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Senior Account Manager With a Cardiac Condition, Depression and Anxiety Wins Hartford Appeal

The case involves a 48-year-old senior account executive for a midsize corporation who stopped working after experiencing significant mental health symptoms, including panic attacks, anxiety, and depression. Her psychiatrist strongly supported her disability and had personally observed episodes involving heavy and labored breathing during panic attacks. Because her position as a senior account executive was highly demanding, her symptoms eventually prevented her from continuing to perform her occupational duties.

Hartford initially accepted the client’s disability, paying her full short-term disability benefits through the 180-day elimination period and then approving long-term disability benefits. However, Hartford paid LTD benefits for only one month before terminating the claim. This meant the insurer effectively concluded that she had remained disabled throughout the six-month elimination period and the following month but had suddenly improved enough to return to work.

Hartford based its termination largely on a paper review conducted by a physician who reviewed portions of the client’s medical records but never examined or met with her. The reviewing physician concluded that her psychiatric symptoms were no longer sufficiently impairing to prevent her from working. When attorney Jason Mackrie began investigating the claim, however, he discovered an important part of the client’s medical history that had not been presented to Hartford: she was also experiencing significant cardiac problems.

Before stopping work, the client had been dealing with a leaky heart valve and tachycardia. She had continued working despite those conditions and did not initially consider them disabling. Once her cardiac problems were combined with severe anxiety, panic attacks, heart palpitations, breathing difficulties, and other mental health symptoms, however, the cumulative effect became significantly more disabling. The client had initially filed her disability claim solely on the basis of her mental health conditions and had not mentioned the cardiac component at all.

Mackrie developed the appeal around the combined impact of the client’s psychiatric and cardiac conditions. Key components of the appeal included:

• Obtaining the client’s cardiac treatment records and developing a more complete history of her heart condition.
• Contacting her cardiologist and explaining the panic attacks, palpitations, breathing problems, and other symptoms she was experiencing alongside her cardiac condition.
• Coordinating the medical evidence from her cardiologist with the evidence provided by her psychiatrist rather than treating the physical and psychiatric conditions separately.
• Obtaining an Attending Physician Statement from the cardiologist documenting her cardiac diagnoses and limitations.
• Establishing that her mental health symptoms aggravated her cardiac problems and that the combined effects interfered with her ability to perform the demanding duties of her occupation.

The cardiologist ultimately supported the client’s disability and explained how her cardiac condition, when combined with her mental health symptoms, affected her ability to work. This allowed the appeal to present Hartford with a more complete picture of her health rather than focusing exclusively on anxiety, depression, and panic attacks. Hartford ultimately reversed its denial and reinstated her long-term disability benefits.

The physical component of the claim may also become important as Hartford continues reviewing her eligibility for benefits. Her policy contains a 24-month limitation applicable to mental health disabilities, and the attorneys anticipate that Hartford may eventually argue that her benefits should end under that limitation. The claim is now supported by evidence of both physical and mental health conditions, however, and her attorneys intend to continue documenting the disabling impact of her cardiac problems independently and in combination with her psychiatric symptoms.

The case demonstrates why disability claims should account for the claimant’s complete medical condition rather than focusing only on the diagnosis that initially caused the person to stop working. Physical and mental health conditions can interact in ways that significantly increase functional limitations. Continued treatment with both her cardiac and mental health providers, compliance with recommended treatment, and consistent documentation of the symptoms preventing her from performing her occupational duties will be particularly important as Hartford continues evaluating the claim.