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Denied Claims Blog
Insurance Companies Don’t Always Win
April 30, 2012
A recent Minnesota court ruling demonstrates that long-term disability insurance companies cannot simply stop paying long-term disability benefits without a significant change in the worker’s condition. Laura Ripka won her case against Hartford Life and Accident Insurance Company, Civil No. 11-0004, US District Court of Minnesota.
Laura Ripka suffered from severe depression, which left her unable to function in a work setting. She was also diagnosed with Fibromyalgia and Chronic Fatigue Syndrome (CFS). Fibromyalgia causes widespread muscle and body pains, along with extreme tiredness, memory problems and mood difficulties. According to the Mayo Clinic, fibromyalgia“amplifies painful sensations by affecting the way your brain processes pain signals.” CFS creates fatigue symptoms similar to those in fibromyalgia. The fatigue often worsens if the patient increases her physical or mental activity, but resting does not help the problem.
Unfair Claims Denial
Initially, Hartford accepted Ripka’s disability claim, acknowledging the diagnosis and the disability. She began receiving payments in 1994 and was still unable to work six years later when Hartford notified her that benefits would be discontinued.
Hartford based its denial on October 2000 video surveillance depicting Ms. Ripka tossing brush from a pickup truck. Thedenial letter of April 2001 indicated benefits would stop April 2003. She appealed the denial and won, showing thecompany could not simply cut off benefits, when prior payments gave weight to the merits of her claim.
The insurance company presented several reports from different doctors, none of whom adequately addressed Ms. Ripka’s condition. A review from a physical therapist in a Functional Capacity Evaluation (FCE) even supported her case, showing she could not work in a full time capacity. Another review, done by a neuropsychologist, showed she had slowed movement and cognitive functioning. She would have a great deal of difficulty learning a new trade or working at her old one. None of these doctors addressed the patient’s Fibromyalgia or CFS in relation to her disability.
The Court’s Ruling
For this reason, the court relied on the medical records from Ripka’s treating doctors, showing her condition remained stable throughout her claim period. Without evidence to show improvement in her disability, Hartford acted unfairly in denying the claim. In his decision, Chief Judge Michael J. Davis noted, “Based on the record as a whole, the Court found that Hartford’s decision to terminate benefits was not supported by substantial evidence because Hartford was not presented with a significant change in information as to Plaintiff’s ability to return to any type of work.” This suit ended with a fair result for the disability claimant, but so many more do not.
If you were unfairly denied long-term disability benefits, contact our office for a free case evaluation. Our experienced attorneys will help you recover the benefits you deserve. Act quickly; the law limits the time available for filing a denial appeal.