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Ortiz Law Firm | National Disability Law Firm
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.
This case shows how ERISA courts weigh evidence: in Randall v. MetLife, short- and long-term disability benefits were denied because the claimant’s reported pain and diagnoses weren’t backed by objective findings or physician opinions restricting work. Doctor conclusions and measurable proof carried more weight than subjective complaints.
In Kavanay v. Liberty Life Assurance Company of Boston, the plaintiff sought long-term disability benefits from Liberty Life, the insurer of his ERISA governed disability plan. The plaintiff worked as an insurance adjuster for Allstate; he was an “outside claims examiner”. Plaintiff’s entitlement to benefits was subject to the “own occupation” …
There is no dispute that Puccio is disabled. She has multiple medical conditions that limit her ability to work. The only dispute is whether her disabilities are covered by the LTD policy or whether she has exhausted the maximum benefits allowed under the policy for her particular conditions.
The present case involves an appeal by Aetna Life Insurance Company (“Aetna”) from a successful motion for summary judgment granted in Christopher Patterson’s (“Patterson”) favor. Regarding the same case, the court had also denied a motion for summary judgment filed by Aetna. Patterson was covered under a long-term disability policy by Aetna …
The Court concluded that the Plaintiff did establish by a preponderance of the evidence that she was “totally disabled” under the “any occupation” standard.
In Fleming v. Unum, Pamela Fleming (“Ms. Fleming”) was a litigation attorney at the firm Kern & Wooley, LLP (“Kern & Wooley”). She was in a serious car accident in 1998, which caused injuries to her thoracic spine and neck. After receiving a cervical spine fusion around 2003, Ms. Fleming kept having back and neck pain, which led …
Okuno has not established that she satisfied the requisite conditions to obtain disability benefits beyond what Reliance has already paid. Reliance's denial of continued long-term disability benefits appears to have been the result of a principled and deliberative reasoning process. Accordingly, Reliance is entitled to judgment on the …
In this case, the medical reports in the administrative record were not sufficient to show by a preponderance of the evidence that Shaw was unable to perform the material duties of her regular occupation. The only reports that supported her claim were conclusory, and provide insufficient information concerning Shaw’s functional capacity.
The Court’s task is not to decide whether Plaintiff was disabled. Prudential denied benefits because Plaintiff was not covered by the Plan when his claim arose. Thus, the question is not whether Plaintiff had a valid disability claim but when his disability claim (whether valid or invalid) arose.
The medical evidence available does not suggest that Aetna abused its discretion by determining that Neno is able to perform the "material duties" of his "own occupation" as defined under the employee welfare benefit plan. Aetna's decision was supported by substantial evidence and was made with deliberate and principled reasoning, as it reviewed …
Sometimes perception does not meet reality. This post is in response to a comment in a local newspaper. In the “Spout Off” section of the Northwest Florida Daily News, a commentator complained: “There are more people going on disability than getting jobs. Apparently it is easier to qualify for disability than get a job. Something …
In the present case, Dave Nagy (“Nagy”) was a Quality Assurance Analyst employed by Oracle America, Inc. (“Oracle”). Around September 8, 2011, he began experiencing symptoms of Chronic Fatigue Syndrome (CFS) as well as other mental health and possibly autonomic dysfunctions. Nagy applied for short-term disability (STD) benefits but was …
When considering the record as a whole, the Court finds that Aetna’s denial of LTD benefits to Murphy was supported by substantial evidence therein and that Murphy has not met her burden to establish that such denial was arbitrary and capricious. Accordingly, Murphy’s objections to Aetna’s denial cannot withstand Aetna’s motion for summary …
In the instant case, Dee Ann Miller (“Miller”) was a senior collector who was employed by Springleaf Finance, Inc. (“Springleaf”). Miller’s job duties “include contacting customers with high risk accounts, negotiating repayment, providing documentation to monitor results and productivity of collection efforts, responding to inquiries, …
Under the arbitrary and capricious standard, the review is limited to whether reasonable grounds existed to support Aetna’s denial of benefits based on the administrative record before it. The Court held that Aetna reasonably concluded that Plaintiff was no longer entitled to long-term disability benefits and that their decision process was neither …
The Court found Aetna’s denial of Plaintiff’s claim for long-term disability to be arbitrary and capricious and ordered Aetna to pay the long-term disability benefits for which he is qualified under the Plan.
Aetna approved the Appellant’s claim for LTD benefits from September 25, 2012, through February 23, 2013, but denied her claim for benefits for any period thereafter. Thus, the Sixth Circuit limited its review to determining, de novo, whether the Appellant was entitled to benefits beyond February 23, 2013.
Melissa McIntyre (“McIntyre”) worked as a Mayo Clinic Health System nurse. She was covered under a long-term disability plan which was administered by Reliance Standard Life Insurance Company (“Reliance Standard”). Around 2011, McIntyre’s health caused her to cease working. McIntyre suffered from Charcot-Marie-Tooth Syndrome, a neurological issue …
In the present case, Brenna Mawa (“Mawa”) worked as a nurse, Branch Director, and Clinical Director; she was employed by LHC Group, Inc. (“LHC”). The company was insured by a Group Long-Term Disability Plan for Employees issued by the Hartford Life & Accident Insurance Company. This plan defined a disability as whether a person can perform the …
Marcia L. Smith (“Smith”) worked as a property manager for Arlington Properties, Inc., and starting on March 1, 2016, she was covered under a long-term disability (LTD) plan administered by United of Omaha Life Insurance Company and Mutual of Omaha Insurance Company (collectively, “United”). The plan provided the following …
Here, Melissa Maher (“Maher”) was Manager of Research and Development at Bonne Bell, L.L.C. (“Bonne Bell”). Her job duties were considered to be light with sedentary demand. Further requirements were the ability to use ten pounds of force and other exertions of lesser amounts more frequently. Because of her employment with Bonne Bell, Maher was …
A dentist from Michigan prevailed on appeal after Provident Life and Paul Revere denied his long-term disability benefits. Although the insurers argued he wasn’t totally disabled because he could still perform managerial duties, the Sixth Circuit affirmed that he was unable to perform the primary duties of his occupation.
Although she initially received long-term disability benefits from Reliance Standard, Lash's claim was later denied under the stricter “any occupation” standard. Lash sued both Reliance Standard and Matrix Absence Management, the plan’s third-party administrator.
The present case involves an ERISA claim for short-term disability and long-term disability insurance benefits where the claimant argues that the administrator improperly denied his claims for benefits. Marc Kouzmanoff (“Kouzmanoff”) was a sales representative for Thompson Reuters Holdings, Inc. (“Thompson Reuters”). In 2001, he developed diabetes; …