease. Others have conditions like a tremor, that may not prevent them from working in other jobs, but have a significant impact on their ability to work as a dentist. Others have mental health conditions (anxiety disorder, panic attacks, PTSD) that cannot be verified by a single, definitive objective test.
Obviously, if your claim is denied or you have a dispute over policy interpretation, you may need an attorney to become involved to resolve the matter. That being said, lawsuits with insurance companies are often costly, stressful, and, in some instances, can drag out over several years, all to the insurance company’s advantage. Even if you prevail, it can be an exhausting process, and companies typically appeal, which can take at least another year or more, all the while you are not getting paid benefits.
In our view, it is more prudent to approach your claim carefully from the outset and have your attorney address any concerns that Hartford may have over the course of the investigation itself, so that you are not placed in a position where benefits have been cut off, you are not working and your only option is a lawsuit.
In our experience, the most common areas where complexities can arise in dentists’ disability claims include:
-
- The timing of the claim (particularly in situations where a disabling condition is slowly progressive);
- Claims made by dentists who own their practice and need to decide whether to sell, bring on new associates, or keep working in a limited capacity;
- Claims where the underlying condition is difficult to diagnose or is diagnosed by exclusion;
- Claims involving multiple co-morbid conditions;
- Claims involving recommendations for or against surgery; and
- Claims involving mental health conditions.
10. When should I contact an attorney about my dentist disability claim?
Dentists who are considering filing a claim for disability insurance benefits should meet with a disability attorney well-before submitting a claim.
Each disability policy has different, complex language that insurance companies may manipulate to circumscribe and restrict coverage. Before filing, dentists should make a coordinated effort, with an attorney’s assistance, to determine whether their particular claim is covered, and if so, how that claim is best presented to ensure payment.
The information provided above is offered purely for informational purposes. It is not intended to create or promote an attorney-client relationship, and does not constitute and should not be relied upon as legal advice.
Every claim is unique and the discussion above is only a limited summary of information that may be relevant to your claim. If you are concerned that Hartford is not handling your claim fairly, an experienced disability insurance attorney can help you assess the situation and determine what options are available to you.
Notable Hartford Disability Insurance Cases
Johnson v. Hartford, No. 22-CV-06394 (PMH), (S.D.N.Y. Mar. 12, 2024).
Popper v. Hartford Fin. Services Group, Inc., No. 7:22-CV-148-D (E.D.N.C. April 18, 2023).
Glover v. Hartford Life and Accident Ins. Co., No. 20-cv-358-LM (D.N.H. July 28, 2022).
Sorensen v. Hartford Ins. Co., No. 4:21-cv-00286 (D. Idaho June 14, 2022).
Franklin v. Hartford Life Ins. Co., No. 8:07-cv-1400-T-23MAP (M.D. Fla. Nov. 25, 2008).
Post v. Hartford Ins. Co., No. CIV.A. 04-3230 (E.D. Pa. Oct. 2, 2008).
Flowers v. Hartford Life and Accident Ins. Co., No. 1:21-CV-05388-MKV (S.D.N.Y. Aug. 31, 2023).
Hartford Disability Insurance Blog Posts
Insurance Company Tactics: IMEs, Rushed Exams and Piecemeal Testing
The Insurer Who Spied on Me – ABC News Investigation
The Hartford Purchases Aetna’s Life and Disability Insurance Business for $1.45 Billion
