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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.
The Social Security Administration (“SSA”) will review your application to make sure you meet some basic requirements for Social Security disability benefits and evaluate any current work activities. If you meet these requirements, Social Security will send your application to the Disability Determination Services (“DDS”) office in your state. The DDS is a state agency …
The first thing you should do if you’ve received a denial letter in your Social Security disability claim is read the letter! I know this seems obvious, but I’ve spoken with countless claimant who were so mad or frustrated that they threw the letter in a drawer or into the trash. What these claimants fail …
When you apply for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, Social Security considers all the medical records and other evidence in your case before it makes any decisions on your eligibility for benefits or your benefit amount. When Social Security makes a decision on your claim, it will send you …
What Is a Trust? A trust is a legal arrangement regulated by State law in which one party holds money and/or property for the benefit of another. In certain situations, a trust can be set up for an SSI recipient. A trust can contain: How Does a Trust Affect My SSI Benefits? If you use …
Social Security Disability Insurance is not an alternative unemployment program of benefits. Any factor that is not related to the claimant’s disability is not relevant to a disability determination. This includes an individual’s inability to find a job in a weak economy with few job vacancies or that an employer would not be likely to …
The first step in evaluating a Social Security disability claim is determining whether a claimant is performing “substantial gainful activity” or SGA. The Unsuccessful Work Attempt According to Social Security’s regulations, work you have done will not ordinarily show that you are capable of performing substantial gainful activity if, after working for a period of …
As an experienced Florida disability attorney who has handled thousands of complex disability cases since 2005, I am continually amazed that many lawyers still have not abandoned what I consider to be the dinosaur of billing method – the billable hourly rate. Why Would You Hire An Attorney At An Outrageous Hourly Fee When You …
MetLife forwarded responses from Santana’s treating physicians to Dr. Simon, an “independent physician,” who reviewed them and concluded that the MRI was normal for a person of Santana’s age and that Santana had still failed to submit clinical evidence showing that he had either radiculopathy or any limitations due to neuropathy. By a letter dated August 19, 2011, MetLife denied Santana’s administrative appeal and upheld its earlier decision to deny him continuing long-term disability benefits. The Court agreed with MetLife that.
None of Liberty’s arguments persuade the Court that denying long-term disability benefits to Ms. Rouleau is appropriate. The preponderance of the evidence – indeed, the great weight of the evidence – reflects that Ms. Rouleau remained “disabled” as the Policy defines it even after the expiration of the “own occupation” period and is therefore entitled to the long-term disability benefits she seeks.
Drew A. Carson (“Carson”) was an attorney employed by Miller Goler Faeges LLP. Through his employment, he was covered by a long-term disability benefits plan which was administered by Unum Life Insurance Company of America (“Unum”). The plan explained that: “‘Disability’ and ‘disabled’ mean that because of injury or sickness: Further, proof of continuous disability and regular visits by …
The COVID-19 pandemic has brought unprecedented changes to every aspect of our lives. One area that is seeing dramatic changes is the healthcare industry. Hospitals have become trauma centers, and doctor’s offices have been overrun with patients experiencing COVID-19 symptoms. Many people are avoiding these areas for fear of contracting the virus. This has made …
The case summarized here involves Damon Zaeske (“Zaeske”), who was a project manager employed by Walmart. He ceased working on April 4, 2014, as a result of chronic back pain. Walmart’s insurance plan was underwritten by Liberty Life Assurance Company of Boston (“Liberty Life”); Zaeske applied for long-term disability (LTD) benefits through this plan. When reviewing Zaeske’s claim for …
In Mozdzierz v. Aetna Life Insurance Company, the plaintiff (claimant) seeks long-term disability benefits from Aetna, the insurer of his ERISA-governed long-term disability plan. The Federal District Court (for the Eastern District of Pennsylvania) found that Aetna did not abuse its discretion in denying plaintiff’s claim based upon the record. In other words, Aetna’s denial of benefits was upheld. It is …
A fast-growing lawsuit in the Eastern District of Pennsylvania has been filed against the NFL by nearly 4,000 former football players. They claim that the NFL “propagated its own industry-funded and falsified research to support its position” that athletes cannot receive long-term brain damage from playing football. The league’s highest medical experts have for years …
The Court granted Plaintiff’s Motion for Summary Judgment: “As explained above, I have identified three primary reasons for determining that Aetna abused its discretion in denying Plaintiff’s benefits: Inappropriate reliance on unreliable findings by Drs. Topper, McPhee, and Polanco; failure to address Plaintiff’s qualifications and ability to engage in sedentary occupations in light of her medication requirements; and failure to address the findings in the APS and Capabilities and Limitations Worksheets showing that Plaintiff could not perform full-time sedentary work.
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 (LTD) claims. In this article, we discuss an …
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, …
Rose Bigham, a Security Technical Program Manager at Amazon, filed suit after Liberty Life terminated her long-term disability benefits despite diagnoses of fibromyalgia, chronic pain, and degenerative disc disease. The court found that medical evidence from her treating physicians clearly supported her inability to perform the cognitive and interpersonal demands of her occupation.
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.
