Nick Ortiz

Filthaut v. AT&T – Court Rules STD Denial Meets Arbitrary And Capricious Standard

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.

Maiden v. Aetna – Experts’ Bread Has Been Buttered By Aetna Before

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.

Evans-Carmichael v. Liberty Mutual – Federal Court Remands Non-ERISA Case To State Court

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.

Esbensen v. LINA – Defendant Acted Arbitrarily And Capriciously

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.

Khan v. Provident – Court Disagrees With Insurer’s Interpretation Of Policy

Farooq Khan, M.D. (“Khan”), is a neurologist who filed for long-term disability insurance benefits. Provident Life and Accident Insurance Company (“Provident”) denied Dr. Khan’s LTD claim. After exhausting his appeals directly with the insurance company, Dr. Khan filed suit against Provident for breach of contract, asking the court to award payment of his long-term disability benefits. Dr. …

Doe v. Prudential – Court Rules That The Mental Illness Limitation Doesn’t Apply

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.

Denney v. Unum – Court Ruled In Favor Of Claimant And Remands Case

Cara R. Denney (“Denney”) was an employee of Wagner Equipment Company (“Wagner”) where she was a Computer and Technology Instructor. Her job duties “required extensive computer use” and “the ability to instruct employees on the use of various computer systems.” She was also required to travel up to fifty percent of the time, be able to …

Krysztofiak v. Boston Mutual – Court Rules Clinical Coordination Manager Is Entitled To Benefits

Dana Krysztofiak (“Krysztofiak”) works as a registered nurse but was previously a Clinical Coordination Manager for the company HomeCare Maryland, LLC. In 2016, Krysztofiak ceased working because of problems with fibromyalgia and psoriatic arthritis. She then filed for long-term disability benefits with Boston Mutual Life Insurance Co. (“Boston Mutual”). According to the language of the policy: Further, payments only …

Cowern v. Prudential – Vocational Expert Not Permitted To Consider All Records

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.

Pearson-Rhoads v. Aetna – Court Rejects Treating Physician’s Opinion In Favor Of Paper Review

In Pearson-Rhoads v. Aetna Life Insurance Company, the plaintiff sued for the payment of long-term disability insurance benefits from the insurer of her ERISA governed plan, Aetna Life Insurance Company. The plaintiff made numerous arguments. All were rejected by the court. Of particular note here is the plaintiff’s argument that Aetna abused its discretion by …

Faciane v. Sun Life – Court Rules In Favor Of Sun Life In Underpayment Suit

In Faciane vs. Sun Life Assurance Company of Canada, the claimant received a monthly benefit for long-term disability benefits pursuant to an ERISA-regulated group insurance policy. The group policy covered employees of Capital One Financial Corporation. He alleged that Sun Life had been underpaying him for years. The material facts of the case were not in …

Carter v. Aetna – Court Rules Plaintiff Did Not Meet Burden Of Proof

Colon Carter (“Carter”) worked as an estimating analyst for Bath Iron Works (“BIW”), a subsidiary of General Dynamics. His job duties included “developing cost proposals for new Navy and commercial work; developing and maintaining proposal support documents and checklists; creating financial models; maintaining company baselines for all Programs; assisting management with department staffing plans; and …

Warner v. Unum – A Claimant Friendly ERISA Federal Court Decision

The Court concluded that Warner’s motion must be granted because Unum abused its discretion in denying her claim without substantively explaining its rejection of her functional capacity evaluation and relying exclusively on the absence of objective tests confirming her subjective symptoms when denying her claim.

Christmas v. Sun Life – Court Rules Evidence Plainly Supports Sun Life’s Conclusion

The case Meghan Christmas v. Sun Life Assurance Company of Canada was decided by the U.S. District Court for the District of Connecticut on December 13, 2018. In this case, Meghan Christmas (“Christmas”), a Manager of Global Solutions Integration for ISGN Corporation, sought long-term disability (“LTD”) benefits from Sun Life Assurance Company of Canada (“Sun Life”). Between …

Dawson v. LINA – Court Rules Claimant Didn’t Provide Enough Objective Evidence

Here, Chernequa Dawson (“Dawson”) worked as a Care Transition Coordination (“CTC”) Nurse Care Manager and was employed by Cigna Corporation (“Cigna”). Through her employment with Cigna, she was covered under both a short-term and long-term disability plan. For these plans, Cigna pays the short-term disability plan benefits, while Life Insurance Company of North America (“LINA”) pays for long-term …

Holmgren v. Sun Life – Court Rules Plaintiff Established That He Was Disabled

Based upon an exhaustive review of the administrative record, the Court found that the plaintiff had established by a preponderance of the evidence that he was disabled under the terms of the Plan during the relevant period.

Cheney v. Standard – Court Finds Claimant Meets The Definition Of Disability

Carole Cheney, a litigation partner at Kirkland & Ellis, filed for long-term disability benefits due to debilitating cervical spine pain that left her unable to sit, stand, or concentrate for extended periods. Standard Insurance denied her claim, asserting she could perform sedentary work with ergonomic accommodations. The court disagreed, finding that Cheney's condition prevented her from performing even one essential duty of her own occupation.

Cheney v. Standard – District Court Decision In Favor Of Plaintiff Reversed

This is an update to the previous District Court Decision in Cheney v. Standard. Here, the U.S. Court of Appeals reversed the lower court decision in favor of the Plaintiff and rules in favor of the insurance company.

Hounihan v. Aetna – Court Rules Claimant Isn’t Totally Disabled

Charlie Craig Hounihan (“Hounihan”) was a technician who was employed by Proctor and Gamble (“P&G”) on the Bounty paper towel line at a plant in Cape Girardeau, Missouri. Through his employment with P&G, Hounihan was covered under both short-term and long-term disability benefit plans with Aetna. The Proctor & Gamble Disability Committee (“Disability Committee”) is …

Carty v. MetLife – Court Orders MetLife To Pay LTD Benefits

In this case, Gary Carty (“Carty”) worked as a manager of Eastman Chemical Company’s (“Eastman”) information technology department. Gary held a policy under the Eastman Chemical Company Welfare Benefit Program which Metropolitan Life Insurance Company (“MetLife”) administered. Under the policy provisions, a claimant is considered disabled if he cannot make 80% of his pre-disability salary …

Sangha v. Cigna – Records Support A Finding Of Disability

In this case, the U.S. District Court for the Northern District of California ruled in favor of Plaintiff Sarabjit Sangha and ruled against Cigna Life Insurance Company of New York. Specifically, the Plaintiff appealed Cigna’s denial of her long-term disability (“LTD”) benefits. After reviewing briefs submitted by both parties, the Judge overturned Cigna’s denial of …

Calhoun v. LINA – Denial Was Arbitrary And Capricious

Because the record establishes that LINA acted arbitrarily and capriciously in denying Calhoun long-term disability benefits, the Sixth Circuit REVERSED the district court’s judgment and REMANDED this case to the district court.

Tracia v. Liberty Life – Court Remands Case For Further Review

Bruce Tracia (“Tracia”) was an employee of Comcast Cable Communication Management, LLC (“Comcast”) and held the job of a business account executive. He had previously worked as a line technician and several other positions while working for Comcast. Through his employment with Comcast, Tracia was covered by a Group Disability Income Policy. Liberty Life Assurance …

Bradshaw v. Reliance Standard – Pre-Existing Condition Exclusion Was Misapplied To Claim

In the instant case, Julissa Bradshaw (“Bradshaw”) was a medical biller for Pyramid Healthcare Solutions, Inc. (“Pyramid”). She held a policy through Reliance Standard Life Insurance Company (“Reliance Standard”) for both short-term and long-term disability coverage. Her coverage under this policy began on May 1, 2013. When Bradshaw was hired by Pyramid, she was several weeks into a pregnancy. She …