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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.
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.
Aetna approved the Appellant’s claim for LTD benefits from September 25, 2012, through February 23, 2013, but denied her claim for benefits for any period thereafter. Thus, the Sixth Circuit limited its review to determining, de novo, whether the Appellant was entitled to benefits beyond February 23, 2013.
Reliance Standard Life Insurance Company (“Reliance Standard”) terminated McIntyre’s long-term disability (“LTD”) benefits under the stricter “any occupation” standard, finding her capable of sedentary work despite her Charcot-Marie-Tooth Syndrome causing progressive muscle atrophy, fatigue, and balance problems. The Minnesota court sided with McIntyre, finding Reliance Standard’s lengthy delay in deciding her appeal was a serious …
Hartford Life & Accident Insurance Company terminated Mawa’s long-term disability (LTD) benefits for peripartum cardiomyopathy once the stricter “any occupation” standard took effect, relying on independent physician reviews that found her capable of full-time sedentary work despite her ongoing lightheadedness and cardiac symptoms. The court upheld the denial, finding a second reviewing physician’s restrictions were …
United of Omaha Life Insurance Company and Mutual of Omaha Insurance Company (collectively, “United”) denied Smith’s long-term disability (LTD) claim for metastatic ovarian cancer, arguing it was a pre-existing condition because she’d been treated for pleural effusion — a cancer symptom — during the policy’s look-back period, even though her cancer wasn’t actually diagnosed until …
Prudential terminated Maher’s long-term disability benefits for fibromyalgia and a disputed Sjogren’s Syndrome diagnosis after three separate physician reviews concluded her medical records didn’t support the diagnosis or explain how it would prevent her from working. The court upheld the denial through two rounds of appeal, finding Prudential’s file reviews were sufficient and its reliance …
A dentist from Michigan prevailed on appeal after Provident Life and Paul Revere denied his long-term disability benefits. Although the insurers argued he wasn’t totally disabled because he could still perform managerial duties, the Sixth Circuit affirmed that he was unable to perform the primary duties of his occupation.
Although she initially received long-term disability benefits from Reliance Standard, Lash's claim was later denied under the stricter “any occupation” standard. Lash sued both Reliance Standard and Matrix Absence Management, the plan’s third-party administrator.
Kouzmanoff sought short- and long-term disability (LTD) benefits, arguing his diabetes combined with the stress of a quota-driven sales job made him unable to work safely. Unum denied both claims, and the Colorado court agreed, finding Kouzmanoff failed to show his diabetes actually caused any work limitation — his own doctor pointed instead to personality, …
In this case, the court found that United of Omaha Life Insurance Company failed to evaluate the medical evidence presented adequately. The insurer ignored favorable evidence submitted by her treating physician(s), selectively reviewed the evidence it did consider from the treating physicians, failed to conduct its own physical examination, and heavily relied on non-treating nurses and other non-physicians.
The Court held, “The level of activity or the lack thereof that Mr. Khalil reported to Liberty in support of his claim of continued disability was undermined by the video evidence that Liberty collected during the three years of review.” The claimant’s claim was further undermined by the fact that his own treating physicians ultimately opined that he was not disabled. The Court denied Plaintiff’s Motion for Summary Judgment and granted Liberty’s Motion for Summary Judgment.
On May 8, 2015, United informed Kerridge’s counsel by letter that it had denied Kerridge’s appeal. United indicated that its decision was based on the records from Dr. Wilson and the Cleveland Clinic, the other records in Kerridge’s file, and Dr. Zafar’s report from the IME. Kerridge filed a civil action in Federal Court seeking review of United’s decision.
The Third Circuit affirmed summary judgment for Sun Life and Health Insurance Company, holding that Sun Life did not abuse its discretion in terminating Kenneth Baker’s long-term disability (LTD) benefits after finding he was capable of performing “Any Occupation” duties. Case at a Glance Insurer Win Case Kenneth Baker v. Sun Life and Health Insurance …
A federal court in Arizona denied American General’s motion for partial summary judgment, holding that a jury could find the company acted in bad faith in terminating Dr. Tyler’s long-term disability benefits based on accommodations her job may not have realistically allowed. Case at a Glance Case Kelly Ann Tyler v. United States Life Insurance …
A federal court in Arkansas affirmed Aetna Life Insurance Company’s decision to terminate Katherine Kochanek’s short-term disability benefits, holding that Aetna’s denial was reasonable and supported by substantial evidence, and dismissed her case with prejudice. Case at a Glance Insurer Win Case Katherine Kochanek v. Aetna Life Insurance Co. Court United States District Court for …
The fact that Dee was eventually diagnosed with cancer and that her shoulder pain “in retrospect” was caused by her cancer is not material to a determination of whether her medical care providers at the time of the medical treatment suspected cancer.
The Eighth Circuit affirmed that Lisa Jones was not entitled to long-term disability (LTD) benefits from Aetna Life Insurance Company and, in this later appeal following an earlier remand, affirmed dismissal of her related breach-of-fiduciary-duty claim because she never raised it during Aetna’s internal administrative appeal process. Case at a Glance Insurer Win Case Lisa …
A federal court sided with Jennifer Coats in a dispute over how Reliance Standard Life Insurance Company calculated her long-term disability (LTD) benefit amount, ruling that her regular work week was correctly interpreted as her normally scheduled hours and that her pay rate should include the shift differential for hours worked between 7:00 PM and …
The court agreed with Doe that Standard's reliance on the DOT description of a generic "lawyer," rather than a job description that fully and accurately encompassed the material duties of Doe's specialized area of legal practice, rendered Standard's decision arbitrary and capricious.
The Second Circuit recently ruled in favor of Hartford in a long-term disability claim involving multiple sclerosis, finding that Hartford's denial of long-term disability coverage was not arbitrary and capricious.
The Court affirmed the district court’s decision granting summary judgment to Reliance Standard on the ground that it did not abuse its discretion in denying the claimant’s long-term disability benefits. In other words, the Court ruled in favor of the insurance company.
The court ruled that Hartford reasonably relied on medical opinions and surveillance evidence in deeming her ineligible for continued benefits, which means Hartford’s decision to terminate LTD benefits was rationally justified and thus is not arbitrary and capricious.