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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.
The Court concluded that Defendant did not act in an arbitrary and capricious manner in denying Plaintiff’s claim for long-term disability benefits. Accordingly, the Court overruled Plaintiff’s Motion for Judgment on the Administrative Record, and sustained Defendant’s Motion for Entry of Judgment on the Administrative Record.
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 …
In this case, Shenita Sapp (“Sapp”) sought to recover long-term disability benefits that were denied by the administrator of her plan. Sapp argued that the claims administrator, Sedgwick Claims Management Services (“Sedgwick”) was acting in an arbitrary and capricious manner when it made its decision. However, the Administrator of the Plan, …
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.
In this case, Teresa A. Seeman (“Seeman”) was an employee of Bank of America and served as a Vice President, Unit Manager from May of 1990 to December of 2007. Through her employment, she was part of a long-term disability plan that was administered by Metropolitan Life Insurance Company (“MetLife”). The plan defined …
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 …
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 …
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 …
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 …
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.
In Kavanay v. Liberty Life Assurance Company of Boston, the plaintiff sought long-term disability benefits from Liberty Life, the insurer of his ERISA governed disability plan. The plaintiff worked as an insurance adjuster for Allstate; he was an “outside claims examiner”. Plaintiff’s entitlement to benefits was subject to the “own occupation” …
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.
The present case involves an appeal by Aetna Life Insurance Company (“Aetna”) from a successful motion for summary judgment granted in Christopher Patterson’s (“Patterson”) favor. Regarding the same case, the court had also denied a motion for summary judgment filed by Aetna. Patterson was covered under a long-term disability policy by Aetna …
The Court concluded that the Plaintiff did establish by a preponderance of the evidence that she was “totally disabled” under the “any occupation” standard.
In Fleming v. Unum, Pamela Fleming (“Ms. Fleming”) was a litigation attorney at the firm Kern & Wooley, LLP (“Kern & Wooley”). She was in a serious car accident in 1998, which caused injuries to her thoracic spine and neck. After receiving a cervical spine fusion around 2003, Ms. Fleming kept having back and neck pain, which led …
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 …
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 …
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 …
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 …
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 …
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, …
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 …