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Home | Archives for Nick Ortiz | Page 16

Nick Ortiz

Tash v. MetLife – Court Finds MetLife Subverted ERISA Process

April 30, 2020 // by Nick Ortiz

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 …

Read moreTash v. MetLife – Court Finds MetLife Subverted ERISA Process
Category: Case Summary Blog
Tags: MetLife

Slaton v. Standard – Claimant’s Failure To Report Symptoms Led To Claim Denial

April 29, 2020 // by Nick Ortiz

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.

Read moreSlaton v. Standard – Claimant’s Failure To Report Symptoms Led To Claim Denial
Category: Case Summary Blog
Tags: Standard

New Department Of Labor Rule Strengthens Protections For Long-Term Disability Claimants

April 29, 2020 // by Nick Ortiz

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 …

Read moreNew Department Of Labor Rule Strengthens Protections For Long-Term Disability Claimants
Category: Long-Term Disability, News

Sapp v. AT&T – Court Rules Sedgwick’s Denial Was Reasonably Supported

April 28, 2020 // by Nick Ortiz

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, …

Read moreSapp v. AT&T – Court Rules Sedgwick’s Denial Was Reasonably Supported
Category: Case Summary Blog
Tags: AT&T Services Inc., Sedgwick

Seese v. Prudential – Court Rules ADA Claim Against Prudential Must Be Dismissed

April 28, 2020 // by Nick Ortiz

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.

Read moreSeese v. Prudential – Court Rules ADA Claim Against Prudential Must Be Dismissed
Category: Case Summary Blog
Tags: Prudential

Seeman v. MetLife – Vice President Wins Long-Term Disability Claim

April 28, 2020 // by Nick Ortiz

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 …

Read moreSeeman v. MetLife – Vice President Wins Long-Term Disability Claim
Category: Case Summary Blog
Tags: MetLife

Sapp v. Liberty Life – Liberty Failed To Consider Plaintiff’s Job Description

April 28, 2020 // by Nick Ortiz

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 …

Read moreSapp v. Liberty Life – Liberty Failed To Consider Plaintiff’s Job Description
Category: Case Summary Blog
Tags: Liberty Mutual

Rowe v. United Of Omaha – Failure To Apply For Social Security Disability Not Relevant

April 28, 2020 // by Nick Ortiz

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 …

Read moreRowe v. United Of Omaha – Failure To Apply For Social Security Disability Not Relevant
Category: Case Summary Blog
Tags: Mutual of Omaha

COVID-19 And Long-Term Disability Insurance

April 27, 2020 // by Nick Ortiz

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 …

Read moreCOVID-19 And Long-Term Disability Insurance
Category: Long-Term Disability

Important Changes For Long-Term Disability Claims In 2018

April 27, 2020 // by Nick Ortiz

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 …

Read moreImportant Changes For Long-Term Disability Claims In 2018
Category: Long-Term Disability, News

Randall v. MetLife – Doctor’s Conclusion Outweighs Subjective Complaints

April 27, 2020 // by Nick Ortiz

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 …

Read moreRandall v. MetLife – Doctor’s Conclusion Outweighs Subjective Complaints
Category: Case Summary Blog
Tags: MetLife

Kavanay v. Liberty Life – Insurer Cannot Ignore A Claimant’s Job Duties During Own Occupation Period

April 27, 2020 // by Nick Ortiz

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 …

Read moreKavanay v. Liberty Life – Insurer Cannot Ignore A Claimant’s Job Duties During Own Occupation Period
Category: Case Summary Blog
Tags: Liberty Mutual

Puccio v. Standard – Plaintiff Is Entitled To Description Of Additional Materials Necessary To Perfect Claim

April 27, 2020 // by Nick Ortiz

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.

Read morePuccio v. Standard – Plaintiff Is Entitled To Description Of Additional Materials Necessary To Perfect Claim
Category: Case Summary Blog
Tags: Standard

Patterson v. Aetna – Court Rules Own Occupation And Regular Occupation Are Interchangeable

April 27, 2020 // by Nick Ortiz

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 …

Read morePatterson v. Aetna – Court Rules Own Occupation And Regular Occupation Are Interchangeable
Category: Case Summary Blog
Tags: Aetna

Parr v. Reliance Standard – Modest Activity Doesn’t Equal Ability To Work

April 27, 2020 // by Nick Ortiz

The Court concluded that the Plaintiff did establish by a preponderance of the evidence that she was “totally disabled” under the “any occupation” standard.

Read moreParr v. Reliance Standard – Modest Activity Doesn’t Equal Ability To Work
Category: Case Summary Blog
Tags: Reliance Standard

Fleming v. Unum – Court Rules Unum Cherry-Picked The Record

April 23, 2020 // by Nick Ortiz

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 …

Read moreFleming v. Unum – Court Rules Unum Cherry-Picked The Record
Category: Case Summary Blog
Tags: Unum

Okuno v. Reliance Standard – Court Rules In Favor Of Reliance Standard

April 23, 2020 // by Nick Ortiz

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 …

Read moreOkuno v. Reliance Standard – Court Rules In Favor Of Reliance Standard
Category: Case Summary Blog
Tags: Reliance Standard

Shaw v. LINA – Claimant Refused To Follow Recommended Treatment Plan

April 23, 2020 // by Nick Ortiz

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.

Read moreShaw v. LINA – Claimant Refused To Follow Recommended Treatment Plan
Category: Case Summary Blog
Tags: Life Insurance Company of North America (LINA)

Nieves v. Prudential – Prudential Failed To Provide A Full and Fair Review

April 23, 2020 // by Nick Ortiz

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.

Read moreNieves v. Prudential – Prudential Failed To Provide A Full and Fair Review
Category: Case Summary Blog
Tags: Prudential

Neno v. Aetna – Court Finds There Was No Abuse Of Discretion

April 23, 2020 // by Nick Ortiz

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 …

Read moreNeno v. Aetna – Court Finds There Was No Abuse Of Discretion
Category: Case Summary Blog
Tags: Aetna

There Are Not More People Going On Disability Than Getting Jobs

April 22, 2020 // by Nick Ortiz

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 …

Read moreThere Are Not More People Going On Disability Than Getting Jobs
Category: Social Security Disability

Nagy v. Hartford – Court Upholds LTD Claim Denial

April 22, 2020 // by Nick Ortiz

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 …

Read moreNagy v. Hartford – Court Upholds LTD Claim Denial
Category: Case Summary Blog
Tags: Hartford

Murphy v. Aetna – Claim Terminated Under Any Occupation Standard

April 22, 2020 // by Nick Ortiz

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 …

Read moreMurphy v. Aetna – Claim Terminated Under Any Occupation Standard
Category: Case Summary Blog
Tags: Aetna

Miller v. Hartford – Court Upholds Denial Of Fibromyalgia And Depression Claim

April 22, 2020 // by Nick Ortiz

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, …

Read moreMiller v. Hartford – Court Upholds Denial Of Fibromyalgia And Depression Claim
Category: Case Summary Blog
Tags: Hartford
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