• Menu
  • Skip to right header navigation
  • Skip to main content
  • Skip to secondary navigation
  • Skip to primary sidebar
  • Skip to footer

Before Header

Has your disability claim been wrongfully denied or terminated? Call us today for help!  (888) 321-8131

  • Facebook
  • Instagram
  • LinkedIn
  • Twitter
  • YouTube

National Disability Law Firm | Ortiz Law Firm

We appeal wrongful long term disability insurance and Social Security Disability denials.

  • ABOUT US
    • Our Team
    • Our Results
    • Areas We Serve
    • Core Values
  • PRACTICE AREAS
    • Administrative Appeals
    • Lawsuits
    • Lump Sum Settlement Offers
  • RESOURCES
    • Top 10 Mistakes That Will Destroy Your LTD Claim
    • Physical RFC Form
    • Mental RFC Form
    • Ultimate Appeal Checklist
    • Long Term Disability Case Study
    • Lump Sum Disability Settlement Calculator
  • BLOG
    • Long Term Disability Denials and Appeals
    • Medical Eligibility for Long Term Disability Claims
    • Eligibility for Long Term Disability Claims
    • Your Chances of Getting Approved for Disability Benefits
    • Additional Parts Of A Claim That Do Not Happen in Every Case
  • Search
  • CONTACT
  • ABOUT US
    • Our Team
      • Nick Ortiz
      • Jessica Ortiz
      • Dawn Keller
      • Tory Nelson
      • Sarah Palag
    • Core Values
    • Our Results
      • Why Choose Ortiz Law Firm
      • What Our Clients Say
      • Testimonials
  • PRACTICE AREAS
    • Long Term Disability
      • Administrative Appeals
      • Lawsuits
      • Lump-Sum Settlement Offers
      • Qualifying Conditions
      • Disability Insurance Companies
      • Qualifying Occupations
      • Case Summary Archives
      • FAQs
    • Social Security Disability
      • Initial Application
      • Request for Reconsideration
      • Hearing Before an Administrative Law Judge
      • Qualifying Conditions
      • FAQs
    • Personal Injury
      • Car Accident Claims in Pensacola, Florida
      • Bicycle Accident Claims in Pensacola, Florida
      • Motorcycle Accident Claims in Pensacola, Florida
      • Truck Accident Claims in Pensacola, Florida
      • Slip & Fall
      • Insurance Companies
      • FAQs
  • AREAS WE SERVE
  • RESOURCES
    • Long Term Disability: Top 10 Mistakes That Will Destroy Your Claim
    • Social Security Disability: Top 10 Mistakes That Will Destroy Your Claim
    • Social Security Disability Training Webinar: Knowing What Wins
    • Residual Functional Capacity Form (Physical)
    • Residual Functional Capacity Form (Mental)
    • Lump Sum Disability Settlement Calculator
  • BLOG
    • Long Term Disability
      • Eligibility for Long Term Disability Claims
      • Medical Eligibility for Long Term Disability Claims
      • Your Chances of Getting Approved for Disability Benefits
      • Long Term Disability Denials and Appeals
      • Additional Parts Of A Claim That Do Not Happen in Every Case
    • Social Security Disability
    • Personal Injury
  • REFER A CASE
  • Search
  • CONTACT

Mobile Menu

Schedule A Free Consultation Now!

Find out how our law firm can help you win your case or you don’t pay a cent.

(888) 321-8131

  • Facebook
  • LinkedIn
  • Twitter
  • YouTube

Liberty’s Long Term Disability Denial was Supported

January 6, 2021

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, the term “disabled” means:

  1. that during the Elimination Period and the next 24 months of Disability the Covered person, as a result of Injury or Sickness, is unable to perform the Material and Substantial Duties of his Own occupation; and
  2. thereafter, the Covered Person is unable to perform, with reasonable continuity, the Material and Substantial Duties of Any Occupation.

“Material and Substantial Duties” are defined as “responsibilities that are normally required to perform the Covered Person’s Own Occupation or any other occupation, and cannot be reasonably eliminated or modified.” Additionally, the term “Elimination Period” is defined as “a period of consecutive days of Disability or Partial Disability for which no benefit is payable.”

In October of 2014, Diaz was injured in a work-related motor vehicle accident, which led to chronic neck and low back pain. He later submitted a claim for workers’ compensation and received recommendations for work restrictions. On November 3, 2014, Diaz was no longer restricted and returned to full-time work duty. By September 2015, Diaz had obtained a transfer from his location in Orlando to another location in Tampa and soon after ceased working. On April 1, 2016, Diaz submitted a claim to Liberty for long-term disability benefits as a result of chronic neck and low back pain, muscular spasms, left shoulder pain, degenerative disc disease, and adjustment disorder with mixed anxiety and depressed mood.

While Liberty began reviewing Diaz’s claim, it also requested a job description from JM Family Enterprises for his occupation. It was determined that the job was sedentary or light, depending on whether Diaz was traveling or at the office. On April 28, 2016, Diaz’s claim was denied for the reason that there was not enough evidence of a disability as defined by the plan. In October of 2016, Diaz sought an appeal for the denial of long-term benefits. However, Liberty upheld its decision, stating that

[W]e acknowledge that Mr. Diaz may have continued to experience some neck and back pain, and anxiety and depression, associated with his condition, beyond April 12, 2016. However, the information does not contain physical, cognitive, or psychiatric exam findings, diagnostic test results, functional capacities evaluation, hospitalization records, or other forms of medical documentation supporting Mr. Dolan’s [sic] symptoms remained of such severity, frequency, and duration that they resulted in restrictions or limitations rendering Mr. Dolan [sic] unable to perform the duties of his own Sales Manager occupation at either the sedentary of [sic] light physical demand level, after October 16, 2015.

Diaz then filed suit on February 21, 2017, arguing that he should receive long-term disability benefits and stating that Liberty “failed to consider objective physical conditions and non-exertional limitations such as the effects of pain, impaired attention and concentration, and side effects of heavy narcotics.”

The main issue which the court must determine is whether Liberty’s denial of Diaz’s benefits was reasonably supported. Diaz claims that there are several reasons why Liberty was wrong in its denial. Firstly, Diaz believes that Liberty did not give enough weight to the results of the Functional Capacity Evaluation (“FCE”) that he underwent. However, Liberty’s Dr. Foland gave three reasons for discounting the results of the FCE. 1. Dr. Foland stated that the FCE results were inconsistent with the medical records that led up to the date that the FCE was performed. 2. Dr. Foland also opined that the person who conducted the FCE, Anthony Pribila, drew conclusions that were not supported by the results of the test. For example, Anthony Pribila indicated that Diaz was able to demonstrate full and consistent effort in all tasks, even though three of the grip and pinch strength tests were outside of the range that was valid, consistent, and reproducible. 3. Further, Dr. Foland also discounted the FCE because the reliability of using FCEs had not yet been fully established in research.

Secondly, Diaz argues that his “counseling records document restlessness, difficulty concentrating, irritability, e.g.” To support this argument, there is only a single document in the record. This document indicates that Diaz may have been moderately impaired from March 1, 2016, to April 7, 2016; however, the court held that that is not enough to show that Diaz was disabled through the whole Elimination Period.

Thirdly, Diaz claims that Liberty improperly relied on its own psychiatrists because they did not actually examine nor interview him themselves. He claimed that “courts routinely discount or entirely disregard the opinion of psychiatrists who have not examined the individual.” However, there are cases in the Eleventh Circuit where courts upheld denial decisions where consulting psychologists or psychiatrists were used. Here, Liberty’s consulting psychiatrists did not reach a conclusion that differed from Diaz’s own treating psychiatrists. More specifically, Dr. Forehand and Dr. Segal simply indicated that there was not enough documentation in the record to show that Diaz had any psychiatric limitations.

Fourthly and lastly, Diaz argues that his pain and side effects of his medication were not accounted for in Liberty’s decision-making process. The policy requires a showing that Diaz was unable to perform his material and substantial duties. However, the court found that the record provided no information that firmly established that Diaz’s pain or side effects from medication kept him from executing the material and substantial duties of his job during the entirety of the Elimination Period.

For all of the reasons above, the court held that Liberty’s decision to deny Diaz’s claim for long-term disability benefits was sufficiently supported. As such, the court believed that Liberty did not make an arbitrary and capricious decision related to Diaz’s benefits. Therefore, the court ruled in favor of Liberty, and ruled against Diaz, resulting in a denial of Diaz’s claim.

[Note: this claim was not handled by the Ortiz Law Firm. It is merely summarized here for a better understanding of how Federal Courts are handling long term disability insurance claims.]

Here is a copy of the decision in PDF:

Diaz v. Liberty Life

Insurance Company: Liberty LifeOccupation: Manager

Primary Sidebar

View All Resources


Jennifer L.

Attorney Nick Ortiz is the best disability Attorney. After extensive research, I contacted Attorney Ortiz in reference to my denied LTD Insurance Claim. After working 30 years and becoming disabled due to TBI, it was a horrible ordeal being on $0 income. Attorney Ortiz is brilliant and compassionate and he truly cares about getting you a winning result. Attorney Ortiz did an outstanding Appeal and had my claim overturned without having to file a lawsuit in Court. When I received the back pay check, I cried because I felt safe having Attorney Ortiz as my Advocator. Thanks to Attorney Ortiz, Alicia and Dawn, I will have a Joyous Holiday Season.

View All Testimonials

Complete this CONFIDENTIAL form or call (888) 321-8131 for a FREE case evaluation

  • This field is for validation purposes and should be left unchanged.

Navigation

  • Free Resources
  • Qualifying Conditions for LTD
  • LTD Insurance Companies
  • Qualifying Occupations for LTD
  • Case Summary Archives
  • LTD FAQ
  • Qualifying Conditions for SSD
  • SSD FAQ
  • PI FAQ
  • PI Insurance Companies
  • Disclaimer

Footer

Our Team

  • Nick Ortiz
  • Jessica Ortiz
  • Dawn Keller
  • Sarah Palag
  • Tory Nelson

Our Law Office

ORTIZ LAW FIRM
(888) 321-8131

823 E. Jackson St.
Pensacola, FL 32501
Monday - Thursday: 9:00 AM - 5:00 PM Friday: 9:00 AM - 2:00 PM

Saturday - Sunday: Closed

Practice Areas

  • National Long Term Disability Attorney
  • Social Security Disability Claims
  • Personal Injury Claims
  • Facebook
  • LinkedIn
  • Twitter
  • YouTube
  • Free Long Term Disability Resources
  • Long Term Disability Frequently Asked Questions
  • Medical Conditions That May Qualify for Long Term Disability
  • LTD Insurance Carriers
  • Occupations That May Qualify for LTD
  • LTD Blog
  • LTD Federal Court Case Summaries
  • Contact
  • Disclaimer

Site Footer

©2020 Ortiz Law Firm, All Rights Reserved. Reproduced with Permission | Privacy Policy