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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.
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 …
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 …
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. …
Because the record establishes that LINA acted arbitrarily and capriciously in denying Calhoun long-term disability benefits, the Sixth Circuit REVERSED the district court’s judgment and REMANDED this case to the district court.
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 …
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 …
In this case, the court found that the evidence MetLife received in 2014, and in 2015 after Black appealed MetLife’s initial denial, showed that Black’s physical condition had in fact improved sufficiently to allow her to perform sedentary work
The Court found that ERISA preempts Ms. Bey’s state law claims and that Reliance is entitled to summary judgment in its favor in all respects. Given the thorough review by an independent physician, the Court did not conclude that Reliance acted arbitrarily or capriciously.
A federal court in Missouri dismissed Tiffany Ausler’s lawsuit against Aetna Life Insurance Company, holding that her short-term disability claim was time-barred under the plan’s 180-day contractual limitations period and that she had failed to exhaust the plan’s required administrative process for her long-term disability claim, without reaching whether she was actually disabled. Case at …
A federal court in North Carolina granted summary judgment to Aetna Life Insurance Company, holding it did not abuse its discretion in denying Charles Arning’s long-term disability claim, given the absence of any significant change in his medical condition and video surveillance conflicting with his treating physician’s restrictions. Case at a Glance Insurer Win Case …
A federal court in Kansas granted summary judgment to Union Security Insurance Company (“Union”), holding that it properly denied Dr. Andrew Scott’s continuing long-term disability (LTD) benefits after finding he no longer met either the Occupation Test or Earnings Test, and rejected his related breach of fiduciary duty claim for lack of evidence of detrimental reliance. …
A federal court in Michigan granted judgment to Unum Life Insurance Company of America, holding that its denial of Susan Usztics’s short-term disability benefits for fibromyalgia was not arbitrary and capricious, given the absence of objective evidence documenting any change in her functional capacity. Case at a Glance Insurer Win Case Susan Usztics v. Unum …
A federal court in Louisiana dismissed Lena Zerangue’s long-term disability claim against Lincoln National Life Insurance Company without prejudice, finding that although further pursuit of her short-term disability claim would have been futile, she could not bring a long-term disability claim in court without first having filed one with Lincoln National at all, and administratively …
A federal court in Ohio granted summary judgment to Aetna Life Insurance Company and the Federal Express Corporation Short Term Disability Plan, holding that the denial of Christopher Draper’s short-term disability benefits was supported by a deliberate, principled reasoning process, even though Aetna’s review of his MRI results was not particularly detailed. Case at a …
A federal court in Colorado held that Life Insurance Company of North America (LINA) acted arbitrarily and capriciously in denying Donna Burkhead’s short-term disability claim under the “own occupation” standard, but found LINA’s separate denial of her long-term disability claim under the stricter “any occupation” standard was reasonable, ordering payment of STD benefits only. Case …
A federal court in Alabama granted judgment to Reliance Standard Life Insurance Company, holding that its denial of Anthony Bowman’s long-term disability (LTD) benefits under the “any occupation” standard was not arbitrary and capricious, given conflicting but reliable medical evidence about his functional capacity. Case at a Glance Insurer Win Case Anthony Bowman v. Reliance …
A federal court in Massachusetts found that The Prudential Insurance Company of America (“Prudential”) and MIT abused their discretion in denying James Ampe’s long-term disability (LTD) claim by giving conclusive weight to one skeptical file reviewer over a treating physician and three examining specialists, and by failing to analyze his limitations against his actual job duties, …
The Fifth Circuit affirmed a district court judgment in favor of Principal Life Insurance Company (“Principal”), holding that Principal did not abuse its discretion in terminating Amanda Foster’s long-term disability (LTD) benefits, given substantial evidence — including a reviewing psychologist’s specific assessment of her cognitive job duties — that her migraines did not functionally impair her …
Aetna’s decision to deny the plaintiff benefits was unsupported by substantial evidence and was, thereby arbitrary and capricious. Aetna gave great weight to the opinions of its own experts and afforded little, to no, weight to the plaintiff’s own physicians. Under the circumstances, the plaintiff’s physicians—who had been treating him for several years—would be better able to recommend health and safety conditions than doctors who simply reviewed his medical files.
The Court determined that Unum came to a reasonable decision after a principled decision-making process. Although the Court may have reached a different conclusion independently, Unum did not abuse its discretion in denying Allen’s claim for long-term disability benefits.
If you have a long-term disability insurance claim that has been managed by Aetna, and now letters are coming to you on letterhead from the Hartford, do not be alarmed. That’s because Hartford entered into a definitive agreement to acquire Aetna’s U.S. group life and disability business in October 2017. This means that Hartford has …