Articles Posted in Long Term Disability

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.

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 the Plaintiff, Dr. B, recently settled a lawsuit against Lincoln National Life Insurance Company (“Lincoln National”) for the denial of Dr. B’s claim for long term disability insurance benefits.

Dr. B was a radiologist at a regional hospital, where he worked approximately 10-14 hour days which consisted primarily of interpreting diagnostic images on a computer monitor. The position demanded absolute accuracy in reading diagnostic images, as even a single mistake or omission could be the difference between life and death for a patient. He also performed interventional procedures (e.g. percutaneous biopsies of various organs, joint injections, and fluoroscopy) and consulted with physicians and patients to review his findings. His position also involved a substantial amount of physical activity, including assisting techs with moving or positioning larger patients, and wearing lead aprons to shield himself from radiation associated with imaging equipment.

Several years ago, Dr. B began to suffer from keratoconjunctivitis sicca (dry eye syndrome), a condition that commonly affects radiologists.[1] Over the next several years, his condition progressively worsened, to the point that he often had to pull over on the drive to or from work to rest his eyes because his vision had become too blurry to drive. While his vision is good when his eyes are well-rested, even a small amount of computer usage causes his eyes to become sore, dry, and itchy, blurring his vision and requiring him to blink excessively and use eye drops to the fullest extent possible.

Psoriatic arthritis is a painful and often debilitating form of arthritis that affects some people who suffer from psoriasis, a common autoimmune disorder that causes the immune system to attack healthy cells and tissue in the body’s skin and joints.[1] This abnormal immune response causes inflammation in the joints and overproduction of skin cells, often causing the skin to form red, scaly patches that may be itchy and painful.[2] Both psoriatic arthritis and psoriasis are chronic diseases that get worse over time, but the symptoms of the diseases often fluctuate, with many patients experiencing periods of unbearably intense symptoms alternating with periods of remission in which the symptoms largely disappear.

Although there is no known cure for psoriasis or psoriatic arthritis, both conditions can be effectively managed with a range of treatments including medications and lifestyle measures such as moisturizing, quitting smoking, and managing stress. Most people experience significant relief when their psoriasis and psoriatic arthritis are properly treated. For example, since announcing that he was being treated for a diagnosis of psoriatic arthritis in late 2010, professional golfer Phil Mickelson has gone on to win five tournaments, including the 2013 British Open.[3] However, in some cases the disabling symptoms of psoriatic arthritis may persist despite treatment.

Because the persistent inflammation associated with psoriatic arthritis can cause permanent joint damage over time, early detection is essential to an effective treatment regimen. When the disease is not diagnosed promptly, it is much more likely to lead to severe and permanent symptoms that may be permanently disabling. To diagnose psoriatic arthritis, rheumatologists look for swollen and painful joints, certain patterns of arthritis, and skin and nail changes typical of psoriasis. X-rays often are taken to look for joint damage. MRI, ultrasound or CT scans can be used to look at the joints in more detail. Blood tests may be done to rule out other types of arthritis that have similar signs and symptoms, including gout, osteoarthritis, and rheumatoid arthritis. In patients with psoriatic arthritis, blood tests may reveal high levels of inflammation and mild anemia but labs may also be normal. Anemia is a condition that occurs when the body lacks red blood cells or has dysfunctional red blood cells. Occasionally skin biopsies (small samples of skin removed for analysis) are needed to confirm the psoriasis.

Amy was employed as a Special Education teacher by Elkhart Community Schools until she became disabled in 2015 due to the disabling effects of orthostatic hypotension, syncope and collapse. By definition, orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that happens when you stand up from sitting or lying down. Orthostatic hypotension can make you feel dizzy or lightheaded, and maybe even faint.  Amy was also treated for autonomic dysfunction, had bradycardia in 2010 with pacer implant with improvement until she was head-butted by a student resulting in subsequent dizziness and syncope (fainting)

Amy’s primary care physician recommended disability for autonomic problems with syncope episodes.  A treating physician at the Cleveland Clinic placed Amy at a class 4 physical impairment, and class 3 mental with a diagnosis of Orthostatic hypotension, syncope, fatigue, dizziness, and memory loss and stated that Amy is disabled from all work and would never return to work.

When Amy was forced to stop working she submitted a claim to Lincoln National Life Insurance Company who is her disability insurer.  Lincoln National approved her disability benefits on February 5, 2016 and paid benefits through November 2, 2017, when Lincoln abruptly terminated with little notice.  To terminate the claim, Lincoln relied on two of their hired record reviewers. One neurologist reviewer was aware of Amy’s abnormal head tilt testing with induction of symptomatic orthostatic hypotension. At baseline her blood pressure was 113/70. Her heart rate was 63.  After three minutes blood pressure was not found and the heart rate was 63. The test was ultimately aborted.  The reviewer also spoke with Amy’s treating physician, who advised him that she has syncopal episodes.

O’Ryan Law Firm, on behalf of Plaintiff, Melissa B., recently settled a lawsuit against American United Life Insurance Company (“AUL”) for the termination of Melissa’s disability insurance benefits after she was diagnosed with cardiomyopathy and congestive heart failure.

Melissa was a teacher with a local public school system and was forced to stop teaching when, shortly after giving birth to her son, she was found to have cardiomyopathy with reduced ejection fraction and chronic systolic congestive heart failure, confirmed by numerous echocardiograms, cardiac MRIs, and other testing procedures. After she was diagnosed with cardiomyopathy, Melissa began suffering from extreme fatigue, shortness of breath, and chest pain. Her cardiologist notified her employer that Melissa had severely reduced left-ventricular systolic function left her at an increased risk for mortality and precluded her from engaging in even light level activities on a full-time basis. Melissa’s treating physicians ordered her off work indefinitely, and AUL awarded her disability benefits under the policy beginning January 1, 2014.

Melissa was awarded Social Security Disability Benefits in September 2015, based on the Social Security Administration’s finding that she had been totally disabled since May 1, 2014.

O’Ryan Law Firm recently filed an appeal for Long Term Disability benefits against Cigna for wrongfully denying a participant’s benefits.  The client was a long-time employee of Toyota, working as a warehouse associate.  She was forced to stop working due to breast cancer, a bilateral mastectomy, and the residual effects of chemotherapy and treatment; including fatigue, migraines, bilateral lower extremity neuropathy and severe pain.

Despite the client’s treating physicians providing objective medical proof that she was unable to continue working due to her condition, Cigna hired a contracted physician to review her claim file.  The contracted physician contended the client could perform a sedentary occupation on a full-time basis even though the client’s own physicians stated she could not work at all.  The treating physicians reported to Cigna that she could not work and never released the client to return to work full-time.

Cigna originally approved the short-term disability and long-term disability claim in full until the time when the definition of Disabled changed to “performing the duties of any occupation.” As soon as this definition kicked in Cigna terminated her benefits.  Cigna’s hired contract physician even agreed with the treatment, limitations and restrictions placed on the client but in order to be hired for another claim file review the contracted doctor opined that the client was able to work a full-time job.  Cigna cited the following definition of “Disability within the long-term disability denial letter: