Nick Ortiz

The Pitfalls Of Employer-Provided Long-Term Disability Policies

Long-term disability insurance offers financial protection if you cannot work due to an illness or injury. However, many employees encounter issues when claiming these benefits from their employer-provided policies. Understanding the potential challenges can help you prepare and navigate the process effectively. Issues with Employer-Provided Policies Policy Exclusions and Limitations Many employer-provided long-term disability policies …

Zall v. Standard – Dentist’s Right To A Full And Fair Review Was Violated

The Zall v. Standard Insurance Company case involves a long-term disability claim filed by Eric S. Zall, a dentist and co-owner of a dental practice, under an insurance policy with Standard Insurance Company. Zall filed this claim in 2013, at the age of 48, because of chronic neck pain and right-handed numbness and weakness resulting …

Communicating With Long-Term Disability Insurance Adjusters

Clear and strategic communication with insurance claims adjusters is essential for claimants seeking long-term disability benefits. Every interaction with the adjuster holds significant weight in the claims process, and effective communication is crucial to ensure you receive the benefits you deserve. However, many claimants face challenges in clearly and strategically communicating their situation and understanding …

The Crucial Role Your Doctor Plays In Getting Your Disability Claim Approved

When applying for disability benefits, the support of your doctor is crucial. Their medical expertise and documentation are fundamental in proving the extent of your disability to the authorities. Without their cooperation and detailed input, getting your disability claim approved can become significantly more challenging. Understanding your doctor’s pivotal role in this process is essential …

Understanding Third-Party Administrators In Disability Insurance Claims

Navigating the world of long-term and short-term disability insurance claims can be complex, especially when third-party administrators come into play. In this blog post, we will delve into the role of third-party administrators in disability insurance claims and the impact they can have on claimants. What Is a Third-Party Administrator in the Context of Disability …

Overcoming Long-Term Disability Claim Challenges For Self-Employed Individuals

Long-term disability insurance is crucial for self-employed individuals, yet the claims process can be complex. Self-employed individuals face unique challenges when filing for long-term disability benefits, encountering hurdles that traditional employees may not experience. From proving loss of income to demonstrating the severity of their condition, self-employed individuals must navigate a distinct set of obstacles. …

Schmill v. MetLife – Court Upholds 12-Month Benefit Limitation For Mental And Musculoskeletal Disorders

The case of Howard Schmill v. Metropolitan Life Insurance Company (MetLife) involved a long-term disability (LTD) claim under a plan governed by the Employment Retirement Income Security Act of 1974 (ERISA). Please note that the Ortiz Law Firm did not handle this case. Schmill, a Louisiana resident, was a foreman at Turner Industries Group, LLC, …

Benefit Limitations In Long-Term Disability Claims For Neuromuscular Disorders

Long-term disability claims for neuromuscular disorders can be complex and overwhelming. Navigating the process requires a clear understanding of the intricacies involved. From the initial application to potential appeals, each step demands attention to detail. This blog post will provide valuable insights to help you understand and navigate long-term disability claims for neuromuscular disorders. Understanding …

Benefit Limitations In Long-Term Disability Claims For Soft Tissue Disorders

Long-term disability claims often involve soft tissue disorders, such as back pain, fibromyalgia, and chronic fatigue syndrome. In this blog post, we will delve into long-term disability claims for soft tissue disorders and the specific challenges and policy limitations associated with these claims. With this knowledge, claimants can navigate long-term disability claims for soft tissue …

How To Transition From Short To Long-Term Disability Benefits

Are you researching how to transition from short to long-term disability benefits? Short-term disability (STD) benefits provide crucial support for individuals during the initial stages of their disability. However, short-term disability coverage usually only pays benefits for a few weeks to several months. If your disability lasts long enough to exhaust your STD coverage, you …

Navy Federal Long-Term Disability Insurance Claims

Navy Federal Credit Union (“NFCU” or Navy Federal) is the largest credit union in the world and the largest private employer in Pensacola and Escambia County, Florida, with nearly 10,000 employees at the Pensacola campus. Navy Federal has excellent employee benefits, including short-term disability (STD) and long-term disability (LTD) insurance benefits. These claims are typically administered …

Viso v. Federated – Plaintiff Failed To Provide Proof Of Disability

This case involves Viso, who filed a long-term disability insurance claim with Federated Insurance due to congenital hearing loss. The policy provided for up to 60 months of disability insurance benefits should Viso become disabled before age 65. The policy included the following definitions: Viso’s physician, Dr. Steven Dear, partially completed his Statement of Disability, …

The Importance Of Long-Term Disability Insurance In The Oil And Energy Industry

Long-term disability coverage is important, especially for those in the oil, gas, or energy sectors. Workers often face dangerous conditions and physical demands in these industries that can lead to disability. These injuries range from minor sprains and strains to severe accidents and exposure to toxic substances, resulting in permanent disability. A long-term disability plan …

Geiger v. Zurich – Failure To Obtain Additional Vocational Evidence Not An Abuse Of Discretion

The case involves a dispute over long-term disability (LTD) benefits between Geiger, the claimant, and Zurich American Life Insurance Company of New York (“Zurich”), the administrator of an ERISA-regulated benefits plan. Background Geiger worked at CBS News in New York as a writer/editor. In March 2018, at the age of 58, Geiger could not go …

Long-Term Disability Insurance Claims For Amazon Employees

Disability insurance claims for Amazon employees can be a crucial aspect of ensuring financial stability in times of unexpected hardship. Amazon employees often rely on disability insurance to provide a safety net when they cannot work due to illness or injury. Understanding the ins and outs of this process is essential for protecting one’s financial …

Sutton v. MetLife – LTD Policy Requires Objective Evidence, Not Conclusive Proof

The plaintiff, Sutton, filed a lawsuit against MetLife, the defendant, for the wrongful denial of long-term disability benefits under his employer’s plan governed by ERISA (Employee Retirement Income Security Act). Background Under the disability plan’s policy documents, if an employee’s disability is attributable to a neuromuscular or musculoskeletal condition, benefits are normally paid for only …

Long-Term Disability Claims And Toxic Work Environments

Most US workers are impacted by workplace stress. A 2023 article by Zippia Research reported that 83% of US workers suffer from work-related stress. That same article also revealed that 25% of workers say their job is the number one stressor in their lives. Constant stress is a characteristic of a toxic work environment, which …

Can A Disability Insurance Company Sue To Recover An Overpayment?

If you receive long-term disability benefits and have been approved for SSDI, you likely have questions. You may wonder if your insurance company can sue to recover the overpayment. The answer is it depends. What Happens If I Don’t Pay Back Long-Term Disability? Under certain circumstances, disability insurance companies may be able to take legal …

The Standard Wrongly Applies Pre-Existing Condition Exclusion To LTD Claim

Recently, we appealed a claim denial issued by The Standard. The claim had been denied because the insurance carrier had determined that the claimant’s condition was caused or contributed to by a pre-existing condition. This is not an unusual basis for a long-term disability claim denial. However, upon further review, we determined this pre-existing denial …

Responding to Peer Review Reports In Long-Term Disability Appeals

It is not uncommon for a disability insurance company to order a peer review during the long-term disability appeal process. If your insurer has requested a peer review report, you may have received a letter that states something like: “We are writing to update you of the status of your appeal request for the above …

How To Apply For Long-Term Disability Insurance Benefits

Are you or a loved one wondering how to apply for long-term disability? Understanding the process thoroughly is crucial to ensure you have the best chance of receiving the support you deserve. This post explains the application process and offers expert tips to help you navigate it confidently. This guide is written by a disability …