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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.

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Home | Archives for Nick Ortiz | Page 19

Nick Ortiz

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 …

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

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 …

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

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 …

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

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.

Read moreWarner v. Unum – A Claimant Friendly ERISA Federal Court Decision

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 …

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

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 …

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

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.

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

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

Case Name: Carole Cheney v. Standard Insurance Company Court: United States District Court for the Northern District of Illinois Date of Decision: August 28, 2014 Type of Claim: Long-Term Disability under the Employee Retirement Income Security Act (“ERISA”) Insurance Company: Standard Insurance Company Claimant’s Employer: Kirkland & Ellis Claimant’s Occupation / Job Position: The plaintiff was a long-time attorney at Kirkland & Ellis …

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

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. Case Name: Cheney v. Standard Court: U.S. Court of Appeals for the Seventh Circuit Date of Decision: July 27, …

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

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 …

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

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 …

Read moreCarty v. MetLife – Court Orders MetLife To Pay LTD Benefits

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 …

Read moreSangha v. Cigna – Records Support A Finding Of Disability

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.

Read moreCalhoun v. LINA – Denial Was Arbitrary And Capricious

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 …

Read moreTracia v. Liberty Life – Court Remands Case For Further Review

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 …

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

Black v. MetLife – Social Media Monitoring Leads To Termination Of Benefits

In this case, the court found that the evidence MetLife received in 2014, and in 2015 after Black appealed MetLife’s initial denial, showed that Black’s physical condition had in fact improved sufficiently to allow her to perform sedentary work

Read moreBlack v. MetLife – Social Media Monitoring Leads To Termination Of Benefits

Bey v. Reliance Standard – Court Rules Reliance Standard Did Not Act Arbitrarily Or Capriciously

The Court found that ERISA preempts Ms. Bey’s state law claims and that Reliance is entitled to summary judgment in its favor in all respects. Given the thorough review by an independent physician, the Court did not conclude that Reliance acted arbitrarily or capriciously.

Read moreBey v. Reliance Standard – Court Rules Reliance Standard Did Not Act Arbitrarily Or Capriciously

Ausler v. Aetna – Court Affirms That Claimants Must Exhaust Appeals to File Suit

In this case, Tiffany Ausler (“Ausler”) worked as a software engineer for Boeing Corporation (“Boeing”). Because she was a Boeing employee, Ausler was covered under both short-term and long-term disability compensation plans where Aetna Life Insurance Company (“Aetna”) was the administrator of the plans. The plan brochure explains that an employee may be eligible for short-term disability benefits …

Read moreAusler v. Aetna – Court Affirms That Claimants Must Exhaust Appeals to File Suit

Arning v. Aetna – Court Rules There Was No Abuse Of Discretion

Charles Buford Arning (“Arning”) was employed full-time by ECMD, Inc. as the President of the Arndt & Herman Building Products Division. Aetna Life Insurance Company (“Aetna”) administered a Long-Term Disability Executives Plan provided to ECMD employees. The Plan’s language provides: “You will be considered disabled while covered under this . . . Plan on the …

Read moreArning v. Aetna – Court Rules There Was No Abuse Of Discretion

Scott v. Union Security – Court Upholds Denial Of Orthopedic Surgeon’s Claim

In this case, Andrew Scott (“Scott”) was an orthopedic surgeon focusing on sports medicine. His employer had a long-term disability (LTD) plan through Union Security Insurance Company (“Union”). The LTD plan defined “disability” as follows: In October 2012, the Plaintiff had surgery for a rotator cuff injury. As a result, he stopped working as a surgeon. Union then …

Read moreScott v. Union Security – Court Upholds Denial Of Orthopedic Surgeon’s Claim

Usztics v. Unum – Court Finds No Evidence To Support Disability

Susan Usztics (“Usztics”) was employed as a program manager for MSX International, Inc. Through her employment, she held a short-term disability benefits policy which was administered by Unum Life Insurance Company of America (“Unum”). Her last day of work was February 4, 2014, following which she applied for short-term disability benefits because of fibromyalgia, anxiety, and …

Read moreUsztics v. Unum – Court Finds No Evidence To Support Disability

Zerangue v. Lincoln – Case Dismissed Because Claimant Did Not Apply For Benefits

In Zerangue v. Lincoln National, Lena Zerangue (“Zerangue”) filed an ERISA suit against The Lincoln National Life Insurance Company (“Lincoln”) in an attempt to recover long-term disability benefits that she believed she should receive. Because of her employment with Alliance Benefit Partners, Zerangue held policy coverage under both short-term and long-term disability plans. Zerangue pleaded that Lincoln …

Read moreZerangue v. Lincoln – Case Dismissed Because Claimant Did Not Apply For Benefits

Draper v. Aetna – Court Rules That MRI Was Not A Significant Finding

In this case, Christopher Draper (“Draper”) worked as a truck driver/courier for Federal Express Corporation (“Fed Ex”). His job duties included doing things such as “maneuvering packages of any weight above 75 lbs. with appropriate equipment and/or assistance from another person.” This claim arose from a denial of Draper’s short-term disability (STD) benefits which originated …

Read moreDraper v. Aetna – Court Rules That MRI Was Not A Significant Finding

Burkhead v. LINA – Denial Was Arbitrary And Capricious

In Burkhead v. Life Insurance Company of North America, the plaintiff filed for short and long-term disability benefits from Life Insurance Company of North America (LINA), the insurer of her ERISA governed plan. In the District Court’s Opinion, the court held that LINA abused its discretion in denying plaintiff benefits under the “own occupation” standard …

Read moreBurkhead v. LINA – Denial Was Arbitrary And Capricious
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