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Home | Disability Law Blog | Page 17

Disability Law Blog

Neno v. Aetna – Court Finds There Was No Abuse Of Discretion

April 23, 2020 // by Nick Ortiz

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 …

Read moreNeno v. Aetna – Court Finds There Was No Abuse Of Discretion
Category: Disability Case Summaries
Tags: Aetna

There Are Not More People Going On Disability Than Getting Jobs

April 22, 2020 // by Nick Ortiz

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 …

Read moreThere Are Not More People Going On Disability Than Getting Jobs
Category: Social Security Disability

Nagy v. Hartford – Court Upholds LTD Claim Denial

April 22, 2020 // by Nick Ortiz

In the present case, Dave Nagy (“Nagy”) was a Quality Assurance Analyst employed by Oracle America, Inc. (“Oracle”). Around September 8, 2011, he began experiencing symptoms of Chronic Fatigue Syndrome (CFS) as well as other mental health and possibly autonomic dysfunctions. Nagy applied for short-term disability (STD) benefits but was …

Read moreNagy v. Hartford – Court Upholds LTD Claim Denial
Category: Disability Case Summaries
Tags: Hartford

Murphy v. Aetna – Claim Terminated Under Any Occupation Standard

April 22, 2020 // by Nick Ortiz

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 …

Read moreMurphy v. Aetna – Claim Terminated Under Any Occupation Standard
Category: Disability Case Summaries
Tags: Aetna

Miller v. Hartford – Court Upholds Denial Of Fibromyalgia And Depression Claim

April 22, 2020 // by Nick Ortiz

In the instant case, Dee Ann Miller (“Miller”) was a senior collector who was employed by Springleaf Finance, Inc. (“Springleaf”). Miller’s job duties “include contacting customers with high risk accounts, negotiating repayment, providing documentation to monitor results and productivity of collection efforts, responding to inquiries, …

Read moreMiller v. Hartford – Court Upholds Denial Of Fibromyalgia And Depression Claim
Category: Disability Case Summaries
Tags: Hartford

Mercado v. Aetna – Court Finds LTD Claim Denial Was Reasonable

April 22, 2020 // by Nick Ortiz

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 …

Read moreMercado v. Aetna – Court Finds LTD Claim Denial Was Reasonable
Category: Disability Case Summaries
Tags: Aetna

Mendez v. Aetna – Aetna Had A Conflict Of Interest

April 22, 2020 // by Nick Ortiz

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.

Read moreMendez v. Aetna – Aetna Had A Conflict Of Interest
Category: Disability Case Summaries
Tags: Aetna

McKenna v. Aetna – Court Gives Little Weight To Opinion Of Non-Examining Physician

April 22, 2020 // by Nick Ortiz

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.

Read moreMcKenna v. Aetna – Court Gives Little Weight To Opinion Of Non-Examining Physician
Category: Disability Case Summaries
Tags: Aetna

McIntyre v. Reliance Standard – Court Finds Claimant Is Disabled Under Any Occupation Standard

April 20, 2020 // by Nick Ortiz

Melissa McIntyre (“McIntyre”) worked as a Mayo Clinic Health System nurse. She was covered under a long-term disability plan which was administered by Reliance Standard Life Insurance Company (“Reliance Standard”). Around 2011, McIntyre’s health caused her to cease working. McIntyre suffered from Charcot-Marie-Tooth Syndrome, a neurological issue …

Read moreMcIntyre v. Reliance Standard – Court Finds Claimant Is Disabled Under Any Occupation Standard
Category: Disability Case Summaries
Tags: Reliance Standard

Mawa v. Hartford – Disability Claim For Peripartum Cardiomyopathy Denied

April 20, 2020 // by Nick Ortiz

In the present case, Brenna Mawa (“Mawa”) worked as a nurse, Branch Director, and Clinical Director; she was employed by LHC Group, Inc. (“LHC”). The company was insured by a Group Long-Term Disability Plan for Employees issued by the Hartford Life & Accident Insurance Company. This plan defined a disability as whether a person can perform the …

Read moreMawa v. Hartford – Disability Claim For Peripartum Cardiomyopathy Denied
Category: Disability Case Summaries
Tags: Hartford

Smith v. United of Omaha – Pre-Existing Condition Or Unspecified Medical Problem?

April 20, 2020 // by Nick Ortiz

Marcia L. Smith (“Smith”) worked as a property manager for Arlington Properties, Inc., and starting on March 1, 2016, she was covered under a long-term disability plan administered by United of Omaha Life Insurance Company and Mutual of Omaha Insurance Company (collectively, “United”). The plan provided the following as part …

Read moreSmith v. United of Omaha – Pre-Existing Condition Or Unspecified Medical Problem?
Category: Disability Case Summaries
Tags: Mutual of Omaha, Pre-Existing Condition

Maher v. Prudential – LTD Denial Was Not Arbitrary And Capricious

April 20, 2020 // by Nick Ortiz

Here, Melissa Maher (“Maher”) was Manager of Research and Development at Bonne Bell, L.L.C. (“Bonne Bell”). Her job duties were considered to be light with sedentary demand. Further requirements were the ability to use ten pounds of force and other exertions of lesser amounts more frequently. Because of her employment with Bonne Bell, Maher was …

Read moreMaher v. Prudential – LTD Denial Was Not Arbitrary And Capricious
Category: Disability Case Summaries
Tags: Prudential

Leonor v. Provident – “The Important Duties” Does Not Equal “All The Important Duties”

April 8, 2020 // by Nick Ortiz

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.

Read moreLeonor v. Provident – “The Important Duties” Does Not Equal “All The Important Duties”
Category: Disability Case Summaries
Tags: Provident

Lash v. Reliance Standard – Case Dismissed For Failure To State Claim Against Matrix

April 8, 2020 // by Nick Ortiz

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.

Read moreLash v. Reliance Standard – Case Dismissed For Failure To State Claim Against Matrix
Category: Disability Case Summaries
Tags: Reliance Standard

Kouzmanoff v. Unum – Court Upholds Unum’s Decision To Deny Diabetes Claim

April 8, 2020 // by Nick Ortiz

The present case involves an ERISA claim for short-term disability and long-term disability insurance benefits where the claimant argues that the administrator improperly denied his claims for benefits. Marc Kouzmanoff (“Kouzmanoff”) was a sales representative for Thompson Reuters Holdings, Inc. (“Thompson Reuters”). In 2001, he developed diabetes; …

Read moreKouzmanoff v. Unum – Court Upholds Unum’s Decision To Deny Diabetes Claim
Category: Disability Case Summaries
Tags: Unum

Koning v. United Of Omaha – Insurer Failed To Adequately Evaluate Medical Evidence

April 8, 2020 // by Nick Ortiz

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 …

Read moreKoning v. United Of Omaha – Insurer Failed To Adequately Evaluate Medical Evidence
Category: Disability Case Summaries
Tags: Mutual of Omaha

Khalil v. Liberty Life – Surveillance Supports Long-Term Disability Claim Denial

April 8, 2020 // by Nick Ortiz

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 …

Read moreKhalil v. Liberty Life – Surveillance Supports Long-Term Disability Claim Denial
Category: Disability Case Summaries
Tags: Liberty Mutual

Kerridge v. United Of Omaha – Medical Evidence Does Not Support Disability

April 8, 2020 // by Nick Ortiz

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 …

Read moreKerridge v. United Of Omaha – Medical Evidence Does Not Support Disability
Category: Disability Case Summaries
Tags: Mutual of Omaha

Baker v. Sun Life – Court Rules In Favor Of Insurance Company

April 8, 2020 // by Nick Ortiz

In this case, Kenneth Baker (“Baker”) was an employee who worked for Dunkin Donuts. Through his employment there, he held a policy for long-term disability benefits. Unfortunately, Baker lost all of his administrative appeals with the insurance companies. He also lost at the lower Federal Court. The opinion below relates to Baker’s appeal of the …

Read moreBaker v. Sun Life – Court Rules In Favor Of Insurance Company
Category: Disability Case Summaries
Tags: Sun Life

Tyler v. American General – Psychiatrist Files Action For Bad Faith And Punitive Damages

April 8, 2020 // by Nick Ortiz

Here, Kelly Ann Tyler (“Tyler”) filed a claim for a breach of disability insurance contract against United States Life Insurance Company and American General Life Insurance Company (together, “American General”). Further, she filed claims for a breach of the covenant of good faith and fair dealing by American General, seeking punitive damages. …

Read moreTyler v. American General – Psychiatrist Files Action For Bad Faith And Punitive Damages
Category: Disability Case Summaries
Tags: American General

Kochanek v. Aetna – Court Upholds Claim Denial Due To Lack Of Medical Evidence

April 8, 2020 // by Nick Ortiz

Katherine Kochanek (“Kochanek”) worked as an employee of Home Depot U.S.A., Inc. (“Home Depot”). Through her employment, she was covered by the Home Depot Welfare Benefits Plan which included short term disability benefits. Aetna Life Insurance Co. (“Aetna”) served as the administrator of the Plan. Under the Plan, a “disability” is considered to be …

Read moreKochanek v. Aetna – Court Upholds Claim Denial Due To Lack Of Medical Evidence
Category: Disability Case Summaries
Tags: Aetna

Kaiser v. Mutual of Omaha – Pre-Existing Condition Exclusion Does Not Apply

April 8, 2020 // by Nick Ortiz

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.

Read moreKaiser v. Mutual of Omaha – Pre-Existing Condition Exclusion Does Not Apply
Category: Disability Case Summaries
Tags: Mutual of Omaha, Pre-Existing Condition

Jones v. Aetna – Court Finds Breach Of Fiduciary Duty Claim Isn’t Duplicative

April 8, 2020 // by Nick Ortiz

Lisa Jones submitted a claim for long-term disability benefits under an LTD Plan provided to her by Boeing. Aetna was the plan administrator; Aetna denied the LTD claim. Ms. Jones sued under the Employee Retirement Income Security Act (ERISA) for denial of benefits and breach of fiduciary duty. The district court (lower court) dismissed the …

Read moreJones v. Aetna – Court Finds Breach Of Fiduciary Duty Claim Isn’t Duplicative
Category: Disability Case Summaries
Tags: Aetna

Coats v. Reliance Standard – Court Finds That Benefit Calculation Is Incorrect

April 8, 2020 // by Nick Ortiz

Jennifer Coats (“Coats”) was employed by Cottage Health Care as a staff nurse. Through her employment, she was able to participate in an employee welfare benefit plan which included coverage for long-term disability benefits. These benefits were funded by Reliance Standard Life Insurance Company (“Reliance Standard”). More specifically, Reliance …

Read moreCoats v. Reliance Standard – Court Finds That Benefit Calculation Is Incorrect
Category: Disability Case Summaries
Tags: Reliance Standard
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