still waiting

[Janice8888]

State: Nebraska

On March 29, 2002, my LTD payments were suddenly terminated by The Hartford. I sought legal advice, (as you suggested when I wrote in April), and my appeal letter, along with attachments, was received by them on July 15.

The Contract which they quote from over and over states that "A decision will be made by The Hartford no more than 60 days after the recipt of the request, except in special circumstance (such as the need to hold a hearing), but in no case more than 120 days after the request for review is received." I understand that my appeal letter and attachments were deemed "special circumstance", and I was told that I would know their decision by November 12, 2002.

On October 29, 2002, The Hartford finally sent me to an Independent Physician for an "independent" examination and as of November 13, The Hartford had not received the physician's report. It has now been 129 days since receipt of my letter. Do you know what "rights" I have? Or is it simply "their contract" and they can manipulate it as they choose, do you think? I want to believe that it is their failing in that they were so late in finally sending me for an IPE. What should/can I do now?

Thank you!

 

[CIAA]

Janice,

Your attorney should be answering these things for you. It certainly seems that an argument can be made that since the IME was necessary you should be paid up to the date of the IME, regardless. However, if your condition has been stationary and stable and the IME is not in you favor, the insurance company may want to take the position that the original denial was warranted.

If the IME was in your favor you should receive benefits. If not, you will have to refute and rebutt the independent physicians' opinion, which could get expensive.

 

[Janice8888]

CIAA,
Thank you for your quick reply!

Hartford has not received the IME report although my IME visit was October 29th, and they are not concerned that the 120 day deadline has passed.

Please expand on your comment that "since the IME was necessary you should be paid up to the date of the IME, regardless".

Thank you,
Janice

 

[CIAA]

Janice,

Our point was simply that if the insurance company felt that an IME was needed in order to terminate benefits, then benefits should not be terminated prior to obtaining on.