David C. Pellegrin
Judge of U.S. Court of Middle District of Louisiana Remands Long-term Disability Case to Insurance Company for Further Review
Published by The Pellegrin Firm September 15, 2020
In a recent case out of the U.S. District Court for the Middle District of Louisiana, Judge John W. deGravelles remanded a case to Hartford Life & Accident Insurance Company to reconsider its termination of a truck driver’s long-term disability benefits. Hartford paid two years of benefits, finding the plaintiff could not return to his old job considering the severity of his back condition. However, Hartford terminated benefits after two years, because the policy states that benefits are only payable after two years if the claimant cannot perform the substantial duties of any occupation. There was some evidence from the plaintiff’s treating physicians that he could go back to some kind of work. Also, Hartford’s consulting physicians found he could work.
Plaintiff exhausted administrative remedies. Then, with the help of counsel, he submitted additional information. Hartford refused to consider this additional information. Parsing unclear Fifth Circuit precedent, Judge deGravelles held that while the record contained plausible grounds for denial, Hartford should consider the additional information submitted after exhaustion of administrative remedies but before a lawsuit was filed. The court remanded the case to the Hartford for further consideration not inconsistent with its opinion. The case is Joseph v. Hartford Life & Accident Insurance Company, No. CV 19-17-JWD-RLB 2020 WL 3979665 (M.D. La. July 13, 2020).