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Home | Case Summary Blog | Page 7

Case Summary Blog

Denney v. Unum – Court Ruled In Favor Of Claimant And Remands Case

April 7, 2020 // by Nick Ortiz

Cara R. Denney (“Denney”) was an employee of Wagner Equipment Company (“Wagner”) where she was a Computer and Technology Instructor.  Her job duties “required extensive computer use” and “the ability to instruct employees on the use of various computer systems.” She was also required to travel up to fifty percent of the time, be able to …

Read moreDenney v. Unum – Court Ruled In Favor Of Claimant And Remands Case
Category: Case Summary Blog
Tags: Unum

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

April 7, 2020 // by Nick Ortiz

Dana Krysztofiak (“Krysztofiak”) works as a registered nurse but was previously a Clinical Coordination Manager for the company HomeCare Maryland, LLC. In 2016, Krysztofiak ceased working because of problems with fibromyalgia and psoriatic arthritis. She then filed for long-term disability benefits with Boston Mutual Life Insurance Co. (“Boston …

Read moreKrysztofiak v. Boston Mutual – Court Rules Clinical Coordination Manager Is Entitled To Benefits
Category: Case Summary Blog
Tags: Boston Mutual

Cowern v. Prudential – Vocational Expert Not Permitted To Consider All Records

April 7, 2020 // by Nick Ortiz

The Court found that Prudential abused its discretion in relying upon a vocational assessment that was based only on Prudential’s hired external medical reviewer’s opinions rather than all of the medical evidence.

Read moreCowern v. Prudential – Vocational Expert Not Permitted To Consider All Records
Category: Case Summary Blog
Tags: Prudential

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

April 7, 2020 // by Nick Ortiz

In Pearson-Rhoads v. Aetna Life Insurance Company, the plaintiff sued for the payment of long-term disability insurance benefits from the insurer of her ERISA governed plan, Aetna Life Insurance Company. The plaintiff made numerous arguments.  All were rejected by the court. Of particular note here is the plaintiff’s argument that Aetna abused its …

Read morePearson-Rhoads v. Aetna – Court Rejects Treating Physician’s Opinion In Favor Of Paper Review
Category: Case Summary Blog
Tags: Aetna

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

April 7, 2020 // by Nick Ortiz

In Faciane vs. Sun Life Assurance Company of Canada, the claimant received a monthly benefit for long-term disability benefits pursuant to an ERISA-regulated group insurance policy. The group policy covered employees of Capital One Financial Corporation. He alleged that Sun Life had been underpaying him for years. The material facts of the …

Read moreFaciane v. Sun Life – Court Rules In Favor Of Sun Life In Underpayment Suit
Category: Case Summary Blog
Tags: Sun Life

Carter v. Aetna – Court Rules Plaintiff Did Not Meet Burden Of Proof

April 7, 2020 // by Nick Ortiz

Colon Carter (“Carter”) worked as an estimating analyst for Bath Iron Works (“BIW”), a subsidiary of General Dynamics. His job duties included “developing cost proposals for new Navy and commercial work; developing and maintaining proposal support documents and checklists; creating financial models; maintaining company baselines for all Programs; …

Read moreCarter v. Aetna – Court Rules Plaintiff Did Not Meet Burden Of Proof
Category: Case Summary Blog
Tags: Aetna

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

April 7, 2020 // by Nick Ortiz

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.

Read moreWarner v. Unum – A Claimant Friendly ERISA Federal Court Decision
Category: Case Summary Blog
Tags: Unum

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

April 7, 2020 // by Nick Ortiz

The case Meghan Christmas v. Sun Life Assurance Company of Canada was decided by the U.S. District Court for the District of Connecticut on December 13, 2018. In this case, Meghan Christmas (“Christmas”), a Manager of Global Solutions Integration for ISGN Corporation, sought long-term disability (“LTD”) benefits from Sun Life Assurance Company …

Read moreChristmas v. Sun Life – Court Rules Evidence Plainly Supports Sun Life’s Conclusion
Category: Case Summary Blog
Tags: Sun Life

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

April 7, 2020 // by Nick Ortiz

Here, Chernequa Dawson (“Dawson”) worked as a Care Transition Coordination (“CTC”) Nurse Care Manager and was employed by Cigna Corporation (“Cigna”). Through her employment with Cigna, she was covered under both a short-term and long-term disability plan. For these plans, Cigna pays the short-term disability plan benefits, …

Read moreDawson v. LINA – Court Rules Claimant Didn’t Provide Enough Objective Evidence
Category: Case Summary Blog
Tags: Life Insurance Company of North America (LINA)

Holmgren v. Sun Life – Court Rules Plaintiff Established That He Was Disabled

April 7, 2020 // by Nick Ortiz

Based upon an exhaustive review of the administrative record, the Court found that the plaintiff had established by a preponderance of the evidence that he was disabled under the terms of the Plan during the relevant period.

Read moreHolmgren v. Sun Life – Court Rules Plaintiff Established That He Was Disabled
Category: Case Summary Blog
Tags: Sun Life

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

April 6, 2020 // by Nick Ortiz

Case Name: Carole Cheney v. Standard Insurance Company Court: United States District Court for the Northern District of Illinois Date of Decision: August 28, 2014 Type of Claim: Long-Term Disability under the Employee Retirement Income Security Act (“ERISA”) Insurance Company: Standard Insurance Company Claimant’s …

Read moreCheney v. Standard – Court Finds Claimant Meets The Definition Of Disability
Category: Case Summary Blog
Tags: Standard

Cheney v. Standard – District Court Decision In Favor Of Plaintiff Reversed

April 6, 2020 // by Nick Ortiz

This is an update to the previous District Court Decision in Cheney v. Standard. Here, the U.S. Court of Appeals reversed the lower court decision in favor of the Plaintiff and rules in favor of the insurance company. Case Name: Cheney v. Standard Court: U.S. Court of Appeals for the Seventh Circuit Date of Decision: July 27, …

Read moreCheney v. Standard – District Court Decision In Favor Of Plaintiff Reversed
Category: Case Summary Blog
Tags: Standard

Hounihan v. Aetna – Court Rules Claimant Isn’t Totally Disabled

April 6, 2020 // by Nick Ortiz

Charlie Craig Hounihan (“Hounihan”) was a technician who was employed by Proctor and Gamble (“P&G”) on the Bounty paper towel line at a plant in Cape Girardeau, Missouri. Through his employment with P&G, Hounihan was covered under both short-term and long-term disability benefit plans with Aetna. The Proctor & Gamble Disability …

Read moreHounihan v. Aetna – Court Rules Claimant Isn’t Totally Disabled
Category: Case Summary Blog
Tags: Aetna

Carty v. MetLife – Court Orders MetLife To Pay LTD Benefits

April 6, 2020 // by Nick Ortiz

In this case, Gary Carty (“Carty”) worked as a manager of Eastman Chemical Company’s (“Eastman”) information technology department. Gary held a policy under the Eastman Chemical Company Welfare Benefit Program which Metropolitan Life Insurance Company (“MetLife”) administered. Under the policy provisions, a claimant is considered disabled if he …

Read moreCarty v. MetLife – Court Orders MetLife To Pay LTD Benefits
Category: Case Summary Blog
Tags: MetLife

Sangha v. Cigna – Records Support A Finding Of Disability

April 6, 2020 // by Nick Ortiz

In this case, the U.S. District Court for the Northern District of California ruled in favor of Plaintiff Sarabjit Sangha and ruled against Cigna Life Insurance Company of New York. Specifically, the Plaintiff appealed Cigna’s denial of her long-term disability (“LTD”) benefits. After reviewing briefs submitted by both parties, the Judge overturned …

Read moreSangha v. Cigna – Records Support A Finding Of Disability
Category: Case Summary Blog
Tags: Cigna

Calhoun v. LINA – Denial Was Arbitrary And Capricious

April 6, 2020 // by Nick Ortiz

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.

Read moreCalhoun v. LINA – Denial Was Arbitrary And Capricious
Category: Case Summary Blog
Tags: Life Insurance Company of North America (LINA)

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

April 6, 2020 // by Nick Ortiz

Bruce Tracia (“Tracia”) was an employee of Comcast Cable Communication Management, LLC (“Comcast”) and held the job of a business account executive. He had previously worked as a line technician and several other positions while working for Comcast. Through his employment with Comcast, Tracia was covered by a Group Disability Income Policy. Liberty …

Read moreTracia v. Liberty Life – Court Remands Case For Further Review
Category: Case Summary Blog
Tags: Liberty Mutual

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

April 6, 2020 // by Nick Ortiz

In the instant case, Julissa Bradshaw (“Bradshaw”) was a medical biller for Pyramid Healthcare Solutions, Inc. (“Pyramid”). She held a policy through Reliance Standard Life Insurance Company (“Reliance Standard”) for both short-term and long-term disability coverage. Her coverage under this policy began on May 1, 2013. When Bradshaw was hired by …

Read moreBradshaw v. Reliance Standard – Pre-Existing Condition Exclusion Was Misapplied To Claim
Category: Case Summary Blog
Tags: Reliance Standard

Black v. MetLife – Social Media Monitoring Leads To Termination Of Benefits

April 6, 2020 // by Nick Ortiz

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

Read moreBlack v. MetLife – Social Media Monitoring Leads To Termination Of Benefits
Category: Case Summary Blog
Tags: MetLife

Bey v. Reliance Standard – Court Rules Reliance Standard Did Not Act Arbitrarily Or Capriciously

April 6, 2020 // by Nick Ortiz

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.

Read moreBey v. Reliance Standard – Court Rules Reliance Standard Did Not Act Arbitrarily Or Capriciously
Category: Case Summary Blog
Tags: Reliance Standard

Ausler v. Aetna – Court Affirms That Claimants Must Exhaust Appeals to File Suit

April 6, 2020 // by Nick Ortiz

In this case, Tiffany Ausler (“Ausler”) worked as a software engineer for Boeing Corporation (“Boeing”). Because she was a Boeing employee, Ausler was covered under both short-term and long-term disability compensation plans where Aetna Life Insurance Company (“Aetna”) was the administrator of the plans. The plan brochure explains that an employee …

Read moreAusler v. Aetna – Court Affirms That Claimants Must Exhaust Appeals to File Suit
Category: Case Summary Blog
Tags: Aetna

Arning v. Aetna – Court Rules There Was No Abuse Of Discretion

April 6, 2020 // by Nick Ortiz

Charles Buford Arning (“Arning”) was employed full-time by ECMD, Inc. as the President of the Arndt & Herman Building Products Division. Aetna Life Insurance Company (“Aetna”) administered a Long-Term Disability Executives Plan provided to ECMD employees. The Plan’s language provides: “You will be considered disabled while covered under …

Read moreArning v. Aetna – Court Rules There Was No Abuse Of Discretion
Category: Case Summary Blog
Tags: Aetna

Scott v. Union Security – Court Upholds Denial Of Orthopedic Surgeon’s Claim

April 6, 2020 // by Nick Ortiz

In this case, Andrew Scott (“Scott”) was an orthopedic surgeon focusing on sports medicine. His employer had a long-term disability (LTD) plan through Union Security Insurance Company (“Union”). The LTD plan defined “disability” as follows: In October 2012, the Plaintiff had surgery for a rotator cuff injury. As a result, he stopped …

Read moreScott v. Union Security – Court Upholds Denial Of Orthopedic Surgeon’s Claim
Category: Case Summary Blog
Tags: Union Security

Usztics v. Unum – Court Finds No Evidence To Support Disability

April 6, 2020 // by Nick Ortiz

Susan Usztics (“Usztics”) was employed as a program manager for MSX International, Inc. Through her employment, she held a short-term disability benefits policy which was administered by Unum Life Insurance Company of America (“Unum”). Her last day of work was February 4, 2014, following which she applied for short-term disability benefits …

Read moreUsztics v. Unum – Court Finds No Evidence To Support Disability
Category: Case Summary Blog
Tags: Unum
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