Nick Ortiz

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 …

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

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.

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 …

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 …

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 …