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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 Paquin v. The Prudential Insurance Company of America, the claimant won reinstatement of his long-term disability (LTD) benefits after the United States District Court for the District of Colorado found that Prudential abused its discretion by terminating a claim it had already paid for nearly 11 years, based on a single contested neuropsychological test. …
Laverne Robinson, a former utility machine operator, sued Aetna Life Insurance Company after her benefits were terminated. Aetna argued Robinson hadn’t been approved for Social Security Disability within the Plan’s 24-month window for continued long-term disability (LTD) benefits — even though the SSA later retroactively awarded her SSDI for that same period. The court ruled …
The claimant received two years of long-term disability benefits before Unum terminated the claim under the policy’s mental health limitation, arguing that his chronic pain didn’t amount to an independent physical disability. The court sided with Unum, ruling that the claimant failed to prove chronic pain alone left him unable to perform any gainful occupation. …
After suffering a stroke at work, Gregg Arenson argued that resulting cognitive impairment left him unable to perform his prior job duties, but Unum denied his long-term disability (LTD) claim, concluding his testing didn’t show a disqualifying impairment. Applying the deferential arbitrary-and-capricious standard of review, the court sided with Unum, finding its reliance on multiple …
Unum stopped paying Susan Moseley’s long-term disability (LTD) benefits under her policy’s mental illness limitation, but the court found that Unum’s failure to order an independent medical examination before terminating her claim was itself an abuse of discretion — regardless of the underlying dispute over her Lyme disease diagnosis. The court remanded the case, ordering …
Jonni Marselle sued Unum in state court alleging breach of contract after it denied her long-term disability (LTD) claim, but Unum removed the case to federal court since the policy qualified as an ERISA plan. The court denied Marselle’s motion to reverse the denial, finding Unum’s decision was the product of a reasoned, well-documented process …
Caroline Foss argued that workplace-specific stress at Boston College left her unable to do her job, but Standard Insurance Company denied her long-term disability claim, concluding her policy’s “normal occupation” standard asks whether she could perform that type of job for any employer — not just her specific workplace. Applying the deferential arbitrary-and-capricious standard, the …
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 her conditions in determining whether she adequately established disability. MetLife contends subjective reports of pain need not be taken at face value and argued at hearing that no disability is established even when considering Ms. Fowkes’s conditions in combination.
Archer received long-term disability (LTD) and life insurance waiver-of-premium benefits from Hartford for several years before Hartford terminated both, relying on a functionality questionnaire from her treating physicians that indicated she could perform sedentary work — even after one of those physicians later walked the assessment back. The court upheld Hartford’s decision as reasonable, finding …
After being approved for short-term disability, Cassidy applied for long-term disability benefits, citing chronic fatigue syndrome and fibromyalgia among several other diagnoses. Aetna denied the claim for lack of objective evidence that these conditions actually limited her ability to work, and the court agreed — holding that proving a diagnosis exists is not the same …
Calkin’s treating physicians found him severely limited by a combination of shoulder, back, knee, and elbow conditions, restricting him to well below even sedentary work. USLIC’s own file-reviewing physician disagreed, concluding Calkin could still perform his regular occupation, and the court sided with USLIC — finding that a reasonable basis to deny the long-term disability …
Harrison argued that her recently diagnosed Right Hemisphere Deficit Syndrome — a congenital brain injury — shouldn’t trigger LINA’s pre-existing condition exclusion merely because she’d only just been diagnosed with it, but LINA denied her long-term disability (LTD) claim by pointing instead to her pre-existing depression and anxiety. The appellate court affirmed the denial, finding …
Reliance Standard paid Tommy Senegal’s long-term disability (LTD) benefits for over two years before terminating them, concluding his medical records showed he could perform sedentary work despite an administrative law judge’s earlier finding that he was totally disabled. The court remanded the case back to Reliance Standard for reconsideration, citing several gaps in its review …
Standard Insurance Company approved Donlick’s long-term disability (LTD) benefits after a motorcycle crash left her with a below-knee amputation, but terminated them after 24 months under the policy’s “any occupation” standard — a decision the court upheld, finding it was based on a thorough medical and vocational record rather than arbitrary reasoning. Case at a …
Diaz sought long-term disability (LTD) benefits for chronic neck and back pain, muscular spasms, and adjustment disorder following a work-related car accident, but Liberty Life Assurance Company of Boston denied the claim for lack of sufficient supporting evidence. The court upheld the denial, finding Liberty reasonably discounted Diaz’s functional capacity evaluation and that the record …
Unum paid Deroo’s long-term disability (LTD) benefits for years before terminating them, concluding she could work as a Nurse Triage or Medical Claims Review Nurse instead. The court sided with Deroo, ruling that no suitable job actually existed that would let her elevate her leg as frequently as her lymphedema required. Case at a Glance …
United of Omaha denied both Counts’s short-term and long-term disability claims for chronic low back pain and related spinal conditions, concluding the medical documentation didn’t support her restrictions. The court disagreed, ruling that Counts met every element of the policy’s disability definition and was entitled to both short- and long-term benefits, leaving United to calculate …
Sedgwick terminated Conner’s long-term disability (LTD) benefits after a functional capacity evaluation and transferable skills analysis concluded she could work in alternative nursing roles, despite her argument that medication side effects left her unable to work any job. Although the court initially remanded the case for Sedgwick to more thoroughly evaluate her medication-related claims, it …
Hartford denied Benson’s long-term disability (LTD) claim, concluding he wasn’t disabled throughout the full elimination period tied to his knee replacement recovery — despite Benson’s argument that fatigue and pain from polymyalgia rheumatica also disabled him. The court affirmed the denial, finding Hartford’s decision wasn’t “wrong” under the deferential Blankenship framework, since Benson’s own treating …
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 August 19, 2011, MetLife denied Santana’s administrative appeal and upheld its earlier decision to deny him continuing long-term disability benefits. The Court agreed with MetLife that.
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 entitled to the long-term disability benefits she seeks.
Drew A. Carson (“Carson”) sought long-term disability (LTD) benefits for chronic pain and related mental health conditions, then argued that Unum Life Insurance Company of America (“Unum”) acted arbitrarily and capriciously by relying on file-only medical reviews rather than examining him in person. The court disagreed, finding no prohibition on file-only reviews by qualified physicians …
Zaeske won reinstatement of his long-term disability (LTD) benefits at the trial court level after it found Liberty Life’s independent medical reviewers unreliable, but the Eighth Circuit reversed on appeal, ruling that those same physicians’ opinions were reasonable and that Liberty Life didn’t abuse its discretion in denying his claim. Case at a Glance Insurer …
Mozdzierz sought long-term disability (LTD) benefits from Aetna under an ERISA-governed plan, but the court upheld Aetna’s denial, finding it did not abuse its discretion. The case is worth noting for the court’s discussion of video surveillance as investigatory evidence in long-term disability claims. Case at a Glance Insurer Win Case Steven Mozdzierz v. Aetna …