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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.
Question: “My job is saying I must resign since I am filing for long-term disability and do not plan to return to work. Should I consider resigning due to a disability?” The simple answer is most likely “no.” In fact, if you resign, you will lose your long-term disability benefits altogether. Except for very few …
In Cassidy v. Aetna Life Insurance Company, the U.S. District Court for the Eastern District of Kentucky ruled in favor of Aetna in a long-term disability insurance claim. The decision was issued on May 21, 2021. The long-term disability insurance claim was governed by the Employee Retirement Income Security Act of 1974 (ERISA). Ms. Cassidy …
Mr. Calkin was a 65-year-old manager of architectural design for AIG from June 10, 2013, through June 24, 2014. Mr. Calkin suffered from impingement syndrome in his left shoulder, brachial plexopathy (a form of neuropathy), bilateral shoulder pain, lower back pain due to degenerative disc disease and stenosis in his lumbar spine, degenerative joint disease in his left knee, as well as …
Ms. Harrison was a claimant who worked as a customer service representative for a cash advance lender. Her duties included selling financial products to customers, providing customer service, handling money, and overseeing financial transactions. She also suffered from depression and anxiety during her time at this place of employment. Ms. Harrison had suffered for many years from depression and …
When you file a long-term disability claim, it is common for the insurance investigator to call you and ask casual questions about your health and daily life. Next, they will say, "We want to send someone to your home to meet with you to discuss your claim." This is called a field interview.
Note: This form is also known as an Attending Physician Statement (APS) or a Medical Source Statement (MSS). We will use these terms interchangeably throughout the rest of this article. What Is A Residual Functional Capacity Assessment? A residual functional capacity assessment evaluates your impairment(s) and any related symptoms, such as pain, that may cause …
In this case, Tommy W. Senegal (“Senegal”) had a long-term disability policy that was administered by Reliance Standard Life Insurance Company (“Reliance Standard”) as a benefit of his employment by Cequel III, LLC (“Cequel”). Senegal worked for Cequel as a field service engineer; his duties were specifically related to supervising cable installation. This installation process …
Marybeth M. Donlick (“Donlick”) was employed as a truck driver for Chesapeake Energy Corporation (“Chesapeake”). Through her employment, Donlick received coverage for a long-term disability benefits plan, which was administered by Standard Insurance Company (“Standard”). On August 7, 2012, Donlick was in a motorcycle crash which caused her to have an amputation below her right …
In this case, David Diaz (“Diaz”) was the district manager at JM Family Enterprises, Inc. (“JM Family Enterprises”) between September 2010 and October 2015. JM Family Enterprises’ had an employee benefit plan which covered long-term disability benefits. This plan was insured by Liberty Life Assurance Company of Boston (“Liberty”). Under the plan, the term “disabled” …
Carianne Deroo (“Deroo”) worked as an employee for Beaumont Hospital as a Clinical Nurse II. This role involved full-time work as a registered nurse which required patient care. Through her employment with Beaumont Hospital, Deroo was covered by a long-term disability benefits policy which was administered by Unum Life Insurance Company of America (“Unum”). The …
Brenda Counts (“Counts”) previously worked as an employee of Denver Wholesale Florist-Flint as a flower sales specialist. Her job title was formally known as “Inside Sales Associate” which required “making sales calls, pulling product[,] and packing.” Through her job, she held a disability insurance policy with United of Omaha Life Insurance Company (“United”). Under this …
Lisa Conner (“Conner”) was a perioperative nurse at St. Vincent’s Medical Center. Through her employment, she held a policy under the Ascension Health (“Ascension”) Long-Term Disability plan. Sedgwick administered this plan. The language of the plan explained that: On May 20, 2013, Conner was in a car accident that left her with injuries to her neck, left arm and left …
Keyton Benson (“Benson”) was employed by Tower Hill Insurance Group. Through his employer, Benson was eligible for long-term disability benefits through a policy issued by Hartford Life & Accident Insurance Company (“Hartford”). The policy language states that it will provide a policyholder with monthly payments if he has: In addition, the policy defined “disability” or …
In a perfect world, anyone who suffers from a physical or emotional disability would have the resources to seek treatment and provide for themselves without supplemental income. But since we live in the real world, many people struggle to make ends meet during a period of disability. Long-term disability insurance is supposed to provide supplemental …
The Definition of Disability One of the most important things to know is how disability is defined in your policy. Whether you have an employer-provided group policy or an individual policy, there are significant differences in the definitions of disability. Understanding these differences is crucial for filing successful long-term disability claims. In this article, we …
What Is an Independent Medical Examination? An independent medical examination (IME) is an exam performed by a medical professional not currently associated with your case. However, we don’t like using the term “independent” when referring to a medical examination ordered by a disability insurance company. The word independent is in quotes because we do not …
Many people on long-term disability worry about whether they will continue to receive benefits beyond the two-year mark, and for a good reason: Long-term disability denials are common after two years because most disability insurance policies change the definition of disability or will no longer pay benefits for certain conditions after benefits have been payable …
When most people file a long-term disability appeal, it is a really basic, one or two-paragraph appeal letter that says, “Look, long-term disability insurance company. I really think you got this one wrong. I think there is more than enough evidence to support my long-term disability claim. I want you to go back, take another …
If your disability insurance company has denied or terminated your long-term disability claim, you should review your insurance policy to familiarize yourself with your appeal rights and requirements. Specifically, you should determine how many appeals you have the right to or are required to file before you can file a lawsuit against your insurer. Most …
When you apply for Social Security Disability Insurance benefits (DIB, also called SSDI or RSDI), Social Security does not tell you that you can (or should) hire a Social Security disability attorney to assist you in your claim. You Have The Right To Representation From The Beginning Many claimants know they can hire an attorney …
A “closed period” of benefits may be appropriate in Social Security disability claims where the claimant’s impairment has lasted for a continuous period of at least 12 months but improves to the point where the claimant is no longer disabled at the time the claim is ultimately decided (in other words, at the time of …
Previously, the “Treating Physician Rule” provided that substantial weight should be given to the impairment opinions given by a treating doctor in a Social Security Disability Insurance claim. However, starting March 27, 2017, the Social Security Administration (SSA) will no longer prioritize the opinions of your personal doctors. Instead, these opinions will be considered equally …
The Social Security Administration uses a five-step sequential evaluation process to decide whether you are disabled. These rules apply to you if you file any of the following applications for Social Security disability benefits: Supplemental Security Income benefits, Social Security Disability Insurance benefits, child’s insurance benefits, and widow’s or widower’s benefits. Social Security will consider …
The Appeals Council is the final level of administrative appeal following an unfavorable decision from an Administrative Law Judge (ALJ) in Social Security disability claims. Sometimes, evidence may not reach the ALJ before your hearing. Fortunately, you can still submit new evidence to the Appeals Council, provided the following conditions are met: Over time, the …
