We often hear stories about individuals collecting insurance benefits due to an injury and then being seen on surveillance video engaging in activity contrary to that alleged injuries. However, we rarely hear about the common insurance company tactic of using worthless surveillance video to deny claims and/or scare claimants into abandoning their claims.
Jack "Rocky" Whitten enjoyed a successful career as a store manager at WalMart for almost a decade. He took great pride in his work and his ability to provide for his wife and two sons. Thus, when Rocky was offered disability insurance, he began making premium payments out of his bi-weekly paychecks. Unfortunately, ten years after taking out the insurance, Rocky Whitten suffered a severe injury and nearly severed his spinal cord. After undergoing emergency surgery, Rocky was determined to get back to work. His physicians warned that he had to be careful and limit his activities while his injuries healed. Unfortunately, Rocky suffered a second fall and reinjured his back. Rocky was left in constant pain in his neck, shoulders, arms, back, and down his legs. He has bilateral carpal tunnel syndrome, constant headaches, limitations in bending or turning his neck, and cannot sit, stand, or walk for prolonged periods of time. Due to the severity of his condition, his physicians recommended that he not return to work and determined that he was disabled. Unable to work, Rocky applied for disability insurance benefits with the Hartford Insurance Company. After an exhaustive investigation, Hartford approved his claim.
Unfortunately, the security he received from Hartford's initial approval did not last. Hartford denied continued benefits, asserting that Rocky's physicians indicated that he could work full-time in another occupation. Rocky's physicians responded by pointing out that their statements were taken out of context and his condition only worsened. After requiring another emergency surgery, Hartford reinstated benefits. Next the Hartford required Rocky to apply for Social Security Disability Benefits and even hired an attorney to assist him. The Social Security Administration determined that Rocky was unable to maintain employment in any occupation and Hartford reduced Rocky's benefit by the amount of his Social Security benefits. Despite this, the Hartford subsequently denied Rocky continued benefits claiming that his physicians again opined that he could work in another occupation. His physicians once again explained that they felt that Rocky was unable to work full-time in any occupation due to his pain and Rocky's benefits were reinstated.
The Hartford then performed an "annual" review of Rocky's claim and determined that he remained disabled under the terms of his policy, was not a good candidate for rehabilitation, and would not likely accept a settlement of his claim. Directly following this assessment, the Hartford decided to place Rocky under surveillance, without explanation. Over the course of two months, Hartford obtained limited video of Mr. Whitten on four days. On those four days, spread over two months, Rocky was seen standing outside his home for a couple of minutes, making a short trip to a restaurant where he ate chips and salsa; being driven by his wife to a doctor's appointment, sitting down while his wife pumped gas for the car, being driven to a couple of stores, standing outside by his car for a few minutes and then resting in the car while he talked on the telephone. Despite the fact that Rocky appeared to walk slowly and awkwardly, rested frequently, and was not seen doing anything his physicians indicated he could not do, Hartford determined that Rocky could work full-time. Hartford went as far as to claim that Rocky was exaggerating his chronic pain and limitations since he was able to open a car door, dip taco chips, and drive short distances. Hartford also indicated that because Mr. Whitten was able to be driven around by his wife for several hours, with breaks, he could sustain full-time employment. Accordingly, Hartford denied further benefits.
Rocky and his family were emotionally and financially devastated. With creditors calling and unsure of how they were going to buy food, they did not know where to turn. After seeing Good Morning America's coverage of another wrongful denial of disability benefits by Cigna Insurance, Rocky contacted the attorney featured in the story, Alicia Paulino-Grisham, of Disability Insurance Law Group. Attorney Paulino-Grisham contacted Rocky's physicians and sent them the videotape. Each explained that the video was irrelevant and did not establish that Rocky could work full-time. Attorney Paulino-Grisham also sent the video and Rocky's records to an independent medical expert, who opined that Rocky walked like a man in pain, had to rest frequently, and the video actually was consistent with the limitations provided by his numerous treating physicians. Disability Insurance Law Group submitted an appeal containing this information, along with medical records, personal statements, and signed statements from Rocky's physicians establishing that he remained unable to maintain gainful employment due to his injuries. Further, Disability Insurance Law Group asserted that it was unreasonable to deny Rocky's claim based on the limited video surveillance. Despite this, Hartford upheld its decision.
Accordingly, Disability Insurance Law Group prepared Rocky's case to file a lawsuit. However, just prior to the filing, Attorney Paulino-Grisham submitted to the Hartford updated medical information and informed Hartford that if the denial was not overturned, litigation would be immediately initiated in Federal Court. Within two weeks, Hartford overturned its decision.
Attorney Paulino-Grisham explained to Good Morning America that insurance companies like Hartford, use video footage of claimants to scare them into abandoning their claims. Essentially, even if the video does not show the claimant doing much of anything, as in Rocky's case, people become scared that any activity can be misunderstood and they can be accused of insurance fraud. As Good Morning America recognized, Rocky's story had a successful outcome because Rocky refused to give into Hartford's scare tactics and sought help. Chris Cuomo explained that Attorney Paulino-Grisham believes that this is a common practice for the Hartford and is looking into the merits of a class action lawsuit.
Attorney Alicia Paulino-Grisham is a partner with Disability Insurance Law Group which focuses on individual and group disability insurance claims at all stages of the claims process. The other founding partners include Attorneys Mindy Chmielarz and Maggie Smith. For more information please visit: www.dilawgroup.com.
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