Nick Ortiz

Eggleston v. Unum – Florida Nurse Loses Disability Benefits Appeal Against Unum Despite Years of Chronic Pain

Yvette Eggleston, a nurse from Florida, lost her long-term disability appeal against Unum after the insurer terminated her benefits based on social media activity and a reassessment of her chronic pain conditions. Despite support from multiple treating doctors and a functional capacity evaluation showing she couldn’t sit or stand for long periods, the court ruled in Unum’s favor. It found the decision was not arbitrary or capricious under ERISA standards.

Can I Quit My Job While on Long Term Disability?

Many long term disability recipients remain “employed” with their employer, perhaps listed as an “inactive employee”. But let’s say there has not been a formal separation either by resignation or termination. Can one “quit” the job while receiving long term disability (LTD) benefits? Yes, you can quit your job while on LTD benefits, but it’s …

Ortiz Law Firm Helps Systems Engineer Recover Long-Term Disability Benefits from MetLife

At the Ortiz Law Firm, we recently had the privilege of helping a client who had been unfairly denied his long-term disability (LTD) benefits. Our client became disabled due to a combination of debilitating medical conditions, including long COVID syndrome with shortness of breath and dizziness, chronic fatigue syndrome, chronic migraines, dyspnea on exertion, cervical …

Your Long-Term Disability Appeal May Be Your Only Chance to Submit New Evidence

Many people assume that if their long-term disability (LTD) appeal is denied, they can simply take the insurance company to court and present all the evidence they didn’t get to include earlier. Unfortunately, that’s not how it works under the law that governs most group LTD policies: ERISA, which is short for the Employee Retirement …

Understanding Long-Term Disability Reviews: Why Your LTD Benefits Aren’t Guaranteed Forever

When an insurance company approves a long-term disability (LTD) claim, many claimants assume that their benefits will continue indefinitely into the future. However, insurers are not required to approve benefits forever. Instead, they conduct periodic reviews to determine whether a claimant still meets the policy’s definition of disability. Understanding how and why these reviews occur …

Peer Review Reports In Long-Term Disability Claims and Appeals

If your long-term disability (LTD) claim has been denied, there’s a good chance that a “peer review report” played a role in that decision. Understanding what these reports are and how they’re used can help you make sense of the denial letter you received and decide what to do next. What Is a Peer Review …

Ortiz Law Firm Secures Reinstatement of Long-Term Disability Benefits for Client Denied by Lincoln National

At the Ortiz Law Firm, we fight for people who have been unfairly denied long-term disability benefits. Our recent success story highlights the importance of perseverance and strong legal advocacy when battling insurance companies like Lincoln National. Case Overview Our client, an airline operations agent, became disabled in March 2023 due to a combination of …

Why It Takes So Long to Receive a Decision on a Long-Term Disability Appeal

You’ve filed your long-term disability (LTD) appeal. You followed the instructions, submitted medical records, maybe even worked with your doctor or an attorney. Now comes the hardest part: waiting. You may be checking the mail or your inbox daily, wondering when the insurance company will respond. If it’s been several weeks, or even months, you’re …

Ortiz Law Firm Helps Client Recover Long-Term Disability Benefits After New York Life Denial

Our client was forced to stop working due to a combination of disabling conditions, including essential tremor, chronic pain and neuropathy, and complications from right shoulder surgery. New York Life initially approved her long-term disability (LTD) claim and paid benefits during the 24-month “own occupation” period. However, after that period ended, the definition of disability …

What Does Disability Mean In A Long-Term Disability Claim?

When people think of disability, they often picture someone who can’t work at all. But when it comes to long-term disability insurance, the word “disability” can mean very different things depending entirely on how it’s defined in your policy. Understanding the exact definition of “disability” in your plan is critical. It’s the basis for whether …

New York Life Reverses Disability Denial for Navy Federal Credit Union Employee

I’m honored to share another story of how we helped a client recover the long-term disability (LTD) insurance benefits she desperately needed after her claim was unfairly denied. This is a testament to the power of perseverance and expertise when it comes to fighting for our clients’ rights against large insurance companies like New York …

Ortiz Law Firm Helps Financial Manager Recover Wrongly Denied Long-Term Disability Benefits

At the Ortiz Law Firm, we fight to make sure insurance companies live up to their obligations. Recently, we helped a Charles Schwab financial manager regain the claimant’s long-term disability (LTD) benefits after Lincoln National wrongfully terminated the claimant’s disability claim. Denial of a Valid Disability Claim Our client is disabled and unable to work …

Hardy v. Unum – Trial Attorney Wins ERISA Lawsuit Against Unum for Wrongful Termination of Disability Benefits

A Minnesota trial attorney diagnosed with multiple myeloma, sued Unum after the insurer wrongfully terminated his long-term disability benefits. Despite medical records and expert testimony confirming that Hardy’s cancer-related symptoms prevented him from working full-time, Unum relied on file reviews by non-examining physicians to justify the termination. The court found that Hardy remained disabled under the terms of his policy and ordered Unum to reinstate his benefits, pay back benefits, and cover attorney’s fees.

The Appeals Process for Mental Health-Related Long-Term Disability Claims

Navigating the appeals process for mental health-related long-term disability (LTD) claims can be particularly challenging. Unlike physical conditions that can be documented with imaging and lab results, mental health disorders rely on more subjective assessments that insurers often undervalue or dismiss. Insurers may also use various tactics to discredit claims, such as surveillance, relying on …

Seneca v. MetLife – IT Administrator Loses Long-Term Disability Appeal Against MetLife

Jason Seneca, an IT Administrator from Louisiana, filed suit after MetLife terminated his LTD benefits based on a shift to the policy’s stricter “any occupation” definition of disability. Despite support from a treating neurologist, the court upheld MetLife’s decision, finding that medical records in 2019–2020 supported functional ability and that MetLife’s review process was reasonable under ERISA.

Research Scientist Wins Reliance Standard Long-Term Disability Appeal

At the Ortiz Law Firm, we understand how devastating it can be when a disability insurance company unfairly denies your claim for benefits. Recently, we had the privilege of helping a brilliant lead research scientist who was struggling with Lance-Adams Syndrome. This condition caused debilitating tremors, ataxia, and startle-induced myoclonus, resulting in frequent falls and …

Sobel v. Sun Life – California Physician Challenges Denial of Long-Term Disability Benefits

A California physician filed an ERISA lawsuit after Sun Life denied his long-term disability claim for chronic fatigue syndrome. Despite multiple medical diagnoses supporting his condition, the insurer cited psychiatric history and lack of conclusive evidence. The court stayed the case and remanded it for further review, ordering a neuropsychiatric evaluation and a comprehensive reassessment of all medical records.

How Long Does A Long-Term Disability Appeal Take?

When filing a long-term disability (LTD) appeal, many people ask: “How long will it take?” Unfortunately, the answer is “it depends.” There are two main phases to the appeal timeline: We’ll break down what happens in each phase and why the entire process can take several months or more. Phase 1: Preparing the Appeal Under …

New York Life’s Independent Medical Reviews and How to Respond

When appealing a long-term disability (LTD) claim denial with New York Life, the employee reviewing your LTD claim may not be a medical professional, but they will likely consult with one. New York Life (NYL) will often ask an independent physician to re-evaluate a claimant’s medical condition and determine if it is consistent with the …

Navigating Lincoln Financial’s Long-Term Disability Appeals Process: Responding to Independent Physician Reviews

When appealing a long-term disability (LTD) claim denial with Lincoln Financial Group, claimants often encounter an independent physician review. Lincoln, like many other insurance companies, uses these independent reviews to re-evaluate a claimant’s medical condition and determine if it is consistent with the reported functional limitations. Here, we’ll explore Lincoln’s physician reviews, including what to …

What The Standard’s Acquisition of Elevance Health’s Life & Disability Business Means For Disability Claimants

On April 1, 2024, The Standard announced the completion of its acquisition of the Life & Disability business of Elevance Health. Elevance Health is the parent company of Anthem. This move marks a significant expansion of The Standard’s presence in the employee benefits marketplace, particularly in the areas of life and disability insurance. While the …