“Melissa Gardner V. Ameritech Sickness And Accident Disability Plan”
“Smith v. Hartford Life & Accident”
2013 U. S. Dist. LEXIS 13868 (N.D. Cal., January 30, 2013)
In Smith v. Hartford Life & Accident, we successfully represented Ms. Smith in a claim for life insurance waiver of premium benefits. Ms. Smith was a bank executive who became disabled by co-morbid conditions as a result of several surgeries on her hands and depression because she could no longer work. Initially, Hartford approved disability benefits and life insurance waiver of premium (“WOP”) benefits, but then it terminated both LTD and WOP benefits. After the termination of benefits by Hartford, Smith was awarded Social Security Disability benefits.
We appealed both denials simultaneously. The issue for the LTD appeal was whether Ms. Smith could perform her “own occupation;” the issue for the WOP appeal was whether she could perform “any occupation.” Hartford granted the LTD appeal but denied the WOP appeal. We then successfully sued to reinstate Ms. Smith’s waiver of premium benefit.
The Court ruled that Hartford abused its discretion by terminating Ms. Smith’s WOP benefit and by failing to grant her appeal of that termination, reasoning that Hartford had a conflict of interest, that Hartford failed to personally examine Ms. Smith, a failure particularly significant because part of her claim was psychological in nature. The Court also held that Hartford either did not provide its reviewing doctors with all the relevant evidence or its doctors failed to consider all of it, explaining that in the course of Ms. Smith’s worker’s compensation claim she was examined by a doctor yet that doctor’s report was not commented upon by Hartford’s doctors and that Hartford’s doctors also did not comment on the findings of the Social Security judge or the vocational evaluation Ms. Smith submitted as part of her appeal. The Court also reasoned that Hartford failed to address in a meaningful way Ms. Smith’s award of Social Security Disability benefits.