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.

You are here: Home / Archives for Case Summary Blog

Case Summary Blog

Koning v. United Of Omaha – Insurer Failed To Adequately Evaluate Medical Evidence

In this case, the court found that United of Omaha Life Insurance Company failed to evaluate the medical evidence presented adequately. The insurer ignored favorable evidence submitted by her treating physician(s), selectively reviewed the evidence it did consider from the treating physicians, failed to conduct its own physical examination, and heavily relied on non-treating nurses and other non-physicians.

Koning v. United Of Omaha – Insurer Failed To Adequately Evaluate Medical EvidenceRead More

Khalil v. Liberty Life – Surveillance Supports Denial of Long-Term Disability Claim

The Court held, “The level of activity or the lack thereof that Mr. Khalil reported to Liberty in support of his claim of continued disability was undermined by the video evidence that Liberty collected during the three years of review.” The claimant’s claim was further undermined by the fact that his own treating physicians ultimately opined that he was not disabled. The Court denied Plaintiff’s Motion for Summary Judgment and granted Liberty’s Motion for Summary Judgment.

Khalil v. Liberty Life – Surveillance Supports Denial of Long-Term Disability ClaimRead More

Kerridge v. United Of Omaha – Medical Evidence Does Not Support Disability

On May 8, 2015, United informed Kerridge’s counsel by letter that it had denied Kerridge’s appeal. United indicated that its decision was based on the records from Dr. Wilson and the Cleveland Clinic, the other records in Kerridge’s file, and Dr. Zafar’s report from the IME. Kerridge filed a civil action in Federal Court seeking review of United’s decision.

Kerridge v. United Of Omaha – Medical Evidence Does Not Support DisabilityRead More

Baker v. Sun Life – Court Rules In Favor Of Sun Life

In this case, Kenneth Baker (“Baker”) was an employee who worked for Dunkin Donuts. Through his employment there, he held a policy for long-term disability benefits. Unfortunately, Baker lost all of his administrative appeals with the insurance company. He also lost at the lower Federal Court. The opinion below relates to Baker’s appeal of the …

Baker v. Sun Life – Court Rules In Favor Of Sun LifeRead More

Tyler v. American General – Psychiatrist Files Action For Bad Faith And Punitive Damages

Here, Kelly Ann Tyler (“Tyler”) filed a claim for a breach of disability insurance contract against United States Life Insurance Company and American General Life Insurance Company (together, “American General”). Further, she filed claims for a breach of the covenant of good faith and fair dealing by American General, seeking punitive damages. Previously, Tyler obtained …

Tyler v. American General – Psychiatrist Files Action For Bad Faith And Punitive DamagesRead More

Kochanek v. Aetna – Court Upholds Decision To Deny LTD Claim Due To Lack Of Medical Evidence

Katherine Kochanek (“Kochanek”) worked as an employee of Home Depot U.S.A., Inc. (“Home Depot”). Through her employment, she was covered by the Home Depot Welfare Benefits Plan which included short-term disability benefits. Aetna Life Insurance Co. (“Aetna”) served as the administrator of the Plan. Under the Plan, a “disability” is considered to be any pregnancy-related …

Kochanek v. Aetna – Court Upholds Decision To Deny LTD Claim Due To Lack Of Medical EvidenceRead More

Jones v. Aetna – Court Finds Breach Of Fiduciary Duty Claim Is Not Duplicative

Lisa Jones submitted a claim for long-term disability benefits under an LTD Plan provided to her by Boeing. Aetna was the plan administrator; Aetna denied the LTD claim. Ms. Jones sued under the Employee Retirement Income Security Act (ERISA) for denial of benefits and breach of fiduciary duty. The district court (lower court) dismissed the …

Jones v. Aetna – Court Finds Breach Of Fiduciary Duty Claim Is Not DuplicativeRead More

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