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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.
On December 16, 2016, the Department of Labor announced the release of a Final Rule to strengthen consumer protections for private-sector workers making long-term disability insurance benefit claims for benefits from their workplace disability insurance plans. This action ensures that disability claimants will receive a full and fair review of their claims, as required by …
In this case, Shenita Sapp (“Sapp”) sought to recover long-term disability (LTD) benefits for PTSD and bipolar disorder. Her claim was denied by Sedgwick Claims Management Services (“Sedgwick”) after an independent medical examiner concluded her test results showed deliberate symptom exaggeration, despite her diagnoses from multiple treating doctors and her award of Social Security disability benefits. The court …
The plaintiff filed a civil action in federal court, asserting four claims under ERISA, a state law breach of contract claim, and an ADA claim. Prudential moved to dismiss the breach of contract claim, as ERISA preempts such a claim. Prudential also moved to dismiss the ADA claim because Prudential is not a proper defendant under that statute.
Metropolitan Life Insurance Company (“MetLife”) paid Teresa A. Seeman’s (“Seeman”) long-term disability (LTD) benefits for two years before terminating them, and after an earlier remand for further review, MetLife terminated her benefits a second time following four separate physician reviews. The court ruled in Seeman’s favor, finding it was an abuse of discretion for MetLife …
Because Liberty failed to consider the evidence of Plaintiff’s job description in its determination of Plaintiff’s occupation, ultimately leading to their denial of Plaintiff’s claim, Liberty abused its discretion under the policy and incorrectly denied Plaintiff’s claim. In assessing the appropriate remedy for the case, the Court saw no need to remand the case back to the administrator.
The Magistrate Judge found that the defendant’s decision to deny benefits does not withstand the arbitrary and capricious standard of review and recommended that the case be remanded for further consideration. Defendant raises four objections to the R&R. The two most interesting objections were those where the defendant objected to (1) the application of the arbitrary and capricious standard of review and (2) the determination that the plaintiff’s failure to apply for Social Security benefits is irrelevant.
With the spread of the COVID-19 (coronavirus), many people are worried about what effect this will have on their disability insurance benefits. In this article, we will attempt to address some of the common questions we have received regarding COVID-19 and long-term disability insurance coverage and claims. How Will COVID-19 Affect My Disability Payments? With …
Before you apply for long-term disability benefits, it’s important to understand the laws governing most disability insurance plans. New regulations were released and began on January 1, 2018. These new regulations add new due process rights for claimants whom insurance companies have mistreated in the past. This is good news for claimants. However, insurance companies have been …
This case shows how ERISA courts weigh evidence: in Randall v. MetLife, short- and long-term disability benefits were denied because the claimant’s reported pain and diagnoses weren’t backed by objective findings or physician opinions restricting work. Doctor conclusions and measurable proof carried more weight than subjective complaints.
Kavanay worked as an Outside Claims Adjuster for Allstate, but Liberty Life evaluated his “own occupation” long-term disability (LTD) claim against the Dictionary of Occupational Titles description for a sedentary “Inside Claims Examiner” instead of his actual job duties. The court found this an abuse of discretion, ruling that while an insurer may look at …
There is no dispute that Puccio is disabled. She has multiple medical conditions that limit her ability to work. The only dispute is whether her disabilities are covered by the LTD policy or whether she has exhausted the maximum benefits allowed under the policy for her particular conditions.
Aetna Life Insurance Company (“Aetna”) terminated Patterson’s long-term disability (“LTD”) benefits after concluding he could perform “sedentary” work under a national-economy definition of his “own occupation” — without ever assessing whether he could perform his actual job duties for his employer. The Third Circuit affirmed summary judgment in Patterson’s favor, holding that “own occupation” unambiguously …
The Court concluded that the Plaintiff did establish by a preponderance of the evidence that she was “totally disabled” under the “any occupation” standard.
Unum paid Fleming’s long-term disability benefits for over a decade before terminating them based largely on two days of surveillance footage showing her carrying groceries and driving. The court ruled in Fleming’s favor, finding Unum improperly gave outsized weight to fifteen minutes of surveillance and cherry-picked statements from a paper-only review, when weighed against a …
Okuno has not established that she satisfied the requisite conditions to obtain disability benefits beyond what Reliance has already paid. Reliance's denial of continued long-term disability benefits appears to have been the result of a principled and deliberative reasoning process. Accordingly, Reliance is entitled to judgment on the administrative record.
In this case, the medical reports in the administrative record were not sufficient to show by a preponderance of the evidence that Shaw was unable to perform the material duties of her regular occupation. The only reports that supported her claim were conclusory, and provide insufficient information concerning Shaw’s functional capacity.
The Court’s task is not to decide whether Plaintiff was disabled. Prudential denied benefits because Plaintiff was not covered by the Plan when his claim arose. Thus, the question is not whether Plaintiff had a valid disability claim but when his disability claim (whether valid or invalid) arose.
The medical evidence available does not suggest that Aetna abused its discretion by determining that Neno is able to perform the "material duties" of his "own occupation" as defined under the employee welfare benefit plan. Aetna's decision was supported by substantial evidence and was made with deliberate and principled reasoning, as it reviewed Neno's medical records and sought opinions from independent sources.
Sometimes perception does not meet reality. This post is in response to a comment in a local newspaper. In the “Spout Off” section of the Northwest Florida Daily News, a commentator complained: “There are more people going on disability than getting jobs. Apparently it is easier to qualify for disability than get a job. Something …
Nagy previously won a lawsuit awarding him long-term disability (LTD) benefits for a defined period, but this case concerns Hartford’s subsequent denial of benefits for the following “any occupation” period, based on chronic fatigue syndrome and related conditions. The court upheld Hartford’s denial, finding Nagy failed to prove continuous disability given a ten-month gap in …
When considering the record as a whole, the Court finds that Aetna’s denial of LTD benefits to Murphy was supported by substantial evidence therein and that Murphy has not met her burden to establish that such denial was arbitrary and capricious. Accordingly, Murphy’s objections to Aetna’s denial cannot withstand Aetna’s motion for summary judgment.
Hartford terminated Miller’s long-term disability (LTD) benefits for fibromyalgia and depression after multiple physician file reviews concluded she could perform light work, despite her primary physician’s opinion that she had debilitating limitations. The court upheld the denial, finding Miller’s own doctor acted “more as an advocate than a doctor rendering objective opinions” by never referring …
Under the arbitrary and capricious standard, the review is limited to whether reasonable grounds existed to support Aetna’s denial of benefits based on the administrative record before it. The Court held that Aetna reasonably concluded that Plaintiff was no longer entitled to long-term disability benefits and that their decision process was neither arbitrary nor capricious. Aetna’s denial of continued long-term disability benefits was affirmed.
The Court found Aetna’s denial of Plaintiff’s claim for long-term disability to be arbitrary and capricious and ordered Aetna to pay the long-term disability benefits for which he is qualified under the Plan.