Nick Ortiz

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 …

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 …

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 …

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 …

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 …

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

Anthony Bowman (“Bowman”) was employed as a Maintenance Mechanic which required the ability to do heavy lifting between fifty and sixty pounds. Injuries throughout his life caused him to have a number of surgeries and resulted in chronic neck and back pain. Bowman also had issues with a sleep disorder and pain medication, which led …

Ampe v. Prudential – Engineer’s Case Remanded For Further Review

This case involves James Ampe (“Ampe”), a Senior Development and Test Engineer employed by MIT Lincoln Laboratories (“MIT”). Ampe’s job duties included not only traditional electrical engineer work, but also regular client interactions. He was employed by the company from 2008 to January 26, 2015. Around August 2011, Ampe injured himself when he fell and …

Foster v. Principal – Court Rules Principal Didn’t Commit An Abuse Of Discretion

In this case, Amanda Foster (“Foster”) worked as an attorney for Sullivan, Stolier & Knight (“Sullivan”) in New Orleans. Her duties involved being able to “review and draft leases and agreements; research and advise clients regarding government laws and regulations; represent clients in administrative appeals; [and] draft compliance plans.” When Foster had been working for …

Charles v. UPS and Aetna – Court Rules Denial Of Benefits Was An Abuse Of Discretion

Aetna’s decision to deny the plaintiff benefits was unsupported by substantial evidence and was, thereby arbitrary and capricious. Aetna gave great weight to the opinions of its own experts and afforded little, to no, weight to the plaintiff’s own physicians. Under the circumstances, the plaintiff’s physicians—who had been treating him for several years—would be better able to recommend health and safety conditions than doctors who simply reviewed his medical files.

Allen v. Unum – Claim Denial Was Not An Abuse Of Discretion

The Court determined that Unum came to a reasonable decision after a principled decision-making process. Although the Court may have reached a different conclusion independently, Unum did not abuse its discretion in denying Allen’s claim for long-term disability benefits.

The Hartford Now Owns Aetna’s Long-Term Disability Group Insurance Division

If you have a long-term disability insurance claim that has been managed by Aetna, and now letters are coming to you on letterhead from the Hartford, do not be alarmed. That’s because Hartford entered into a definitive agreement to acquire Aetna’s U.S. group life and disability business in October 2017. This means that Hartford has …