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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.
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, …
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 …
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 …
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 …
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 …
MetLife forwarded responses from Santana’s treating physicians to Dr. Simon, an “independent physician,” who reviewed them and concluded that the MRI was normal for a person of Santana’s age and that Santana had still failed to submit clinical evidence showing that he had either radiculopathy or any limitations due to neuropathy. By a letter dated …
None of Liberty’s arguments persuade the Court that denying long-term disability benefits to Ms. Rouleau is appropriate. The preponderance of the evidence – indeed, the great weight of the evidence – reflects that Ms. Rouleau remained “disabled” as the Policy defines it even after the expiration of the “own occupation” period and is therefore …
Drew A. Carson (“Carson”) was an attorney employed by Miller Goler Faeges LLP. Through his employment, he was covered by a long-term disability benefits plan which was administered by Unum Life Insurance Company of America (“Unum”). The plan explained that: “‘Disability’ and ‘disabled’ mean that because of injury or sickness: Further, proof …
The case summarized here involves Damon Zaeske (“Zaeske”), who was a project manager employed by Walmart. He ceased working on April 4, 2014, as a result of chronic back pain. Walmart’s insurance plan was underwritten by Liberty Life Assurance Company of Boston (“Liberty Life”); Zaeske applied for long-term disability (LTD) …
In Mozdzierz v. Aetna Life Insurance Company, the plaintiff (claimant) seeks long-term disability benefits from Aetna, the insurer of his ERISA-governed long-term disability plan. The Federal District Court (for the Eastern District of Pennsylvania) found that Aetna did not abuse its discretion in denying plaintiff’s …
The Court granted Plaintiff’s Motion for Summary Judgment: “As explained above, I have identified three primary reasons for determining that Aetna abused its discretion in denying Plaintiff’s benefits: Inappropriate reliance on unreliable findings by Drs. Topper, McPhee, and Polanco; failure to address Plaintiff’s qualifications and ability to …
In granting summary judgment for MetLife, the district court reasoned that when Sumpter became disabled, Delphi’s plan did not provide the benefit he sought and that he was not entitled to equitable relief. The U.S. Court of Appeals for the Seventh Circuit upheld this decision.
In this case, the plaintiff noted that the Policy’s states that “‘Proof’ means the evidence in support of a claim for benefits and includes, but is not limited to, the following.” Plaintiff thus argued that, while objective medical evidence may be sufficient to support a disability claim, it was not necessary to do so.
A court must take into consideration the conflict of interest inherent in a benefits system in which the entity that pays the long-term disability benefits maintains discretionary control over the ultimate benefits decision. This is done by weighing the structural conflict as one of the many factors relevant to the benefits …
One of the hardest things I must explain to clients is how the insurance company does not care about the client’s disabling condition. Disability insurance companies are for-profit corporations constantly seeking ways to increase their bottom lines. More often than not, they accomplish this by denying long-term disability claims. In this …
Anne Wittmann (“Wittmann”) was an attorney at Baker, Donelson, Bearman, Caldwell, Berkowitz PC (“Baker Donelson”). Unum Life Insurance Company of America (“Unum”) administered and underwrote the long-term disability (LTD) plan that covered Wittmann. Wittmann filed a claim for disability benefits on April 7, 2014, since she had not worked from …
Rose Bigham, a Security Technical Program Manager at Amazon, filed suit after Liberty Life terminated her long-term disability benefits despite diagnoses of fibromyalgia, chronic pain, and degenerative disc disease. The court found that medical evidence from her treating physicians clearly supported her inability to perform the cognitive and …
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 …
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, …
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 …
In this case, Fredrick Smith (“Smith”) was employed as a plant manager for Charles Craft, Inc. (“Craft”) reaching back to the 1970’s. Through his job, he held group policies with Reliance Standard Life Insurance Company (“Reliance Standard”). Two of these polices included a long-term disability benefits plan and a life insurance policy. If an …
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 …
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 …
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.