Appealing Hartford LTD Decisions

If Hartford denies your LTD claim or you believe their calculation is wrong, you have appeal rights.

Reasons to Appeal

Claim Denial

Hartford may deny your claim for:

• Failing to meet the "own occupation" or "any occupation" definition of disability
• Pre-existing condition exclusion
• Missing medical documentation or attending physician statement
• Alleged misrepresentation

Benefit Calculation Disputes

You might dispute:

• Wrong 12-month window used — they must use your highest 12 consecutive months within the preceding 36 (CBA §27.J.6), not just the last 12
• Incorrect offset amount (e.g., offsetting SSDI family benefits, which are excluded for disabilities after Oct 30, 2006)
• Wrong IRS 401(a)(17) cap year applied
• Missing earnings components (flight pay, override pay, per diem)

Other Issues

• Benefits terminated at the 24-month "any occupation" transition without updated vocational analysis
• Retroactive denial
• Benefits terminated before age 65 for a general physical condition

The 180-Day Deadline

Counting the Days

Day 0:     Denial letter date
Day 1:     Next day (start counting)
Day 180:   FINAL day to submit appeal

Mark the deadline on your calendar the day the letter arrives. Do not wait until day 180.

Before You Appeal

Request Your Claim File

Under ERISA § 503 and 29 C.F.R. § 2560.503-1(h)(2)(iii), you're entitled to a complete copy of your claim file. Send a written request:

I hereby request, pursuant to ERISA § 503 and 
29 C.F.R. § 2560.503-1(h)(2)(iii), a complete 
copy of my claim file including all documents, 
records, and other information relevant to my 
claim for benefits.

Claim Number: [Your claim number]

Hartford must provide this free of charge. Review it before writing your appeal — it often reveals which medical records they had, which they ignored, and what their internal reviewers concluded.

Review the Denial Carefully

Work through the denial letter systematically:

1. Which specific policy language did Hartford cite as the basis for denial?
2. Which medical records did they rely on?
3. Did they obtain an independent file review (paper review) rather than an actual IME?
4. Did they apply the wrong disability standard (any occupation when you're still within the first 24 months)?

Writing Your Appeal

Required Elements

1. Clear statement of appeal referencing your claim number and denial date
2. Point-by-point response to each denial reason, quoting the policy language Hartford cited
3. Additional evidence — new medical records, specialist reports, AME documentation
4. Request for specific remedy — benefit reinstatement from a specific date, recalculated benefit amount, etc.

Appeal Letter Template

[Date]

Hartford Life and Accident Insurance Company
[Appeals Address from denial letter]

RE: APPEAL OF CLAIM DENIAL
Claim Number: [Your claim number]
Claimant: [Your name]
SSN: [Last 4 digits]
Date of Denial: [Date from denial letter]

Dear Hartford Appeals:

I am writing to formally appeal the denial of my 
Long-Term Disability claim dated [date].

REASON FOR DENIAL:
Hartford denied my claim stating [quote their reason].

MY RESPONSE:
[Explain why their denial reason is wrong or 
incomplete. Be specific and factual.]

ADDITIONAL EVIDENCE:
I am submitting the following additional evidence:
1. [List each document]
2. [With brief description of what it shows]

POLICY PROVISIONS:
The policy provides that [quote relevant sections].
My situation meets this requirement because [explain].

REQUESTED REMEDY:
I request that Hartford:
1. Reverse the denial of my claim
2. Pay benefits from [date] forward
3. [Any other specific requests]

I reserve all rights under ERISA, including the 
right to bring a civil action if this appeal is 
denied.

Please confirm receipt of this appeal in writing.

Sincerely,
[Signature]
[Printed name]
[Contact information]

ENCLOSURES:
[List all attachments]

Strengthening Your Appeal

Medical Evidence

1. Detailed attending physician statement
   • Specific diagnosis with ICD-10 code
   • Objective findings (imaging, lab results, functional testing)
   • Quantified functional limitations (e.g., cannot sit more than 20 minutes)
   • Explicit statement that you cannot hold a first-class FAA medical
2. Medical records — all visit notes, test results, hospital records, and treatment plans since disability onset
3. Specialist reports — if Hartford used a paper review by a specialist who never examined you, obtain a competing opinion from a physician who did

Pilot-Specific Arguments

• Any medical restriction that disqualifies you from a first-class medical ends your ability to fly the line — there is no "light duty" or modified flying assignment
• "Own occupation" under CBA §27.J means airline transport pilot, not a general sedentary occupation
• Cite CBA §27.J.1 if you triggered LTD through sick bank exhaustion or disability-related seat change, not just the 180-day waiting period

Expert Opinions

Consider obtaining:

• Independent medical examination from an aviation medicine specialist (HIMS AME if applicable)
• Vocational expert opinion at the 24-month transition if Hartford claims you can perform "any occupation"
• ERISA attorney review of the claim file before submitting your appeal

After Submitting

Timeline

Hartford has 45 days to decide your appeal:

• May extend once to 90 days total with written notice citing special circumstances
• Must provide a written decision explaining the specific reason(s) for any denial
• If they miss the deadline, ERISA treats the appeal as denied, which opens the door to federal litigation

If Appeal Approved

• Benefits should begin within 30 days
• Retroactive benefits are owed for the period of wrongful denial — confirm the back-pay amount in writing

If Appeal Denied

You have two options:

1. ERISA lawsuit in federal court — limited to the administrative record (what's in your claim file)
2. PBRB process — FedEx/ALPA Pilot Benefit Review Board, a contractual alternative to litigation

Getting Help

Legal Representation

For appeals involving benefit termination at the 24-month transition or calculation disputes above $50,000:

• Retain an ERISA-experienced attorney — ERISA litigation is highly specialized
• Many work on contingency (typically 25-40% of recovered benefits)
• ERISA record closes at the end of internal appeal — add all evidence before the deadline

ALPA Resources

• ALPA R&I committee — initial guidance and referrals; contact ri@alpa.org
• ALPA Aeromedical Office — if the denial turns on FAA medical certification issues
• Pilots who have navigated the PBRB process are sometimes available through ALPA peer support

ERISA Litigation

If your appeal is denied, you can sue Hartford in federal court under ERISA § 502(a)(1)(B).

Key Points

• Must exhaust administrative remedies (internal appeal) before filing suit
• Court typically reviews the claim file under an "abuse of discretion" or de novo standard depending on plan language — this matters for strategy
• The administrative record is largely closed after internal appeal; add all evidence before that deadline
• Experienced ERISA attorney is essential — general disability or employment attorneys typically lack the specialized knowledge

Time Limits

Varies by plan; typically 2-3 years from the final denial date. Check your policy. California's statute of limitations for ERISA claims may also apply. Do not rely on memory — calendar this date immediately.

Next Steps

• PBRB Process - FedEx-specific alternative to litigation
• Templates - Appeal letter template
• Contacts - Hartford contact information