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.
// by Nick Ortiz
After reviewing the administrative record and giving no deference to Provident’s decision to terminate benefits, the court found substantial evidence supporting Provident’s decision to terminate Gilewski’s long-term disability benefits.
Gilewski v. Provident – Substantial Evidence Supports Decision To Terminate ClaimRead More
// by Nick Ortiz
The Court held that Life Insurance considered all relevant information, including Abbey’s treatment notes, treatment notes from Plaintiff’s treaters at Philhaven, and the notes from the board-certified psychiatrist based on his peer review of Plaintiff’s medical records. The Court concluded that in light of the foregoing thorough review and subsequent basis for its denial, Life Insurance’s decision to deny long-term disability benefits to Plaintiff was not without reason and did not meet the required arbitrary and capricious standard. The Court further held that Life Insurance did not engage in any action violating Section 503 of ERISA and that Plaintiff did not have a separate, private cause of action for attorney’s fees and litigation costs.
Gailey v. LINA – Court Upholds Long-Term Disability Claim DenialRead More
// by Nick Ortiz
The Court addressed several issues within the Plan’s determination that the Court found did meet the required arbitrary and capricious standard. (1) Whether the Plan ignored favorable evidence from the Plaintiff’s treating physicians. (2) Whether the Plan conducted a selective review of the evidence from Plaintiff’s treating physicians. (3) Whether the Plan failed to conduct its own physical evaluation of Plaintiff. (4) Whether the Plan relied too heavily on non-treating physician consultants.
Filthaut v. AT&T – Court Rules STD Denial Meets Arbitrary And Capricious StandardRead More
// by Nick Ortiz
The problems in Aetna’s review of Maiden’s evidence—inexplicably disregarding the opinions of treating physicians and ignoring evidence supporting disability while cherry-picking evidence to support a denial—lend an unmistakable hue of capriciousness to Aetna’s review.
Maiden v. Aetna – Experts’ Bread Has Been Buttered By Aetna BeforeRead More
// by Nick Ortiz
The parties’ supplemental briefing clarifies that, as an initial matter, they dispute the applicable policy to Plaintiff’s disability claim. Defendant argues that the Los Alamos National Security, LLC (“LANS”) Group Disability Income Policy (“LANS Policy”) applies to Plaintiff’s disability claim. Plaintiff disagrees and maintains that a University of California (“UC”) Supplemental Disability Policy (“UC Policy”) applies.
Evans-Carmichael v. Liberty Mutual – Federal Court Remands Non-ERISA Case To State CourtRead More
// by Nick Ortiz
In this case, the court ruled that the conclusion by the peer review consultant was without reason when the evidence of record was examined. Thus, defendant acted arbitrarily and capriciously when relying on the peer review report to deny benefits.
Esbensen v. LINA – Defendant Acted Arbitrarily And CapriciouslyRead More
// by Nick Ortiz
Farooq Khan, M.D. (“Khan”), is a neurologist who filed for long-term disability insurance benefits. Provident Life and Accident Insurance Company (“Provident”) denied Dr. Khan’s LTD claim. After exhausting his appeals directly with the insurance company, Dr. Khan filed suit against Provident for breach of contract, asking the court to award payment of his long-term disability benefits. Dr. …
Khan v. Provident – Court Disagrees With Insurer’s Interpretation Of PolicyRead More
// by Nick Ortiz
The plaintiff argues that his disability has a physiological cause – in particular, brain damage likely resulting from HIV – and that Prudential should not have applied the mental health limitation. In this case, the Court agreed.
Doe v. Prudential – Court Rules That Mental Illness Limitation Doesn’t ApplyRead More
// by Nick Ortiz
Cara R. Denney (“Denney”) was an employee of Wagner Equipment Company (“Wagner”) where she was a Computer and Technology Instructor. Her job duties “required extensive computer use” and “the ability to instruct employees on the use of various computer systems.” She was also required to travel up to fifty percent of the time, be able to …
Denney v. Unum – Court Remands Unum LTD Claim For Further ReviewRead More
// by Nick Ortiz
Dana Krysztofiak (“Krysztofiak”) works as a registered nurse, but was previously a Clinical Coordination Manager for the company HomeCare Maryland, LLC. In 2016, Krysztofiak ceased working because of problems with fibromyalgia and psoriatic arthritis. She then filed for long-term disability benefits with Boston Mutual Life Insurance Co. (“Boston Mutual”). According to the language of the policy: Further, payments only …
Krysztofiak v. Boston Mutual – Court Rules Clinical Coordinator Is Entitled To LTD BenefitsRead More
Ortiz Law Firm is a national disability law firm specializing in long-term disability appeals, disability insurance lawsuits, and Social Security Disability claims. Contact us for a free case review.
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