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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.
A federal court sided with Jennifer Coats in a dispute over how Reliance Standard Life Insurance Company calculated her long-term disability (LTD) benefit amount, ruling that her regular work week was correctly interpreted as her normally scheduled hours and that her pay rate should include the shift differential for hours worked between 7:00 PM and …
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.
The Second Circuit recently ruled in favor of Hartford in a long-term disability claim involving multiple sclerosis, finding that Hartford's denial of long-term disability coverage was not arbitrary and capricious.
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.
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.
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.”
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
A federal court in New York, following a bench trial on the administrative record, held that Dr. Farooq Khan is entitled to long-term disability (LTD) benefits under both the “Your Occupation” and “Any Occupation” provisions of his policy, finding that Provident Life and Accident Insurance Company (“Provident”) erred in requiring objective proof the policy didn’t demand …
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.
A federal court in Colorado ruled in favor of Cara Denney, remanding her long-term disability (LTD) claim to Unum Life Insurance Company of America for further review of whether she satisfied the plan’s 180-day elimination period, after finding Unum failed to adequately explain how that standard applied to her case. Case at a Glance Remanded …
A federal court in Maryland granted summary judgment to Dana Krysztofiak, holding that Boston Mutual Life Insurance Company (“Boston Mutual”) abused its discretion in terminating her long-term disability benefits and declaring her entitled to payment of benefits for the 24-month period at issue, based on her fibromyalgia. Case at a Glance Claimant Win Case Dana …
The Court found that Prudential abused its discretion in relying upon a vocational assessment that was based only on Prudential’s hired external medical reviewer’s opinions rather than all of the medical evidence.
A federal court in Pennsylvania granted summary judgment to Aetna Life Insurance Company, holding that its decision to deny Vanessa Pearson-Rhoads’s long-term disability claim was reasonable and not an abuse of discretion. Case at a Glance Insurer Win Case Vanessa Pearson-Rhoads v. Aetna Life Insurance Company Court United States District Court for the Eastern District …
Sun Life Assurance Company of Canada never disputed that Faciane is disabled or that his benefit calculation might have been wrong. The entire ruling turns on a single question: did Faciane wait too long to sue? The court found he did — his policy required any lawsuit within 3 years of when “Proof of Claim” …
A federal court in Maine granted summary judgment to Aetna Life Insurance Company, holding that its decision to deny Colon Carter’s long-term disability claim was reasonable and supported by sufficient evidence, despite Carter’s arguments that the reviewing physician had mischaracterized his treating providers’ findings. Case at a Glance Insurer Win Case Colon L. Carter v. …