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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

Filthaut v. AT&T – Court Rules STD Denial Meets Arbitrary And Capricious Standard

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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.

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Evans-Carmichael v. Liberty Mutual – Federal Court Remands Non-ERISA Case To State Court

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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.

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Esbensen v. LINA – Defendant Acted Arbitrarily And Capriciously

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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.

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Khan v. Provident – Court Disagrees With Insurer’s Interpretation Of Policy

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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 …

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Doe v. Prudential – Court Rules That The Mental Illness Limitation Doesn’t Apply

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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.

Read moreDoe v. Prudential – Court Rules That The Mental Illness Limitation Doesn’t Apply
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Denney v. Unum – Court Ruled In Favor Of Claimant And Remands Case

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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 …

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Krysztofiak v. Boston Mutual – Court Rules Clinical Coordination Manager Is Entitled To Benefits

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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 …

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Pearson-Rhoads v. Aetna – Court Rejects Treating Physician’s Opinion In Favor Of Paper Review

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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 …

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Faciane v. Sun Life – Court Rules In Favor Of Sun Life In Underpayment Suit

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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” …

Read moreFaciane v. Sun Life – Court Rules In Favor Of Sun Life In Underpayment Suit
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Carter v. Aetna – Court Rules Plaintiff Did Not Meet Burden Of Proof

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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. …

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Warner v. Unum – A Claimant Friendly ERISA Federal Court Decision

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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.

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Christmas v. Sun Life – Court Rules Evidence Plainly Supports Sun Life’s Conclusion

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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 …

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Dawson v. LINA – Court Rules Claimant Didn’t Provide Enough Objective Evidence

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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’ …

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Cheney v. Standard – Court Finds Claimant Meets The Definition Of Disability

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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.

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Hounihan v. P&G Disability Committee – Court Rules Claimant Isn’t Totally Disabled

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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 …

Read moreHounihan v. P&G Disability Committee – Court Rules Claimant Isn’t Totally Disabled
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Carty v. MetLife – Court Orders MetLife To Pay LTD Benefits

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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 …

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Sangha v. Cigna – Records Support A Finding Of Disability

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A federal court in California, following a bench trial, overturned Cigna Life Insurance Company of New York’s denial of Sarabjit Sangha’s long-term disability (LTD) benefits, finding by a preponderance of the evidence that her degenerative spine condition rendered her disabled from any occupation, and ordered the parties to calculate the retroactive benefits and interest owed. …

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Tracia v. Liberty Life – Court Remands Case For Further Review

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A federal magistrate judge in Massachusetts found that Liberty Life Assurance Company of Boston (“Liberty Life”) deprived Bruce Tracia of a full and fair review of his long-term disability (LTD) claim, holding its denial arbitrary and capricious, but declined to award benefits outright and instead remanded the case to Liberty for further review with clear instructions …

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Bradshaw v. Reliance Standard – Pre-Existing Condition Exclusion Was Misapplied To Claim

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The Eleventh Circuit reversed a district court judgment in favor of Reliance Standard Life Insurance Company (“Reliance Standard”), holding that Reliance misapplied its policy’s pre-existing condition exclusion to deny Julissa Bradshaw’s long-term disability (LTD) claim, and ordered an award of ERISA benefits. Case at a Glance Claimant Win Case Julissa Bradshaw v. Reliance Standard Life Insurance …

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