PUBLIC SUBMISSION

Received: November 06, 2017

Status: Pending_Post 

Tracking No. 1k1-8zn2-zzvv

Comments Due: December 11, 2017

Submission Type: Web

Docket: EBSA-2015-0017

Claims Procedure for Plans Providing Disability Benefits; Extension of Applicability

Date

Comment On: EBSA-2015-0017-0291

Claims Procedure: Plans Providing Disability Benefits

Document: EBSA-2015-0017-DRAFT-0406

Comment on FR Doc # 2017-22082

Submitter Information

Name: W. Miller

Address:

Email:

Phone:

General Comment

See attached file(s)

Attachments 

RIN 1210-AB39

November 6, 2017 

Regarding proposed claims procedure by the Employee Benefits Security Administration on 

10/12/2017 RIN 1210-AB39
The perspective that I present is that of a spouse of a claimant who has had multiple claim 

reviews denials, reinstatement and twice litigation to insure her benefits. I have spent many 

hours working to insure she receives a full and fair review and have a meaningful dialogue with 

the Plan Administrator (The Hartford Life & Accident). However, I failed to achieve both. 

I feel the new Claims Procedure for Plans providing disability benefits would achieve both goals 

stated above. First off under Disclosure Requirements in our situation we have been given the 

standard response that "We recognize you are awarded Social Security Disability (SSDI) 

benefits. It is possible to qualify for SSDI, but no longer continue to qualify for private longterm disability (LTd) benefits from the Hartford". This has been their standard acknowledgment 

that she receives SSDI. They give no other explanation why it would be different. I feel this 

statement is just to justify that they acknowledge her receiving SSDI. I feel a meaningful 

dialogue should be established to explain why it is different. 

The very most important part of the proposed claim procedure is Review and Respond to New 

Information. In her situation she was given and independent medical exam and a peer to peer 

review to determine that she did not qualify for benefits under the 1st denial. The peer to peer 

review Doctor contacted her treating physician and mischaracterized the conversation to support 

that she was not disabled under the definition of the plan. The Hartford sent a fax to Dr. Zachary 

Stowe and gave him 5 days to answer if he disagreed with the report. Dr. Stowe is one of the top 

100 physicians in his field and is employed by a major university in research and teaching. It 

would be impossible to respond in such a short time as he lectures all over the US. 

The Hartford send Dr. Stowe this letter but failed to inform us that they contacted him or made 

us aware they needed a response from him. This resulted in us not having the ability to respond 

to the letter or new information that Hartford had received. Many courts view this tactic as a 

failure to have a meaningful dialogue and it is appears to be a common practice. Dr. Stowe sent 

a letter explaining that the peer doctor has misconstrued what he said. But this was only after 

Hartford made a denial of benefits. With a meaningful dialogue of a simple phone call or letter 

to the claimant this would have been resolved prior to denial of benefits. 

Upon appeal of the denial of benefits Hartford again had their peer to peer review doctor contact 

Dr. Stowe. Again, whether intentional or from carelessness the peer doctor notated her the last 

time she had symptoms where the exact day but put down the wrong year. He reported Dr. 

Stowe said her last symptom was January 2015, April 2015 and 7/25/2015 when the actual dates 

were January, April, July 25, 2016. The Hartford even had records showing January 2016 and 

April 2016 but failed to notice the discrepancy. If we would have been informed of this new 

evidence, we could have easily corrected Hartford's mistake and received a fair review. 

This was the determining factor that denied the continuation of her benefits. If the Hartford 

would have just informed us of the new evidence or rationale and had a meaningful dialogue I 

feel we would not have been denied benefits. Because of the denial we were forced to file suit 

Miller v. Hartford Life & Accident Insurance Company 4:17-cv-00108 . 

In conclusion I feel that Review and Respond to New Information is vital to ensure that the Plan 

Administration has a meaningful dialogue with the claimant. It is been notated that the proposed 
plan would increase costs to insure. I strongly disagree and feel that having an open dialogue 

would actually reduce costs especially due to not having to file litigation with our case if we 

would have had the opportunity to respond to erroneous information and have open dialogue 

with Hartford we would not have been forced to file suit. Review and Respond to New 

Information only insures the Plan Administrator will have a meaningful dialogue with the 

claimant.