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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.

Disability Law Blog

Williams v. Standard – Court Rules In Favor Of Standard

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Defendant advances two grounds for terminating the plaintiff’s long-term disability benefits. First, the defendant contends the plaintiff does not qualify for an exception to the “Other Limited Conditions” provision under the Plan because he does not have a herniated disc with documented neurological abnormalities. Second, the defendant claims the plaintiff is not disabled from all occupations and thus does not qualify for benefits during his policy's “Any Occupation” period. If established, either of these grounds would provide a recognized justification for the termination of the plaintiff’s benefits under the terms of the Plan.

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Wilkinson v. Sun Life – Sun Life Abused Its Discretion By Denying Benefits

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The Fourth Circuit held that Sun Life abused its discretion when it terminated Wilkinson’s benefits because he provided sufficient evidence to support his eligibility for coverage and because Sun Life’s decision to terminate benefits was not the result of a principled reasoning process and not supported by substantial evidence. The Fourth Circuit, therefore, affirmed the district court’s decision.

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Till v. Lincoln – Claimant Failed To Provide Adequate Documentation To Support Claim

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Lincoln denied the Plaintiff’s LTD claim. The plaintiff filed a lawsuit in Federal Court. Lincoln filed a motion for judgment as a matter of law, to which Till responded with a motion for summary judgment. After a full briefing, the district court entered an order granting Lincoln’s motion and denying Till’s. The district court also subsequently denied Till’s motion to reconsider. After carefully considering the record on appeal, the parties’ briefs, and the relevant law, the Eleventh Circuit concluded that the district court decision is due to be affirmed.

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Smith v. Reliance Standard – Reliance Standard Committed Abuse Of Discretion

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Reliance Standard Life Insurance Company (“Reliance Standard”) repeatedly reversed course on Smith’s long-term disability (“LTD”) benefits after a series of heart attacks, strokes, and related conditions — paying, terminating, reinstating, then terminating again — despite every one of his treating physicians stating he could never return to work. After the district court ruled in Smith’s favor …

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Mayer v. Mercy And LINA – Court Cannot Determine If Disability Plan Is A Church Plan

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Ursula Mayer (“Mayer”) was an employee of Mercy Health Services, LLC (“Mercy”) and was covered under a long-term disability insurance policy that was issued by Cigna Group Insurance (“Cigna”). She claimed that she was totally disabled according to the definition within the policy, that she applied for benefits with Cigna, and that her claim was denied. …

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Tash v. MetLife – Court Finds MetLife Subverted ERISA Process

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The Court held that MetLife undermined the ERISA process by failing to issue a proper denial and, further, by failing to notify the insured about the issues in dispute. The Court ordered MetLife to pay past-due benefits, with interest, and to continue paying benefits so long as they continue to remain due under the provisions of the Plan, unless and until MetLife issues a denial that is in full compliance with the requirements contained in ERISA.

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Slaton v. Standard – Claimant’s Failure To Report Symptoms Led To Claim Denial

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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.

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New Department Of Labor Rule Strengthens Protections For Long-Term Disability Claimants

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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 their claims, as required by …

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Seese v. Prudential – Court Rules ADA Claim Against Prudential Must Be Dismissed

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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.

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Seeman v. MetLife – Vice President Wins Long-Term Disability Claim

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Metropolitan Life Insurance Company (“MetLife”) paid Teresa A. Seeman’s (“Seeman”) long-term disability (LTD) benefits for two years before terminating them, and after an earlier remand for further review, MetLife terminated her benefits a second time following four separate physician reviews. A Delaware court ruled in Seeman’s favor, finding it was an abuse of discretion for …

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Sapp v. Liberty Life – Liberty Failed To Consider Plaintiff’s Job Description

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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 remand the case back to the administrator.

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Rowe v. United Of Omaha – Failure To Apply For Social Security Disability Not Relevant

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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 application of the arbitrary and capricious standard of review and (2) the determination that the plaintiff’s failure to apply for Social Security benefits is irrelevant.

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COVID-19 And Long-Term Disability Insurance

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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 Payments? With …

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Important Changes For Long-Term Disability Claims In 2018

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Before you apply for long-term disability (LTD) 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 claimants. However, insurance companies …

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Randall v. MetLife – Doctor’s Conclusion Outweighs Subjective Complaints

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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.

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Kavanay v. Liberty Life – Insurer Cannot Ignore A Claimant’s Job Duties During Own Occupation Period

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Kavanay worked as an Outside Claims Adjuster for Allstate, but Liberty Life evaluated his “own occupation” long-term disability (LTD) claim against the Dictionary of Occupational Titles description for a sedentary “Inside Claims Examiner” instead of his actual job duties. The Mississippi court found this an abuse of discretion, ruling that while an insurer may look …

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Puccio v. Standard – Plaintiff Is Entitled To Description Of Additional Materials Necessary To Perfect Claim

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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.

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Patterson v. Aetna – Court Rules Own Occupation And Regular Occupation Are Interchangeable

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Aetna Life Insurance Company (“Aetna”) terminated Patterson’s long-term disability (“LTD”) benefits after concluding he could perform “sedentary” work under a national-economy definition of his “own occupation” — without ever assessing whether he could perform his actual job duties for his employer. The Third Circuit affirmed summary judgment in Patterson’s favor, holding that “own occupation” unambiguously …

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Fleming v. Unum – Court Rules Unum Cherry-Picked The Record

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Unum paid Fleming’s long-term disability (LTD) benefits for over a decade before terminating them based largely on two days of surveillance footage showing her carrying groceries and driving. The court ruled in Fleming’s favor, finding Unum improperly gave outsized weight to fifteen minutes of surveillance and cherry-picked statements from a paper-only review, when weighed against …

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Okuno v. Reliance Standard – Court Rules In Favor Of Reliance Standard

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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 administrative record.

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Shaw v. LINA – Claimant Refused To Follow Recommended Treatment Plan

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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.

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Nieves v. Prudential – Prudential Failed To Provide A Full and Fair Review

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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.

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

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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 Neno's medical records and sought opinions from independent sources.

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