Ortiz Law Firm is dedicated to helping people recover the disability benefits they deserve. We handle group Long Term Disability (LTD) claims, individual disability insurance policy claims, ERISA disability claims, and Social Security Disability claims.

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Nick Ortiz

Coats v. Reliance Standard – Court Rules LTD Benefit Calculation Incorrect

Jennifer Coats (“Coats”) was employed by Cottage Health Care as a staff nurse. Through her employment, she was able to participate in an employee welfare benefit plan which included coverage for long-term disability benefits. These benefits were funded by Reliance Standard Life Insurance Company (“Reliance”). More specifically, Reliance “shall serve as the claims review fiduciary with respect to …

Coats v. Reliance Standard – Court Rules LTD Benefit Calculation IncorrectRead More

Doe v. Standard – Insurer’s Decision Was Based On The Wrong Occupation

The court agreed with Doe that Standard’s reliance on the DOT description of a generic “lawyer,” rather than a job description that fully and accurately encompassed the material duties of Doe’s specialized area of legal practice, rendered Standard’s decision arbitrary and capricious.

Doe v. Standard – Insurer’s Decision Was Based On The Wrong OccupationRead More

Killen v. Reliance Standard – Court Finds There Was No Abuse Of Discretion

The Court affirmed the district court’s decision granting summary judgment to Reliance Standard on the ground that it did not abuse its discretion in denying the claimant’s long-term disability benefits. In other words, the Court ruled in favor of the insurance company.

Killen v. Reliance Standard – Court Finds There Was No Abuse Of DiscretionRead More

Campbell v. Hartford – Claim Denial Supported By Surveillance And Treating Physician

The court ruled that Hartford reasonably relied on medical opinions and surveillance evidence in deeming her ineligible for continued benefits, which means Hartford’s decision to terminate LTD benefits was rationally justified and thus is not arbitrary and capricious.

Campbell v. Hartford – Claim Denial Supported By Surveillance And Treating PhysicianRead More

Hans v. Unum – Court Upholds Denial Of Chronic Fatigue Syndrome Claim

The judge stated that, “the record, the policy, and the Parties’ arguments do not support the assertion that Plaintiff was disabled as of July 2012 (termination of LTD benefits) and August 2012 (termination of LWOP benefits). The Court, therefore, has no alternative other than to affirm Unum’s decision to deny Plaintiff’s benefits.”

Hans v. Unum – Court Upholds Denial Of Chronic Fatigue Syndrome ClaimRead More

Griffin v. Hartford – Plaintiff Failed To Furnish Proof Of Loss

In this case, the court agreed with the district court that Hartford’s decision was reasonable and did not amount to an abuse of discretion. The record readily shows that Griffin received a fair and thorough consideration of his claim and that the available evidence reasonably supported Hartford’s conclusion.

Griffin v. Hartford – Plaintiff Failed To Furnish Proof Of LossRead More

Granville v. Aetna – Aetna’s LTD Denial Was Arbitrary And Capricious

Here, Aetna has engaged in multiple procedural irregularities, including conducting a self-serving paper review of the medical files based on the incorrect disability standard, relying on the opinion of a non-treating, non-examining physician without reason, and denying benefits based on inadequate information and lax investigatory procedures, as evidenced by Aetna’s decision not to pursue an independent medical examination and its failure to analyze the specific requirements of Plaintiffs own occupation. These irregularities compounded each other and lead the Court to find that Aetna acted arbitrarily and capriciously in denying Plaintiffs LTD benefits.

Granville v. Aetna – Aetna’s LTD Denial Was Arbitrary And CapriciousRead More

Graham v. LINA – Court Rules LINA Must Review Claim Under “Medium-Occupation” Standard

Defendant informed Plaintiff that her claim for LTD benefits was denied because the medical information provided did not support restrictions and limitations and did not demonstrate a functional loss. The plaintiff argued that she was not required to submit objective medical evidence to prove her disability.

Graham v. LINA – Court Rules LINA Must Review Claim Under “Medium-Occupation” StandardRead More

Godmar v. Sedgwick – Decision To Deny Claim Was Arbitrary And Capricious

Disability benefits were paid for approximately one month and then were terminated. The termination letter acknowledged that “a medical condition may exist” but stated that “there must be objective medical information to support disability benefits” under the Plan. However, the court concluded that the decision to deny Godmar’s claim for short-term disability benefits beginning in July was arbitrary and capricious.

Godmar v. Sedgwick – Decision To Deny Claim Was Arbitrary And CapriciousRead More