If The Hartford has denied or terminated your long term disability benefits after conducting surveillance or sending you for a medical examination, the first question you may be asking yourself is whether the insurer was entitled to investigate.
But that is not the key issue: the question is whether what the investigation produced actually supports the conclusion drawn from it.
Surveillance footage and examination reports carry an authority in a claim file that they don’t always deserve, and answering them requires engaging with what they show rather than objecting that they exist. At Edelstein Martin & Nelson, LLP we handle those questions for claimants across Philadelphia.
What These Denials Usually Rest On
A termination that follows an investigation can cite multiple reasons for such a decision. The claimant was observed performing an activity said to be inconsistent with the reported restrictions. An examining physician retained by the insurer reached a different conclusion from the treating physician. Or the file is said to show inconsistency between what the claimant reported and what the record documents.
Framed that way, the letter puts the claimant’s credibility rather than the claimant’s condition at the centre of the case. That framing is what needs to be dismantled by a strong Philadelphia disability claim, because this type of claim is decided on whether documented limitations preclude the duties of an occupation.
Surveillance and What It Proves
Insurers may conduct surveillance, and the footage can be part of a claim file. What surveillance captures is a period of observation, which can be as short as a few hours across a small number of days, chosen by the investigator.
The gap between that and the disability question is wide. Almost every condition that produces a disability claim fluctuates. A claimant with degenerative disc disease can carry a bag on a good afternoon and be unable to sit through a working day for the rest of the week.
In this sense, capacity for an isolated activity is not capacity for sustained, reliable, full time work, and the policy asks about the second.
Answering surveillance therefore means placing it in context rather than disputing that it happened. That means treating records covering the same period, an account of what the observed activity cost the claimant afterward, and, where appropriate, a professional opinion explaining why intermittent capability is consistent with the diagnosed condition.
It also means checking what the footage actually shows against what the report claims it shows, which are not always the same.
Can an insurer use video surveillance to stop my benefits?
Insurers may conduct surveillance and place the footage in the claim file. What matters is whether brief observed activity genuinely contradicts documented restrictions, since most disabling conditions vary from day to day.
Independent Medical Examinations
An examination arranged by the insurer is commonly described as independent, though the examiner is selected and paid by the party that will pay the benefit if the claim succeeds.
Attending is required by the policy, and refusing can itself become a ground for denial. What you can do as a claimant is prepare yourself. Bring a written account of symptoms and history so the record does not depend on you recalling under pressure. Note the length of the examination and what was actually done in it. Where the policy or plan permits, request a copy of the report.
Remember: the resulting report is evidence, not a verdict. Where it conflicts with a longer treating relationship, the appeal should say why the treating record is better founded, and reasons for that can be the duration of observation, breadth of testing, and familiarity with the response to treatment over time.
The Pre-Existing Condition Clause
Other denials are based on when the condition began. Here is a detailed look into the subject.
Group policies commonly exclude claims arising from conditions for which the claimant received treatment, advice, or medication during a defined look back period before coverage started, usually where disability then begins within a stated period after enrolment.
For instance, a routine consultation about back pain months before a job change can become the basis for denying a claim filed a year later.
These provisions are enforceable, and the dispute tends to be factual and narrow. It turns on what the medical records actually show during the look back window, whether the earlier complaint is genuinely the same condition as the disabling one, and whether the policy’s own definitions have been applied as written.
Since the analysis is based on documentation, it helps to start by reviewing records early, particularly those the claimant may not have revisited since the visit.
The Conflict That Courts Weigh
Where the insurer both decides the claim and pays the benefit, that dual role is a structural conflict that’s even been recognised at the court level. In Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105 (2008), the Supreme Court held that such a conflict is a factor a court takes into account when reviewing a benefits denial for abuse of discretion.
That conflict analysis applies where the plan is governed by ERISA, which is why establishing whether your policy is governed by ERISA comes before any argument about the surveillance itself.
Its weight depends on what the record shows about how the claim was actually handled, which is why procedural detail belongs in the appeal file rather than in an argument made afterward.
The Third Circuit has also recognised that a court may consider evidence outside the administrative record on the question of a conflict of interest, as it noted in Howley v. Mellon Financial Corp., 625 F.3d 788 (3d Cir. 2010).
A Philadelphia Example
You may be wondering how all of these assessments and conflicts actually work in real life. Consider a claimant living in Northeast Philadelphia with a chronic pain condition who is filmed over two afternoons: loading shopping into a car, standing outside a house, driving. The report describes a person moving normally. As a consequence, disability benefits stop.
What the footage does not show is the two days that followed, the medication taken before the errand, the fact that the shopping was the only activity attempted that week, or the absence of any observation of sustained sitting, concentration, or an eight hour day.
An appeal that establishes those points through recent, updated records and a clear functional opinion is engaging with the evidence. An appeal that simply objects to being watched is not. This is a clear example of why hiring a disability attorney can be beneficial for you and your claim.
The Statements You Make Along the Way
As you may have noticed, surveillance and examinations are the visible part of an investigation. There is also a quieter part that can also have a direct impact on the outcome of the investigation: the record a claimant builds without realising it.
Activity questionnaires ask claimants to describe a typical day, and answers written quickly can read as either broader or narrower than the truth. Telephone interviews with claim handlers are frequently documented in the file, and the note that results is the insurer’s account of the conversation rather than a transcript. Social media posts, including posts by other people showing the claimant, sit in public view and are routinely reviewed.
None of this is a reason to put your routine or your social life on hold. Instead, it is a reason to describe function accurately and consistently, in terms of what can be sustained rather than what is possible once. A claimant who reports they can drive should be able to say how far, how often, and what follows.
Where a file already contains statements that appear inconsistent, the appeal is the place to reconcile them. An explanation offered in the record carries weight, so it is important to include it. The same explanation offered after the record closes may never be read.
Deadlines
On an ERISA governed plan, 29 C.F.R. § 2560.503-1 requires at least 180 days after an adverse benefit determination for the claimant to file an appeal, and also gives them the right to receive claim-related documents without charge. So, requesting the file early matters most here, because surveillance reports and examination reports sit inside it.
The deadline to file an ERISA lawsuit is a separate issue. ERISA does not impose a single universal limitations period for benefit claims, and the applicable deadline is usually governed by a limitation provision in the plan or insurance policy.
These contractual deadlines can shorten the time available to sue, so you should always review the governing policy language and confirm that deadline before relying on any general limitations period.
Frequently Asked Questions
Do I have to attend an insurance medical examination?
Usually, yes. Most policies require attendance, and refusing can become an independent ground for denial.
Can I record the examination?
That depends on the policy terms and on the examiner’s rules. Ask in advance and in writing rather than at the appointment.
Is surveillance legal?
Observation in public places is generally permitted. The question in a claim is what the footage proves.
What if the insurer’s report misstates what happened?
If the insurance company’s report says something inaccurate or leaves out important facts, you should make sure to include the correct information in the appeal file. The judge does not start over and investigate everything from scratch; they review the evidence that was included in the official record.
How Edelstein Martin & Nelson, LLP Handles The Hartford Denials in Philadelphia
Edelstein Martin & Nelson, LLP represents claimants whose benefits stopped after an investigation, and our approach is based on collecting all available evidence and getting the actual facts on your routine and actual limitations straight to counter the insurer’s arguments.
Keith L. Martin, one of our partners, obtains the claim file, reviews the surveillance material and the examination report against what the medical record actually documents, and builds the answer into the appeal while the record is still open.
Our firm acts as a Philadelphia long term disability lawyer for claimants across Pennsylvania, and we help claimants deal with insurance companies and surveillance.
We get paid only if you are awarded your disability benefits. Make sure to bring the termination letter, the policy, and anything the insurer has sent you about the investigation. You can contact our Philadelphia office or dial (215) 731-9900 to arrange your complimentary case review.