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.

O’Ryan Law Firm, on behalf of their client, recently filed a lawsuit against a Liberty Mutual company, Liberty Life Assurance Company of Boston, for denial of a Dow Chemical employee’s long term disability benefits.  Our client was employed by Dow Chemical Company as a Global Adverse Effects Coordinator, responsible for ensuring compliance with the US FIFRA (Federal Insecticide, Fungicide and Rodenticide Act) regulations which protects consumers and the environment.  As an employee of Dow Chemical, she was eligible for disability benefits under the Dow Chemical long term Disability insurance policy.

Dow Chemical is a large producer of plastics, including synthetic rubber. It is also a major producer of ethylene oxide, various acrylates, surfactants, and cellulose resins. It produces agricultural chemicals including the pesticide Lorsban and consumer products including Styrofoam.

After 27 years of working for Dow Chemical, our client was forced to stop working when she became disabled from the severe symptoms of Crohn’s Disease.  Crohn’s Disease is an inflammatory bowel disease that causes inflammation of the digestive tract, which leads to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition.  The inflammation caused by Crohn’s disease often spreads deep into the layers of the affected bowel tissue and can be both painful and debilitating.  Unfortunately, there is no cure for Crohn’s Disease yet.

Christine W. is 54 years old and worked in marketing for a large network of hospitals and healthcare facilities until she was forced to stop working in early 2018 due to severe back and leg pain resulting from severe scoliosis and flat back syndrome subsequent to Harrington rod surgery. Since that time, she has also undergone major spinal reconstructive surgery and is currently in the process of recovering from that surgery.

When Christine was forced to stop working, she applied for short term disability (STD) benefits through her employer’s disability plan, which was insured by The Hartford. Under the terms of the Hartford policy, Christine was entitled to receive STD benefits for up to 6 months if she was unable to perform the material duties of her own occupation. Because Christine’s medical conditions prevented her from working in her own occupation, The Hartford awarded her STD benefits, which it paid until March of 2018.

In March of 2018, Christine received an epidural steroid injection to treat her back pain, and it provided her with limited relief for 1-2 weeks. Unfortunately, because her treating physician’s records noted that her back pain had improved as of mid-March, The Hartford latched onto this statement and used it to terminate her STD benefits, claiming that she was able to return to work as a result of her improved condition.

A former employee of Mid America Clinical Laboratories hired O’Ryan Law Firm after Lincoln National wrongfully terminated her short term disability benefits and then refused to pay any long term disability benefits.  The client initially applied for short term disability benefits that were offered through her employee benefit plan, although the employee paid all of the premiums herself for the disability coverage.  Lincoln National was the disability insurance company who accepted all of her premiums and agreed to pay her monthly disability benefits in the event she became unable to work due to a serious illness or injury.

The employee suffered from the severe symptoms of Lyme disease including muscle and joint pain, headaches, and disabling fatigue.  The employee treated with one of the best Lyme disease specialists in Indiana, Dr. Kimberly Lentz, whose office is located in Zionsville.  Dr. Lentz reported to Lincoln that the employee had the classic symptoms of Lyme disease and was unable to continue working because of the debilitating consequences of contracting Lyme disease.  Lincoln paid her short term disability benefits for a month but then terminated the claim after they hired a record reviewing doctor to review the records.  After the short term disability was terminated, the employee hired O’Ryan Law Firm to appeal the premature termination of her short term benefits and to assist her with applying for long term disability benefits.

Prior to her serious medical conditions, the employee worked as a medical technician with Mid America Clinical Laboratories for two years.  Her job required her to analyze blood and body fluids, operate sophisticated laboratory equipment and computerized instruments, log data from medical tests, discuss lab findings with physicians, and supervise and train other medical lab technicians.  An extensive amount of concentration and focus was necessary to perform the duties of her position and any mistakes could lead to serious consequences. Mid America is the largest clinical laboratory in Indiana. They complete over 4.5 million tests per year. Mid America is not only located in Indianapolis, but also has over 30 Patient Service Centers throughout central Indiana.

Dan T. is 60 years old and was a cable splicing technician with a telecommunications company, where he worked for approximately 29 years until late 2015, when he was forced to stop working due to the debilitating effects of bilateral knee osteoarthritis and cervical and lumbar spondylosis. Since that time, he has also undergone total replacements of both knees and developed severe, debilitating chronic cervicogenic/occipital headaches that occur on a daily basis; moderate to severe bilateral carpal tunnel syndrome; and increasingly severe lower back and leg pain that persists despite a lumbar spinal fusion surgery in early 2018.

When Dan was forced to stop working, he applied for long term disability (LTD) benefits through his employer’s disability plan, which was insured by Prudential. Under the terms of the Prudential policy, Dan was entitled to receive LTD benefits for up to 24 months if he was unable to perform the material duties of his own occupation. Because Dan’s medical conditions prevented him from working in his own occupation as a cable splicing technician, Prudential awarded him LTD benefits, which it paid until May of 2018.

However, the terms of the Prudential LTD policy dictate that after 24 months of receiving LTD benefits, Dan was only entitled to continue receiving benefits if he could prove that he was disabled from performing any gainful occupation for which he was “reasonably fitted by education, training or experience.” As a result, Prudential terminated Dan’s benefits after 24 months, based on a vocational review that concluded that he was able to perform certain sedentary work for which he was qualified by his education and experience.

O’Ryan Law firm has extensive experience representing clients in appeals and litigation under the Employee Retirement Income Security Act of 1974 (ERISA), which governs most claims for benefits under employer-sponsored insurance plans. Earlier this year, the US Department of Labor amended its regulations under ERISA, providing claimants with some additional rights during the process of appealing denials of benefits under plans governed by ERISA.

One important additional right granted under the new ERISA regulation is the opportunity to review and respond to any additional evidence considered by an insurance company during an appeal of a benefits claim denial. This means that if a claimant appeals a denial or termination of benefits and the insurance company sends the file to a reviewing physician, the claimant has a right to read and respond to the report of that reviewing physician before the insurance company can make its final decision on the appeal. O’Ryan Law firm recently took advantage of this new protection to obtain short term disability (STD) benefits for a client who had previously had her STD benefits terminated.

Kim M was a Repair Service Attendant at a large telecom company and was forced to stop working in early 2017[1] as a result of failed back syndrome, multilevel degenerative disc disease, lumbar facet arthritis, and spondylopathy. After she was unable to return to work, she was awarded STD benefits under her employer’s disability plan, which was administered by Sedgwick. However, Sedgwick terminated Kim’s STD benefits several months later, claiming there was no longer sufficient medical evidence to support her claim. In the letter explaining its termination of Kim’s benefits, Sedgwick relied on the opinions of two reviewing physicians who asserted that Kim was not disabled.