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Home | Disability Case Summaries | Page 3

Disability Case Summaries

Cannon v. Aetna – Aetna Not Bound By SSA Disability Determination

July 24, 2023 // by Nick Ortiz

In Gregory Cannon v. Aetna, a pharmacist challenged Aetna’s denial of short-term disability benefits, arguing the insurer ignored his symptoms, failed to follow internal procedures, and overlooked his Social Security approval. The court sided with Aetna, finding no abuse of discretion and concluding Cannon failed to provide sufficient objective …

Read moreCannon v. Aetna – Aetna Not Bound By SSA Disability Determination
Category: Disability Case Summaries
Tags: Aetna

Dardick v. Unum – Court Upholds Cardiac LTD Claim Denial

July 24, 2023 // by Nick Ortiz

In Dardick v. Unum Life Insurance Company of America and First Unum Life Insurance Company, Unum succeeded in denying the claimant long-term disability insurance benefits. Dardick filed a lawsuit after Unum Life Insurance Company of America denied his claim for benefits under a group disability benefits plan provided by his previous …

Read moreDardick v. Unum – Court Upholds Cardiac LTD Claim Denial
Category: Disability Case Summaries
Tags: Unum

Gaines v. Aetna – Court Rules Aetna Refused To Credit Reliable Evidence

July 24, 2023 // by Nick Ortiz

Plaintiff appealed the initial denial of benefits under the Plan, stating that her request for disability was not based solely on her thyroid surgery but rather on symptoms associated with lupus and chronic pain. On September 12, 2011, ALIC again upheld the denial of benefits to the Plaintiff. As allowed under ERISA, the Plaintiff sued to challenge …

Read moreGaines v. Aetna – Court Rules Aetna Refused To Credit Reliable Evidence
Category: Disability Case Summaries
Tags: Aetna

Brown v. LINA – Can A Peer Review Physician Outweigh My Physician’s Opinion?

July 24, 2023 // by Nick Ortiz

In this case, the Court found that the Plaintiff's complaints of pain were credible there was no reason to question the Plaintiff's credibility. As such, the Defendants' motion for decision was denied and Plaintiff's motions was granted.

Read moreBrown v. LINA – Can A Peer Review Physician Outweigh My Physician’s Opinion?
Category: Disability Case Summaries
Tags: Life Insurance Company of North America (LINA)

Abrams v. Unum – Disabling Symptoms Matter, Not The Diagnosis

July 12, 2023 // by Nick Ortiz

Today we review Abrams v. Unum Life Insurance Company of America that was decided by the United States District Court for the Western District of Washington. William Abrams was a trial and appellate lawyer for the Schwabe Law Firm. His disabilities were described as debilitating symptoms from an illness. Although the exact medical condition was …

Read moreAbrams v. Unum – Disabling Symptoms Matter, Not The Diagnosis
Category: Disability Case Summaries
Tags: Unum

Paquin v. Prudential – Insurer Wrongfully Disregarded Opinions Of Treating Physicians

April 27, 2023 // by Nick Ortiz

In this case, the claimant won a reinstatement of his long-term disability insurance benefits in the United States District Court for the District of Colorado. The Plaintiff’s Medical History and Claim History:  Mr. Paquin worked for Transistor Devices, Inc. as a Business Development Director. In 2003, Mr. Paquin contracted encephalitis from a …

Read morePaquin v. Prudential – Insurer Wrongfully Disregarded Opinions Of Treating Physicians
Category: Disability Case Summaries
Tags: Prudential

Robinson v. Aetna – Court Remands Claim For Any Occupation Review

April 27, 2023 // by Nick Ortiz

Plaintiff Laverne Robinson brought a lawsuit against Aetna Life Insurance Company (“Aetna”) and Mondelez Global LLC Employee-Paid Group Benefits Plan (“the Plan”) for unpaid long-term disability (“LTD”) benefits under the Employee Retirement Income Security Act of 1974 (“ERISA”). Robinson was a former utility machine …

Read moreRobinson v. Aetna – Court Remands Claim For Any Occupation Review
Category: Disability Case Summaries
Tags: Aetna

Director of Software v. Unum – Court Finds Plaintiff Failed To Meet His Burden Of Proof

April 14, 2023 // by Nick Ortiz

On April 7, 2023, the United States District Court for the District of Massachusetts decided an ERISA long-term disability insurance case against the Unum Insurance Company of America. The Court ruled in favor of Unum. The claimant worked with Symbiotic LLC Plan as the Director of Software Quality Assurance. He had worked in the computer …

Read moreDirector of Software v. Unum – Court Finds Plaintiff Failed To Meet His Burden Of Proof
Category: Disability Case Summaries
Tags: Unum

Arenson v. Unum – Court Sides With Unum Under Deferential Standard Of Review

March 28, 2023 // by Nick Ortiz

Today we review Arenson v. First Unum Life Insurance Company that was decided by the United States District Court for the Northern District of Illinois. Gregg Arenson was a futures and options trade broker. He sued his former employer’s benefits administrator, First Unum Life Insurance Company (hereinafter “Unum”) under ERISA. He …

Read moreArenson v. Unum – Court Sides With Unum Under Deferential Standard Of Review
Category: Disability Case Summaries
Tags: Unum

Moseley v. Unum – Unum Should Have Ordered IME

March 22, 2023 // by Nick Ortiz

Unum paid long-term disability (LTD) insurance benefits to Susan Moseley, but stopped paying after a period of time pursuant to the mental illness limitation in her long-term disability policy (a policy is also called a “plan” of benefits). Moseley appealed the case all the way to federal court, arguing that Unum abused its discretion …

Read moreMoseley v. Unum – Unum Should Have Ordered IME
Category: Disability Case Summaries
Tags: Unum

Marselle v. Unum – Kentucky District Court Finds Unum Made A Reasoned Determination

September 12, 2022 // by Nick Ortiz

Jonni Marselle was covered for long-term disability (LTD) benefits under a group plan provided to Humana, Marselle’s former employer. Marselle was a consultant with Humana. The position was sedentary as it required her to constantly sit, occasionally stand, and occasionally walk. She mostly did computer work. Her disabilities included …

Read moreMarselle v. Unum – Kentucky District Court Finds Unum Made A Reasoned Determination
Category: Disability Case Summaries
Tags: Unum

Foss v. Standard – “Own Occ” Is With Any Employer, Not A Specific Employer

September 2, 2022 // by Nick Ortiz

I’ve been away from case summaries for a bit. Going to turn that around with a recent decision in Foss v. Standard Insurance Company, Case No. 20-cv-2449, decided by the United States District Court for the District of Minnesota on August 19, 2022. Unfortunately, the Court ruled in favor of the insurance company. Plaintiff Caroline …

Read moreFoss v. Standard – “Own Occ” Is With Any Employer, Not A Specific Employer
Category: Disability Case Summaries
Tags: The Standard

Fowkes v. MetLife – Claimant Did Not Prove Disability

April 8, 2022 // by Nick Ortiz

Ms. Fowkes does not contend the Plan’s written evidence requirement violates ERISA. Instead, she takes issue with MetLife's procedures to evaluate her LTD claim. In particular, she contends MetLife required her to present “objective evidence” supporting her LTD claim. At the hearing, she argued that MetLife did not consider the cumulative effect of …

Read moreFowkes v. MetLife – Claimant Did Not Prove Disability
Category: Disability Case Summaries
Tags: MetLife

Archer v. Hartford – Court Upholds Long-Term Disability Claim Denial

July 16, 2021 // by Nick Ortiz

The claimant in Archer v. Hartford Life and Accident Insurance Company was an Assistant Store Manager at TJX Marshall’s Department Store. She had group long-term disability (LTD) coverage. She also had life insurance benefits. Both of these categories of group benefits were issued and administered by Hartford. Hartford had what we call …

Read moreArcher v. Hartford – Court Upholds Long-Term Disability Claim Denial
Category: Disability Case Summaries
Tags: Hartford

Cassidy v. Aetna – Court Holds There Is A Difference Between Diagnosis and Limitation

June 10, 2021 // by Nick Ortiz

In Cassidy v. Aetna Life Insurance Company, the U.S. District Court for the Eastern District of Kentucky ruled in favor of Aetna in a long-term disability insurance claim. The decision was issued on May 21, 2021. The long-term disability insurance claim was governed by the Employee Retirement Income Security Act of 1974 (ERISA). Ms. Cassidy …

Read moreCassidy v. Aetna – Court Holds There Is A Difference Between Diagnosis and Limitation
Category: Disability Case Summaries
Tags: Aetna

Calkin v. USLIC – Court Finds Reasonable Basis For Long-Term Disability Denial

May 14, 2021 // by Nick Ortiz

Mr. Calkin was a 65-year-old manager of architectural design for AIG from June 10, 2013, through June 24, 2014. Mr. Calkin suffered from impingement syndrome in his left shoulder, brachial plexopathy (a form of neuropathy), bilateral shoulder pain, lower back pain due to degenerative disc disease and stenosis in his lumbar …

Read moreCalkin v. USLIC – Court Finds Reasonable Basis For Long-Term Disability Denial
Category: Disability Case Summaries
Tags: AIG Benefits Solutions, United States Life Insurance Company (USLIC)

Harrison v. LINA – Claim Denied Based On Pre-Existing Condition Exclusion

May 11, 2021 // by Nick Ortiz

Ms. Harrison was a claimant who worked as a customer service representative for a cash advance lender. Her duties included selling financial products to customers, providing customer service, handling money, and overseeing financial transactions. She also suffered from depression and anxiety during her time at this place of …

Read moreHarrison v. LINA – Claim Denied Based On Pre-Existing Condition Exclusion
Category: Disability Case Summaries
Tags: Life Insurance Company of North America (LINA)

Senegal v. Reliance Standard – Court Remands Case For Further Review

January 7, 2021 // by Nick Ortiz

In this case, Tommy W. Senegal (“Senegal”) had a long-term disability policy that was administered by Reliance Standard Life Insurance Company (“Reliance Standard”) as a benefit of his employment by Cequel III, LLC (“Cequel”). Senegal worked for Cequel as a field service engineer; his duties were specifically related to supervising cable …

Read moreSenegal v. Reliance Standard – Court Remands Case For Further Review
Category: Disability Case Summaries
Tags: Reliance Standard

Donlick v. Standard – Claim Denial Was Not Arbitrary And Capricious

January 6, 2021 // by Nick Ortiz

Marybeth M. Donlick (“Donlick”) was employed as a truck driver for Chesapeake Energy Corporation (“Chesapeake”). Through her employment, Donlick received coverage for a long-term disability benefits plan, which was administered by Standard Insurance Company (“Standard”). On August 7, 2012, Donlick was in a motorcycle crash which caused her to have …

Read moreDonlick v. Standard – Claim Denial Was Not Arbitrary And Capricious
Category: Disability Case Summaries
Tags: The Standard

Diaz v. Liberty Life – Court Rules LTD Claim Denial Was Supported

January 6, 2021 // by Nick Ortiz

In this case, David Diaz (“Diaz”) was the district manager at JM Family Enterprises, Inc. (“JM Family Enterprises”) between September 2010 and October 2015. JM Family Enterprises’ had an employee benefit plan which covered long-term disability benefits. This plan was insured by Liberty Life Assurance Company of Boston (“Liberty”). Under the plan, …

Read moreDiaz v. Liberty Life – Court Rules LTD Claim Denial Was Supported
Category: Disability Case Summaries
Tags: Liberty Mutual

Deroo v. Unum – Court Rules Job Suitable For Claimant Doesn’t Exist

January 6, 2021 // by Nick Ortiz

Carianne Deroo (“Deroo”) worked as an employee for Beaumont Hospital as a Clinical Nurse II. This role involved full-time work as a registered nurse which required patient care. Through her employment with Beaumont Hospital, Deroo was covered by a long-term disability benefits policy which was administered by Unum Life Insurance Company of America …

Read moreDeroo v. Unum – Court Rules Job Suitable For Claimant Doesn’t Exist
Category: Disability Case Summaries
Tags: Unum

Counts v. United Of Omaha – Court Rules United Of Omaha Must Pay Benefits

January 6, 2021 // by Nick Ortiz

Brenda Counts (“Counts”) previously worked as an employee of Denver Wholesale Florist-Flint as a flower sales specialist. Her job title was formally known as “Inside Sales Associate” which required “making sales calls, pulling product[,] and packing.” Through her job, she held a disability insurance policy with United of Omaha Life Insurance …

Read moreCounts v. United Of Omaha – Court Rules United Of Omaha Must Pay Benefits
Category: Disability Case Summaries
Tags: Mutual of Omaha

Conner v. Sedgwick – Court Finds Claim Denial Was Reasonable And Supported

January 6, 2021 // by Nick Ortiz

Lisa Conner (“Conner”) was a perioperative nurse at St. Vincent’s Medical Center. Through her employment, she held a policy under the Ascension Health (“Ascension”) Long-Term Disability plan. Sedgwick administered this plan. The language of the plan explained that: On May 20, 2013, Conner was in a car accident that left her …

Read moreConner v. Sedgwick – Court Finds Claim Denial Was Reasonable And Supported
Category: Disability Case Summaries
Tags: Sedgwick

Benson v. Hartford – Court Affirms Hartford LTD Claim Denial

January 6, 2021 // by Nick Ortiz

Keyton Benson (“Benson”) was employed by Tower Hill Insurance Group. Through his employer, Benson was eligible for long-term disability benefits through a policy issued by Hartford Life & Accident Insurance Company (“Hartford”). The policy language states that it will provide a policyholder with monthly payments if he has: In addition, the …

Read moreBenson v. Hartford – Court Affirms Hartford LTD Claim Denial
Category: Disability Case Summaries
Tags: Hartford
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