The O’Ryan Law Firm, on behalf of Plaintiff, Timothy E., recently filed a federal lawsuit against Life Insurance Company of North America (LINA), a subsidiary of Cigna, for their refusal to continue paying disability benefits to a city employee who had been disabled for more than 5 years. The Plaintiff was employed by the City of Bloomington, and became unable to continue working in his extremely physical job from severe back issues and cardiac problems.  He had been employed for the City of Bloomington for more than 20 years when he was forced to stop working because of his medical conditions.  Cigna paid him for 5 years and then abruptly terminated his monthly disability payments saying he had miraculously recovered his ability to return to work, after 5 years.  In the meantime, he had been approved by the Social Security Administration who found him unable to perform any substantial, gainful activity.

Facts of the Case Against Cigna

The Plaintiff was employed by the City of Bloomington from 1987 until he became disabled in June 2010 and unable to work due to coronary artery disease, back pain, COPD, hypertension, fatigue, sleep apnea, and hyperlipidemia. Plaintiff’s treating physicians provided objective medical proof that the Plaintiff was unable to continue working due to these medical conditions.

The O’Ryan Law Firm, on behalf of Plaintiff Sherry M., recently filed a federal lawsuit against Anthem Life Insurance Company (“Anthem”). The Plaintiff was employed with Anthem Life as an Operations Expert, which made her eligible for disability benefits under the Anthem Life Long Term Disability (LTD) Plan (the “Plan”).  Anthem was both her employer as well as the insurance company for her long term disability benefits.  It always is particularly troubling to see an employee, who has worked hard for a number of years for an insurance company, be mistreated when they become disabled by their own employer.

Facts of the Case

The Plaintiff was employed by Anthem Life until she became disabled in 2015 due to the disabling effects of lupus erythematosus.  According to WEB MD, lupus is an autoimmune disease, which means that the immune system mistakes the body’s own tissues as foreign invaders and attacks them. Some people with lupus suffer only minor inconvenience. Others suffer significant lifelong disability. Nine out of 10 people with lupus are women. The disease usually strikes between age 15 and 44, although it can occur in older individuals. There are two kinds of lupus:

O’Ryan Law Firm, on behalf of Plaintiff Amy R., recently filed a lawsuit against Sun Life and Health Insurance Company (“Sun Life”). The Plaintiff was employed as an Accounting Clerk with Members Advantage Credit Union for many years which made her eligible for disability benefits under the Members Advantage Credit Union Insurance employee benefit plan.  Her employer provided her with both short and long term disability coverage in the event she became unable to continue working due to a serious illness or injury.  However, the insurance company who insured the benefits, Sun Life, refused to complete their end of the bargain and prematurely terminated Amy’s disability benefits despite the fact her doctors continued to report that she was unable to return to work.

Facts of the Case

Amy was a very hard working and productive employee of Members Advantage Credit Union for over twenty years until she became disabled in 2014 due to the disabling effects of lumbar and cervical herniated discs, back pain, degenerative disc disease, chronic pain, lumbar radiculitis, and osteoporosis.  She had struggled with these conditions for many years but loved her job and did everything possible to continue working as long as possible despite the chronic pain she endured from her multiple back problems.

O’Ryan Law Firm, on behalf of Plaintiff Dee Ann Miller recently filed a federal lawsuit against The Hartford Life and Accident Insurance Company (“Hartford”) for payment of disability benefits. The Plaintiff was employed as a Senior Collector with Springleaf Finance, Inc., which made her eligible for disability benefits under the Springleaf Finance Disability Plan and Hartford policy who insures the Plan.  In Miller v .The Hartford Life and Accident Insurance Company, the Plaintiff filed a lawsuit to gain the long term disability benefits she was entitled to under the terms of the Hartford policy and promised to her by her former employer.

Facts of the Case

Ms. Miller was employed by Springleaf Finance for over 15 years until she became disabled in 2014 due to the disabling effects of Fibromyalgia, psoriatic arthritis, osteoarthritis, and chronic pain.  Ms. Miller submitted a claim to Hartford and was paid disability benefits by Hartford. from September 2014 to April 2015.  Her condition did not improve and her medical records showed that she continued to actively seek treatment for her multiple medical conditions.  The last report from her rheumatologist showed that she had 18 of 18 tender points.  She also has difficulty grasping with her hands because of her arthritis.

O’Ryan Law Firm, on behalf of Plaintiff Jo Ellen W., recently filed a lawsuit against Sedgwick Claims Management Services, Inc. (“Sedgwick”). The Plaintiff was employed as a Labor and Delivery Clinical Nurse with Franciscan Alliance which made her eligible for disability benefits under the Franciscan Alliance, Inc. Short-Term and Long-Term Disability Benefit Plans (the “Plan”).

In Jo Ellen W. v .Franciscan Alliance, Inc. Short-Term and Long-Term Disability Plans and Sedgwick Claims Management Services, the Plaintiff filed a lawsuit to gain the long term disability benefits she was entitled to under the terms of the Franciscan Alliance Plan.

Facts of the Case

O’Ryan Law Firm, on behalf of Plaintiff Shane C., recently filed a federal lawsuit against The Prudential Insurance Company of America (“Prudential”). The Plaintiff was employed as Senior Vice President Regional Manager with Custard Insurance Adjusters, Inc. which made him eligible for disability benefits under the Custard Insurance Adjusters, Inc. Long Term Disability Plan (the “Plan”).  As a Regional Manager, Shane was required to travel to 9 different offices throughout the Midwest to oversee and supervise these 9 offices.

In Shane C. v. The Prudential Insurance Company of America and Custard Insurance Adjuster, Inc. Long Term Disability Plan, the Plaintiff filed a lawsuit under ERISA to gain the long-term disability benefits he was entitled to under the terms of the Prudential policy.

Facts of the Case Against Prudential

At the O’Ryan Law Firm, we represent numerous clients who have become disabled and their disability claim was denied by their insurance company. We then represent the clients in the appeal process to appeal the denial of their disability benefits.  Lately, many of the insurance companies have be issuing late determination decisions on the appeals that we submit to those companies.  By law, an insurance company is required to issue a decision within 45 days of the date of receipt of the appeal unless an extension is warranted due to “special circumstances” but even then, a decision on the appeal must be rendered within 90 days at the latest.

The Supreme Court in Firestone Tire & Rubber v. Bruch, 489 U.S. 101, 115 (1989) held that de novo adjudication of employee benefit claims is the norm. Because the de novo standard of review is the default standard in an ERISA employee benefits case, the plan administrator or insurance company bears the burden of showing that the more deferential standard should apply. Fay v. Oxford Health Plan, 287 F.3d 96, 104 (2d Cir.2002)Marguez-Massas v. Squibb Mfg., Inc., 344 F.Supp.2d 315, 320 (D.P.R. 2004); McDonald v. Timberland Co. Group LTD Coverage Program, 2002 WL 122382, at *3 (D.N.H. Jan.23, 2002). Accordingly, once in litigation, a disability insurance company bears the burden of proving that their decision is entitled to deferential review by the Court.

The regulations governing ERISA disability claims require insurance companies to issue a decision on a claimant’s appeal within 45 days of the date that the insurance company received the appeal unless “special circumstances” warrant an extension of time for an additional 45 days; however, in “no event” shall the extension of time exceed 45 days. 29 C.F.R. §2560.503-1(i)(1), (i)(3), (i)(4).

At the O’Ryan Law Firm, we have represented several clients who have become disabled due to the severe symptoms of Scleroderma.

According to the American College of Rheumatology:

WHAT IS SCLERODERMA?

The Dow Chemical Company is a multinational chemical corporation headquartered in Midland, Michigan.  Dow manufactures plastics, chemicals, and agricultural products. With a presence in about 160 countries, it employs about 54,000 people worldwide.  Dow Chemical also has a large complex on the northwest side of Indianapolis.

Liberty Mutual provides disability insurance to employees of Dow.  Liberty Mutual Insurance is an American diversified global insurer, and the second-largest property and casualty insurer in the  world.   Based in Boston, Massachusetts, it employs over 50,000 people in more than 900 locations throughout the world.

In the disability policy provided to Dow employees, Liberty Mutual defines disability as follows:

The University of Notre Dame is a Catholic research university located near South Bend, Indiana. Notre Dame’s Catholic character is reflected in its commitment to the Catholic faith, numerous ministries funded by the school, and the architecture around the campus. Notre Dame rose to national prominence in the early 1900s for its Fighting Irish football team, especially under the guidance of the legendary coach Knute Rockne and is well known for “Touchdown Jesus.”

Cigna is an American worldwide health services organization, whose policies are underwritten by Life Insurance Company of North America (“LINA”). Cigna’s insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and services, the majority of which are offered through employers and other groups.

In June 2015, U.S. health insurer Anthem Inc. announced an offer to acquire Cigna for more than $47 billion in cash and stock. Anthem confirmed it had reached a deal to buy Cigna on July 24, 2015.

Cigna/LINA provides disability coverage to Notre Dame University employees. Cigna disability claims by Notre Dame employees are exempt from the Employee Retirement Income Security Act because the disability plan is considered a “church plan”; therefore, the lawsuit is filed under state law with breach of contract and bad faith counts.
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