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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.
Defendant informed Plaintiff that her claim for LTD benefits was denied because the medical information provided did not support restrictions and limitations and did not demonstrate a functional loss. The plaintiff argued that she was not required to submit objective medical evidence to prove her disability.
Disability benefits were paid for approximately one month and then were terminated. The termination letter acknowledged that “a medical condition may exist” but stated that “there must be objective medical information to support disability benefits” under the Plan. However, the court concluded that the decision to deny Godmar’s claim for short-term disability benefits beginning in July was arbitrary and capricious.
After reviewing the administrative record and giving no deference to Provident’s decision to terminate benefits, the court found substantial evidence supporting Provident’s decision to terminate Gilewski’s long-term disability benefits.
The Court held that Life Insurance considered all relevant information, including Abbey’s treatment notes, treatment notes from Plaintiff’s treaters at Philhaven, and the notes from the board-certified psychiatrist based on his peer review of Plaintiff’s medical records. The Court concluded that in light of the foregoing thorough review and subsequent basis for its denial, Life Insurance’s decision to deny long-term disability benefits to Plaintiff was not without reason and did not meet the required arbitrary and capricious standard. The Court further held that Life Insurance did not engage in any action violating Section 503 of ERISA and that Plaintiff did not have a separate, private cause of action for attorney’s fees and litigation costs.
The Court addressed several issues within the Plan’s determination that the Court found did meet the required arbitrary and capricious standard. (1) Whether the Plan ignored favorable evidence from the Plaintiff’s treating physicians. (2) Whether the Plan conducted a selective review of the evidence from Plaintiff’s treating physicians. (3) Whether the Plan failed to conduct its own physical evaluation of Plaintiff. (4) Whether the Plan relied too heavily on non-treating physician consultants.
The problems in Aetna's review of Maiden's evidence—inexplicably disregarding the opinions of treating physicians and ignoring evidence supporting disability while cherry-picking evidence to support a denial—lend an unmistakable hue of capriciousness to Aetna's review.
The parties’ supplemental briefing clarifies that, as an initial matter, they dispute the applicable policy to Plaintiff’s disability claim. Defendant argues that the Los Alamos National Security, LLC (“LANS”) Group Disability Income Policy (“LANS Policy”) applies to Plaintiff’s disability claim. Plaintiff disagrees and maintains that a University of California (“UC”) Supplemental Disability Policy (“UC Policy”) applies.
In this case, the court ruled that the conclusion by the peer review consultant was without reason when the evidence of record was examined. Thus, defendant acted arbitrarily and capriciously when relying on the peer review report to deny benefits.
A federal court in New York, following a bench trial on the administrative record, held that Dr. Farooq Khan is entitled to long-term disability (LTD) benefits under both the “Your Occupation” and “Any Occupation” provisions of his policy, finding that Provident Life and Accident Insurance Company (“Provident”) erred in requiring objective proof the policy didn’t demand …
The plaintiff argues that his disability has a physiological cause – in particular, brain damage likely resulting from HIV – and that Prudential should not have applied the mental health limitation. In this case, the Court agreed.
A federal court in Colorado ruled in favor of Cara Denney, remanding her long-term disability (LTD) claim to Unum Life Insurance Company of America for further review of whether she satisfied the plan’s 180-day elimination period, after finding Unum failed to adequately explain how that standard applied to her case. Case at a Glance Remanded …
A federal court in Maryland granted summary judgment to Dana Krysztofiak, holding that Boston Mutual Life Insurance Company (“Boston Mutual”) abused its discretion in terminating her long-term disability benefits and declaring her entitled to payment of benefits for the 24-month period at issue, based on her fibromyalgia. Case at a Glance Claimant Win Case Dana …
The Court found that Prudential abused its discretion in relying upon a vocational assessment that was based only on Prudential’s hired external medical reviewer’s opinions rather than all of the medical evidence.
A federal court in Pennsylvania granted summary judgment to Aetna Life Insurance Company, holding that its decision to deny Vanessa Pearson-Rhoads’s long-term disability claim was reasonable and not an abuse of discretion. Case at a Glance Insurer Win Case Vanessa Pearson-Rhoads v. Aetna Life Insurance Company Court United States District Court for the Eastern District …
Sun Life Assurance Company of Canada never disputed that Faciane is disabled or that his benefit calculation might have been wrong. The entire ruling turns on a single question: did Faciane wait too long to sue? The court found he did — his policy required any lawsuit within 3 years of when “Proof of Claim” …
A federal court in Maine granted summary judgment to Aetna Life Insurance Company, holding that its decision to deny Colon Carter’s long-term disability claim was reasonable and supported by sufficient evidence, despite Carter’s arguments that the reviewing physician had mischaracterized his treating providers’ findings. Case at a Glance Insurer Win Case Colon L. Carter v. …
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.
A federal court in Connecticut granted judgment to Sun Life Assurance Company of Canada (“Sun Life”), holding that its denial of Meghan Christmas’s long-term disability (“LTD”) benefits claim was supported by well more than substantial evidence, based on three independent physicians’ reviews finding no objective evidence of a disabling condition. Case at a Glance Insurer …
A federal court in Florida granted summary judgment to Cigna Corporation and Life Insurance Company of North America (“LINA”), holding that the denial of Chernequa Dawson’s short-term and long-term disability benefits was supported by reasonable grounds and not arbitrary or capricious, and separately granted the defendants’ counterclaim to recover an overpayment offset by her workers’ …
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.
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.
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.
A federal court in Missouri granted summary judgment to the Proctor & Gamble Disability Committee, holding that its determination that Charlie Hounihan was only partially — not totally — disabled was reasonable and supported by substantial evidence, and separately granted summary judgment on Hounihan’s breach of fiduciary duty claim. Case at a Glance Insurer Win …
A federal court in Tennessee ordered Metropolitan Life Insurance Company (“MetLife”) to pay Gary Carty retroactive long-term disability benefits and restore his ongoing benefits, finding — for the second time in this case — that MetLife acted arbitrarily and capriciously, and declining to remand a third time given the extensive record already before it. Case …