Shanna was a Pharmaceutical Sales Representative with a large international pharmaceutical company for seven years until late 2014, when she was forced to stop working after undergoing surgery to remove a neuroma from her right foot. Since that time, Shanna has been diagnosed with a host of additional conditions that leave her unable to return to work, including complex regional pain syndrome (“CRPS”), osteoporosis, osteopenia, degenerative joint disease, degenerative arthritis, advanced osteoarthritis with heterotopic ossification of the jaw requiring bilateral arthroplasty of the temporomandibular joints, spontaneous intracranial hypotension subsequent to cerebrospinal fluid leak, and level 3 chronic kidney disease. Shanna also suffers from severe chronic intractable migraines, which have significantly worsened over the past five years.

As a Pharmaceutical Sales Representative, Shanna was required to frequently travel to medical facilities, often walking long distances throughout the facilities to reach the physicians and staff members with whom she would be speaking. Her job required significant time on her feet, often without the opportunity to take breaks as necessary. As Shanna’s conditions became progressively debilitating, it became increasingly difficult for Shanna to keep up with the volume of sales calls necessary to sustain her position. When she was unable to continue working, Shanna filed claims for short term disability (“STD”) and long term disability (“LTD”) benefits under policies provided by her employer. Both claims were approved, and Liberty Mutual paid her long term disability benefits for more than three years without any issues.

Unfortunately, in early 2018, Liberty Mutual began seeking to terminate Shanna’s benefits, contacting several of her medical providers to request confirmation that she could return to work in a sedentary capacity. Although Shanna’s physicians disagreed, Liberty nonetheless terminated her benefits in October of 2018 based on a critically flawed report by an “independent” reviewing physician hired by Liberty to evaluate Shanna’s claim.

Navigating through the process of obtaining or keeping your short-term or long-term disability includes obtaining supportive statements from your treating physicians.  Not only is it important to collect medical records for your claim but also it is imperative that you garner an attending physician statement that will support your disability.

Prior to filing for short-term or long-term insurance benefits, you should make an appointment with your doctor to discuss your decision to leave work. Once you arrive at your appointment, be sure to take the time to explain why you need their help in the claims process.  If you need a form or letter written, make sure that the doctor explains in as much detail as possible the severity of the symptoms you experience and how they impact your ability to work.

One of the most common reasons for a disability claim denial by an insurance company is due to lack of proof of disability.  Starting the process with your physician should happen prior to submitting a disability claim.  Waiting to file a disability claim until after confirming first that your physician will be willing to provide support will help ensure a positive outcome.

Michael P is a Gulf War veteran who served in special forces with the US Marines during Operation Desert Storm. During his time in combat, Michael was exposed to hazardous chemicals from burning oil wells and experienced firsthand the horrors of war.

After returning home and receiving an honorable discharge from the Marine Corps, Michael went to work as an electrician in a heavy industrial manufacturing facility in northwest Indiana. As part of his role, Michael was frequently required to work on cranes and other heavy industrial equipment high above a foundry floor in a facility in which molten steel was transported and poured. According to his job description, he was required to keep electrical equipment such as wiring motors, switches, and electrical mechanisms in good repair and operating condition; install a variety of complicated electrical and some mechanical equipment; and diagnose and remedy trouble quickly to avoid shutdowns.

In June of 2017, Michael was diagnosed with very severe post-traumatic stress disorder (“PTSD”) as a result of his combat experience. He also suffered from severe headaches, frequently lasting hours at a time. When he presented for an MRI to evaluate the cause of his headaches, his doctors noted atrophy in the cerebral cortex, a common feature of many brain diseases that is frequently associated with dementia, seizures, and impaired comprehension, often resulting from underlying traumatic brain injury.

Working as a Purchasing Agent for Purdue University for over 40 year, Dennis H. found he could no longer perform his job duties due to debilitating pain caused by osteoarthritis, right cervicalgia, tremors in his head that caused pain, and lumbar radiculopathy.  These medical conditions cause pain or significant discomfort in his neck, especially at the back and along the sides of his neck. Lumbar radiculopathy results from a nerve in the lower back that is pinched or irritated.  Dennis sought relief through many forms of treatment including epidural steroid injections, without success.  He even tried radiofrequency ablation, which burns off the troubling nerve, in order to improve his neck and back function, reduce his pain medications, and to avoid surgery but unfortunately he received very little relief from the ablation.

When he was unable to continue working, Dennis filed a claim for long term disability benefits provided by Purdue’s employee benefit plan and insured by Life Insurance Company of North America (“LINA”), a subsidiary of Cigna.  Cigna is a global health service company with 95 million customers around the world.  Cigna is a major provider of health-related products and services, the majority of which are offered through employers and other groups. Cigna is the long term disability insurance company for Purdue employees.

Cigna approved Dennis’ claim and paid his benefits from October 2017 through August 2018, when they were abruptly terminated by Cigna without any improvement in his medical condition. While he was receiving Cigna disability benefits, Purdue also provided him with medical coverage and life insurance coverage. When Cigna wrongfully terminated the disability benefits, these other critical benefits were also terminated.

Narcolepsy is a chronic neurological disorder affecting the brain’s ability to direct sleep/wake cycles and if left undiagnosed, may interfere with psychological, social and cognitive function inhibiting academics, social interaction and work.  People with narcolepsy may experience broken sleep patterns throughout the night or an inability to sleep.  They may awaken in the morning refreshed only to experience extreme sleepiness during the day.

Nearly all individuals with narcolepsy with cataplexy have extremely low levels of naturally occurring chemical hypocretin.  Hypocretin regulates your REM sleep and wakefulness.  While the causes of narcolepsy are not totally understood, much of the research shows that it may result from a combination of factors such as autoimmune disorders, family history and brain injuries

Narcolepsy is diagnosed by clinical examination as well as a detailed medical history.  A physical exam is important to rule out other conditions that may be causing the symptoms but there are two specialized tests, Polysomnogram and Multiple Sleep Latency Test, performed to diagnose Narcolepsy.  Although there is no cure for narcolepsy, some of the symptoms can be treated with medications such as Modafinil, antidepressants, sodium oxybate, and life style changes.  Taking short naps, maintaining a regular sleep schedule, avoiding caffeine or alcohol prior to bedtime, avoiding smoking and exercising daily are just some of the things you can do to reduce the symptoms of narcolepsy.

Lois M was a factory worker for a large manufacturing company. By June of 2017, decades of working in very heavy duty manufacturing jobs had taken their toll on her body, leaving her unable to continue working due to severe and debilitating degenerative joint disease in her left hip, mild scoliosis, severe multilevel degenerative disc disease, bulging discs, facet arthrosis of the lower spine, and osteoporosis.

When she was unable to continue working, Lois filed a claim for short term disability (“STD”) benefits under a disability benefits plan provided by her employer and administered by Life Insurance Company of North America (“LINA”), a subsidiary of Cigna. Despite significant supportive medical records and strong statements from her treating physicians in support of her claim, LINA denied Lois’ claim based on a review by a nurse case manager.

After her claim was denied, Lois hired O’Ryan Law Firm to represent her to appeal the denial of her STD claim and assist her in filing a claim for long term disability (“LTD”) insurance benefits. We helped Lois gather substantial additional supportive medical evidence, including strong supportive statements from multiple treating physicians, and compiled an appeal of LINA’s denial of her STD benefits. Unfortunately, Lois’ employer continued to refuse to pay her STD benefits despite overwhelming evidence that she was truly disabled from performing her heavy duty manufacturing occupation.

On behalf of our client, Charlene L., O’Ryan Law Firm recently filed a lawsuit against Cigna Life Insurance Company of New York (“Cigna”). Prior to becoming disabled, Charlene was employed as a Store Manager with Ann Taylor, Inc.  Ann Taylor, Inc. is an American group of specialty apparel retail chain stores for women. The company is headquartered in New York City and currently operates as a subsidiary of Ascena Retail Group. The stores offer classic styled suits, separates, dresses, shoes and accessories. The brand is marketed under five divisions: Ann Taylor, Loft, Lou & Grey, Ann Taylor Factory and Loft Outlet.  As Store Manager, Charlene managed all aspects of the operation of a retail store, including sales, scheduling, pricing, inventory management, accounting, and employee supervision.

Charlene was forced to stop working due to the disabling symptoms of severe recurring headaches, chronic pain, fibromyalgia, and hypertension.  According to the Mayo Clinic, “fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues.  Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress.  Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.”

When Charlene was unable to continue working due to her disabling medical conditions, she submitted a claim for long term disability  (LTD) benefits to Cigna.  Cigna initially approved her LTD benefits for two years, but Cigna notified her that it was terminating her benefits based on a review by its in-house medical staff.  Cigna claimed that although she could no longer perform her job as a Store Manager, she could perform jobs that were more sedentary.

A Facility Maintenance Manager with Purdue University hired O’Ryan Law Firm to assist him with his appeal for long term disability benefits with Cigna.  Cigna approved him for long term disability benefits and Cigna paid him disability benefits for 19 months, under the terms of the Cigna policy, but then they abruptly terminated his benefits in September 2017.  Our client worked at Purdue for over 13 years before he became disabled.  As a Facility Maintenance Manager he was responsible for keeping the Purdue campus premises and office buildings in a clean and orderly condition.  This position required heavy lifting, carrying, pushing and pulling from 20-50 pounds frequently.

Purdue’s main campus is located in West Lafayette, Indiana and is one of the premiere educational institutions for higher education in Indiana.  Purdue offers more than 200 majors for undergraduates, over 69 masters and doctoral programs, and professional degrees in pharmacy and veterinary medicine.

Cigna is a Pennsylvania insurance company who provides the group disability coverage to all Purdue employees.  Under the Cigna policy, Purdue employees are entitled to receive disability benefits if they are determined to be disabled pursuant to the following definition from the policy:

Chuck A is 61 years old and was a freight truck driver for a large international shipping company, where he worked for 23 years until the spring of 2017, when he was forced to stop working due to the debilitating effects of severe intractable pain of the neck, back, arms, and legs resulting from a host of conditions including trigeminal nerve paresthesia, cervical spondylosis, multiple lumbar spondylosis, lumbar radiculopathy, arthritis, COPD, chronic pain syndrome, post-laminectomy syndrome of the lumbar and cervical regions, lumbar neuritis, arthropathy of the knee, and lumbar stenosis with neurogenic claudication. Despite several surgeries to the lumbar and surgical spine, Chuck has been unable to obtain meaningful relief of his severe, debilitating pain.

When Chuck was forced to stop working, he applied for long term disability (LTD) benefits through his employer’s disability plan, which is administered by Aetna. Under the terms of the plan, Chuck was entitled to receive LTD benefits for up to 12 months if he was unable to perform the material duties of his own occupation. Because Chuck’s medical conditions prevented him from working in his own occupation as a freight truck driver, Aetna awarded him LTD benefits, which it paid until October of 2018.

However, the terms of his employer’s disability plan dictate that after 12 months of receiving LTD benefits, Chuck was only entitled to continue receiving benefits if he could prove that he was disabled from performing any gainful occupation for which he “is, or may reasonably become qualified based on education, training, or experience” and was unable to earn 60% or more of his pre-disability earnings. As a result, Aetna terminated Chuck’s benefits after 12 months, based on a vocational review that concluded that he was able to perform certain other occupations for which he was qualified by his education and experience.

Bill M. worked for a large industrial company until he became disabled in 2005. When Bill’s illness became so severe that he began to become concerned that he may not live much longer, he called his employer’s benefits center in April of 2018 to confirm that he was still covered for $226,000 in group life insurance provided by the employer in order to ensure that his wife Diana would be financially protected if he passed away. The benefits center provided written confirmation that Bill was still covered for $226,000 of group life insurance. The next month, Bill passed away and Diana contacted the employer’s benefits center to file a claim for the $226,000 in life insurance benefits under the group life insurance policy.

Unfortunately, although the employer’s benefits center promised Diana that it was processing her claim through their insurance department, months and months went by without any action on her life insurance claim. After several months and dozens of phone calls to the employee benefits center without receiving payment of her life insurance proceeds, Diana contacted O’Ryan Law Firm to help her pursue payment of her husband’s life insurance benefits.

After thoroughly reviewing Diana’s claim, O’Ryan Law Firm filed a lawsuit in the United States District Court for the Southern District of Indiana seeking to force the employer to pay the life insurance proceeds. The employer contended that Bill’s life insurance coverage ended when he stopped receiving long term disability (“LTD”) benefits under the employer’s group LTD policy. Diana’s attorneys at O’Ryan Law Firm requested and obtained documents from the employer that provided evidence as to why Bill’s LTD benefits had been terminated and why the employer had represented that Bill was still covered under its group life insurance policy as of April of 2018.