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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.
In granting summary judgment for MetLife, the district court reasoned that when Sumpter became disabled, Delphi’s plan did not provide the benefit he sought and that he was not entitled to equitable relief. The U.S. Court of Appeals for the Seventh Circuit upheld this decision.
In this case, the plaintiff noted that the Policy’s states that “‘Proof’ means the evidence in support of a claim for benefits and includes, but is not limited to, the following.” Plaintiff thus argued that, while objective medical evidence may be sufficient to support a disability claim, it was not necessary to do so.
A court must take into consideration the conflict of interest inherent in a benefits system in which the entity that pays the long-term disability benefits maintains discretionary control over the ultimate benefits decision. This is done by weighing the structural conflict as one of the many factors relevant to the benefits determination decision. However, this conflict of interest …
Television personality Robin Roberts has disclosed that she has Myelodysplastic Syndrome, which can qualify an individual to receive long-term disability benefits. Myelodysplastic syndromes, commonly referred to as MDS, are not easily categorized. They encompass numerous different diseases and are a group of blood and bone marrow disorders. In MDS, stem cells do not mature normally. As such, …
One of the hardest things I must explain to clients is how the insurance company does not care about the client’s disabling condition. Disability insurance companies are for-profit corporations constantly seeking ways to increase their bottom lines. More often than not, they accomplish this by denying long-term disability claims. In this article, we discuss an insurance …
Anne Wittmann (“Wittmann”) was an attorney at Baker, Donelson, Bearman, Caldwell, Berkowitz PC (“Baker Donelson”). Unum Life Insurance Company of America (“Unum”) administered and underwrote the long-term disability (LTD) plan that covered Wittmann. Wittmann filed a claim for disability benefits on April 7, 2014, since she had not worked from December 31, 2013. Under the plan, …
Case Name: Rose Bigham v. Liberty Life Assurance Company of Boston Court: United States District Court for the Western District of Washington at Seattle Type of Claim: Long-Term Disability Insurance Company: Liberty Life Assurance Company of Boston a/k/a Liberty Mutual Insurance Company (hereinafter “Liberty Life”) Claimant’s Employer: Amazon, LLC Claimant’s Occupation / Job Position: Security Technical Program Manager Disabilities: chronic intractable pain, fibromyalgia, …
Defendant advances two grounds for terminating the plaintiff’s long-term disability benefits. First, the defendant contends the plaintiff does not qualify for an exception to the “Other Limited Conditions” provision under the Plan because he does not have a herniated disc with documented neurological abnormalities. Second, the defendant claims the plaintiff is not disabled from all occupations and thus does not qualify for benefits during his policy's “Any Occupation” period. If established, either of these grounds would provide a recognized justification for the termination of the plaintiff’s benefits under the terms of the Plan.
The Fourth Circuit held that Sun Life abused its discretion when it terminated Wilkinson’s benefits because he provided sufficient evidence to support his eligibility for coverage and because Sun Life’s decision to terminate benefits was not the result of a principled reasoning process and not supported by substantial evidence. The Fourth Circuit, therefore, affirmed the district court’s decision.
Lincoln denied the Plaintiff’s LTD claim. The plaintiff filed a lawsuit in Federal Court. Lincoln filed a motion for judgment as a matter of law, to which Till responded with a motion for summary judgment. After a full briefing, the district court entered an order granting Lincoln’s motion and denying Till’s. The district court also subsequently denied Till’s motion to reconsider. After carefully considering the record on appeal, the parties’ briefs, and the relevant law, the Eleventh Circuit concluded that the district court decision is due to be affirmed.
In this case, Fredrick Smith (“Smith”) was employed as a plant manager for Charles Craft, Inc. (“Craft”) reaching back to the 1970’s. Through his job, he held group policies with Reliance Standard Life Insurance Company (“Reliance Standard”). Two of these polices included a long-term disability benefits plan and a life insurance policy. If an employee is considered …
Ursula Mayer (“Mayer”) was an employee of Mercy Health Services, LLC (“Mercy”) and was covered under a long-term disability insurance policy that was issued by Cigna Group Insurance (“Cigna”). She claimed that she was totally disabled according to the definition within the policy, that she applied for benefits with Cigna, and that her claim was denied. …
The Court held that MetLife undermined the ERISA process by failing to issue a proper denial and, further, by failing to notify the insured about the issues in dispute. The Court ordered MetLife to pay past-due benefits, with interest, and to continue paying benefits so long as they continue to remain due under the provisions of the Plan, unless and until MetLife issues a denial that is in full compliance with the requirements contained in ERISA.
The Court concluded that Defendant did not act in an arbitrary and capricious manner in denying Plaintiff’s claim for long-term disability benefits. Accordingly, the Court overruled Plaintiff’s Motion for Judgment on the Administrative Record, and sustained Defendant’s Motion for Entry of Judgment on the Administrative Record.
On December 16, 2016, the Department of Labor announced the release of a Final Rule to strengthen consumer protections for private-sector workers making long-term disability insurance benefit claims for benefits from their workplace disability insurance plans. This action ensures that disability claimants will receive a full and fair review of their claims, as required by …
In this case, Shenita Sapp (“Sapp”) sought to recover long-term disability benefits that were denied by the administrator of her plan. Sapp argued that the claims administrator, Sedgwick Claims Management Services (“Sedgwick”) was acting in an arbitrary and capricious manner when it made its decision. However, the Administrator of the Plan, AT&T Services, Inc. (“AT&T”) argued that Sapp had …
The plaintiff filed a civil action in federal court, asserting four claims under ERISA, a state law breach of contract claim, and an ADA claim. Prudential moved to dismiss the breach of contract claim, as ERISA preempts such a claim. Prudential also moved to dismiss the ADA claim because Prudential is not a proper defendant under that statute.
In this case, Teresa A. Seeman (“Seeman”) was an employee of Bank of America and served as a Vice President, Unit Manager from May of 1990 to December of 2007. Through her employment, she was part of a long-term disability plan that was administered by Metropolitan Life Insurance Company (“MetLife”). The plan defined “disability” as follows: By June 2008, …
Because Liberty failed to consider the evidence of Plaintiff’s job description in its determination of Plaintiff’s occupation, ultimately leading to their denial of Plaintiff’s claim, Liberty abused its discretion under the policy and incorrectly denied Plaintiff’s claim. In assessing the appropriate remedy for the case, the Court saw no need to remand the case back to the administrator.
The Magistrate Judge found that the defendant’s decision to deny benefits does not withstand the arbitrary and capricious standard of review and recommended that the case be remanded for further consideration. Defendant raises four objections to the R&R. The two most interesting objections were those where the defendant objected to (1) the application of the arbitrary and capricious standard of review and (2) the determination that the plaintiff’s failure to apply for Social Security benefits is irrelevant.
With the spread of the COVID-19 (coronavirus), many people are worried about what effect this will have on their disability insurance benefits. In this article, we will attempt to address some of the common questions we have received regarding COVID-19 and long-term disability insurance coverage and claims. How Will COVID-19 Affect My Disability Payments? With …
Before you apply for long-term disability benefits, it’s important to understand the laws governing most disability insurance plans. New regulations were released and began on January 1, 2018. These new regulations add new due process rights for claimants whom insurance companies have mistreated in the past. This is good news for claimants. However, insurance companies have been …
Case Name: Randall v. Metropolitan Life Insurance Company Court: United States District Court for the Northern District of California Date of Decision: February 6, 2017 Type of Claims: Short-term disability, long-term disability, and related health, dental, vision, and life insurance benefits. Insurance Company: Metropolitan Life Insurance Company, aka MetLife. Claimant’s Employer: Verizon Wireless Claimant’s Occupation / Job Position: Facilities Network Engineer Disabilities: Randall …
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 court held that Liberty abused its discretion, granted plaintiff summary judgment, and awarded disability benefits. The plaintiff worked as an insurance adjuster for Allstate; he was an “outside claims …
