O’Ryan Law Firm has sued Cigna on behalf of a Finish Line employee who became disabled.  Cigna paid long term disability benefits for one year, and then terminated her benefits.  The client worked as an IT Business Relationship Manager at the Finish Line corporate office in Indianapolis.  Her job required her to sit for more than 6 hours during her shift, and stand for up to 4 hours at a time periodically.  Her average work week was 45-50 hours. It was a very physically demanding job.

The Finish Line is an American retail chain that sells athletic shoes and related apparel and accessories. The company operates 660 stores in 47 states, mostly in enclosed shopping malls, as well as Finish Line-branded athletic shoe departments in more than 450 Macy’s stores.   The Finish Line has one of its’ corporate offices located in Indianapolis.  The following is a statement from the Indianapolis Corporate Office:

“Finish Line has the latest running shoes, basketball sneakers, casual shoes and athletic gear from brands like Nike, Jordan, Adidas, Under Armour, Puma, Champion and more. We’re committed to providing top-notch customer service and offering a variety of products for men, women and kids so you can find all the shoes, clothing or accessories that you’ve been looking for.”

Nick M. hired O’Ryan Law Firm to assist with his appeal for long term disability benefits from Life Insurance Company of North America (“LINA”), a CIGNA company.  LINA approved and paid his long term disability benefits claim for seven years. After seven years of paying his disability benefits, and despite having no evidence that his condition had improved, LINA abruptly terminated Nick’s benefits in May 2018.  Previously, Nick worked as an Information Analyst with Purdue University for almost ten years before he became disabled.  Purdue’s main campus is located in West Lafayette Indiana and is one of the premiere educational institutions for higher education.  Purdue offers more than 200 majors for undergraduates, over 69 masters and doctoral programs, and professional degrees in pharmacy and veterinary medicine

LINA is a Cigna corporation whose principal place of business is in Philadelphia, Pennsylvania. Under the LINA policy, Nick is entitled to continue receiving disability benefits if meets the definition of disabled pursuant to the following definition from the policy:

After Disability Benefits have been payable for 12 months, the Employee is considered Disabled if, solely due to Injury or Sickness, he or she is:

Katie P was a Customer Service Manager for a small web-based company (“Company A”) for several years. Her employer was acquired by a larger company (“Company B”) in July of 2016, but her job was not impacted by the acquisition. She kept her job, but technically became an employee of Company B. Her employee benefits, including her long term disability insurance coverage, were transferred to Company B’s benefits plan at the time the acquisition was completed.

For years, Katie had been struggling with numerous medical conditions that made it difficult for her to work. These conditions became progressively more severe over time, to the point that Katie became totally disabled and was forced to stop working in February of 2017.

Katie filed a claim for long term disability (“LTD”) benefits under the Prudential Life Insurance Company (“Prudential”) LTD policy provided by Company B’s group benefits plan. However, despite acknowledging that Katie was truly disabled, Prudential denied her LTD claim, arguing that Katie’s conditions were preexisting and therefore excluded from coverage under the LTD policy.

Fibromyalgia is a very complex chronic pain disorder that affects an estimated 10 million individuals in the United States and approximately three to six percent of the world population.  For those suffering from fibromyalgia, the disease causes widespread pain and tenderness to touch and can affect the entire body.  Fibromyalgia symptoms can include stiffness, pain, fatigue, tiredness, depression/anxiety, memory, sleep issues, concentration, and headaches including at times migraines.  Fibromyalgia symptoms can be very severe and debilitating affecting a persons’ work, social and daily life.

The criteria, established by the American College of Rheumatology in 1990, contains a history of widespread pain in all four quadrants of the body for the duration of three months or more and pain in at least 11 of the 18 designated tender points when pressure is applied.  In 2000, the American College of Rheumatology ceased using the criteria of tender points and instead focused on pain being widespread and accompanied by symptoms such as sleep problems, problems with thinking and fatigue.  Unfortunately, those who suffer with fibromyalgia typically have normal results with conventional testing. A physician knowledgeable about the disease, such as a rheumatologist, is necessary to make the diagnosis in part by ruling out other causes.

The National Fibromyalgia Institute (NFI) website states that fibromyalgia is marked by profound, chronic, and widespread pain that can migrate to all parts of the body in varying intensities.  The pain can be described as stabbing, shooting, muscle aching, throbbing and twitching.  Neurologists have noted that patients with this disease can experience numbness and tingling, aggravated by stress, weather and movements.

O’Ryan Law Firm, on behalf of our client who is a disabled hospital ultrasound technician, recently filed a lawsuit against Madison National Life Insurance Company.  Our client was forced to stop working due to severe chronic migraines, which she suffered several days a week. These migraines were often so intense that they caused her to become nauseous to the point of vomiting, frequently spending entire days in the bathroom as a result.

After our client became disabled, Madison National paid her benefits for nearly four years under the long term disability policy it provided through her employer. The Social Security Administration also awarded our client disability benefits, finding that she was unable to perform any gainful occupation. Madison National even continued to pay our client benefits for more than a year after the policy’s “own occupation” period ended and the policy’s definition of “disability” changed to require her to be disabled from performing not only her own job, but any job for which her education, skills, and experience qualified her.

Unfortunately, in January of 2017, Madison National abruptly notified our client that her claim was being closed based on a review of her medical records that allegedly determined that she was no longer disabled. In our experience, this is a common tactic that Madison National uses to terminate claims that it no longer wishes to continue paying.

O’Ryan Law Firm, on behalf of our client who is a disabled Notre Dame employee, recently filed a  lawsuit against a Cigna subsidiary, Life Insurance Company of North America.  The client had been employed as an Academic Program Administrator with the University of Notre Dame.  Notre Dame is a private, non-profit Catholic research university in the community of Notre Dame, Indiana, near the city of South Bend, Indiana.  Notre Dame is consistently recognized as one of the top universities in the world.  Notre Dame started as a small all-male institution in 1842 by a French priest and seven other members of the Congregation of Holy Cross on 524 acres in northern Indiana.  In April of 1879 a disastrous fire destroyed the main building which housed virtually the entire University; however, 300 laborers, working all summer, rebuilt the structure that still stands today, topped by the gleaming Golden Dome.

In its early days, Notre Dame University enrolled religious novitiates, preparatory and grade school students and manual labor students but its classical collegiate curriculum never maintained more than a dozen students a year in the early decades.  Father John Zahm, who accompanied former President Theodore Roosevelt on a South American expedition, became the builder of the science departments at Notre Dame and inspired the University’s first steps in research. Father James Burns, Notre Dame’s great theorist of education, revolutionized Notre Dame University in the 1920s by eliminating the preparatory school and dramatically upgrading the law school.

Beginning in the 1930s Notre Dame University was strengthened by an influx of distinguished European scholars fleeing the Nazis and, drawing on their expertise, Father (later Cardinal) John O’Hara, expanded the graduate school to include programs in biology, physics, philosophy and mathematics. Notre Dame first enrolled women undergraduates in 1972.  The school is officially named the University of Notre Dame du Lac (University of Our Lady of the Lake).

The United States District Court for the Southern District of Indiana overturned Life Insurance Company of North America’s (LINA) Termination of long term disability benefits owed to Greg D., an O’Ryan Law Firm client who was forced to leave his job as a maintenance mechanic with Ohio Valley Electric Corporation/Indiana-Kentucky Electrical Corporation (OVEC/IKEC) after he was forced to stop working due to severe back, neck, shoulder, hip, and leg pain. The Court’s opinion, written by District Judge William T. Lawrence, is the result of several months of zealous litigation by the O’Ryan Law Firm on behalf of Greg.

After working for OVEC/IKEC for more than 27 years, Greg underwent shoulder surgery in December of 2006 to locate and repair a tear in his rotator cuff. Unfortunately, his shoulder pain did not subside after the surgery, despite diligent treatment by Greg’s physicians and a rigorous course of more than 50 physical therapy sessions between February and July of 2007. As a result, Greg was unable to return to work in his heavy-duty occupation as a maintenance mechanic. Meanwhile, he also continued to seek treatment for his chronic neck and back pain.

After the shoulder surgery, LINA awarded Greg benefits under the long term disability policy it had issued through his employer. A few months after it began paying Greg’s benefits, LINA hired an investigator to perform surveillance on Greg because they believed he was working while collecting benefits. The investigator’s surveillance revealed no evidence of activity that would be inconsistent with Greg’s disability, and LINA continued paying his benefits for 24 months. After 24 months of benefits, the definition of “disability” under the LINA policy changed to require that Greg be disabled from performing any occupation, not just his own heavy duty occupation. Upon this change in the definition of “disability,” LINA terminated Greg’s benefits, arguing that he could perform some sedentary work.

The O’Ryan Law Firm has sued Cigna on behalf of a Subaru employee who became disabled, was paid short term disability benefits but then Cigna denied his long term disability benefits.  The client was a Warehouse Associate with Subaru of America for several years.  His job at Subaru as a Warehouse Associate included the following responsibilities:

  • Reading production schedules, customer orders, work orders, shipping orders and requisitions to determine items to be moved, gathered or distributed.
  • Conveying materials and items from receiving or production areas to storage or to other designated areas by hand, hand-truck, or electric hand-truck.

O’Ryan Law Firm, on behalf of client Stacy K., recently filed a federal lawsuit against Reliance Standard Life Insurance Company after Reliance Standard wrongfully terminated her disability benefits after paying the benefits for three years. Stacy was employed as a Case Manager with Southern Hills Counseling Center which made her eligible for disability benefits under her employee benefit plan.

Stacy was forced to stop working in May 2014 due to the disabling effects of Multiple Sclerosis and severe migraine headaches.  Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body.  MS is a type of autoimmune disorder. It isn’t known what causes Multiple Sclerosis, although environmental factors and genetics are believed to play a role.  Common symptoms include problems with balance and sensation, difficulty walking, leg or arm movement, fatigue, muscle spasms, tingling, numbness, and bladder control.  The symptoms, severity, and duration can vary from person to person.  Tremors can occur during precise movements, in the hands, or limbs.

Currently, multiple sclerosis is not a curable disease. Treatment strategies can help slow or modify the course of the disease, including treatment of relapses, and make the patient more comfortable.

O’Ryan Law Firm, on behalf of our client, Regan W., recently won an appeal of MetLife’s decision to deny payment of a $66,000 death benefit for a life insurance policy purchased by Regan’s late father prior to his death. As a result of O’Ryan Law Firm’s work, MetLife paid the full $66,000 death benefit, plus more than $2,000 in interest for the time in which it had wrongfully withheld the benefit payment.

Approximately two years before his death, Regan’s father signed up for optional life insurance (“OLI”) offered by his employer through MetLife, with a death benefit of $66,000. According to the fine print of the OLI policy, MetLife was entitled to request additional evidence of insurability, including a Statement of Health form, before allowing the coverage to take effect. However, neither MetLife nor his employer ever requested any such evidence from Regan’s father. Instead, his employer began deducting the premiums for his OLI coverage from his paychecks. Regan’s father continued to pay the premiums, via payroll deduction, as they became due, until he passed away in late 2017. MetLife happily accepted these premium payments, while never insisting on any “evidence of insurability.”

When Regan made a claim for the death benefits under her father’s MetLife policy, MetLife refused to pay the $66,000 OLI death benefit, arguing that her father’s coverage had never taken effect because he never submitted a Statement of Health form as the policy required. As we noted in a previous blog post, this scenario has recently become increasingly common with MetLife policies.