Articles Posted in Long Term Disability

Shauna was a Quality Supervisor with a large international engineering company for four years until August 2016, when she was forced to stop working due to severe bilateral degenerative foot deformities that have required a total of nine surgeries to date. Shauna also suffers from post-traumatic arthritis of the bilateral hands, feet, and ankles; cervical spondylosis and radiculopathy; degenerative changes to the thoracic and lumbar spine requiring surgical implantation of a pain pump to deliver pain medication directly into her spinal canal; and post-laminectomy syndrome of the lumbosacral region.

Shauna applied for and received long term disability (LTD) benefits under her employer’s LTD policy with Liberty Mutual. The Liberty Mutual policy provided that in order to continue receiving disability benefits for longer than 24 months, Shauna was required to prove that she was disabled from any occupation for which she was reasonably fitted by training, education, experience, age, physical and mental capacity. Unfortunately, Liberty Mutual terminated her LTD benefits in February of 2019, arguing that she was able to return to work in a sedentary capacity and listing several obscure occupations (including thermometer maker and multifocal-lens assembler) that it asserted she could perform despite her condition.

After her benefits were terminated, Shauna hired O’Ryan Law Firm to represent her to appeal the termination of her LTD benefits. We gathered substantial additional supportive medical evidence, including strong supportive statements from her treating physicians, and compiled an appeal of Liberty’s termination of Shauna’s LTD benefits. We also provided updated diagnostic imaging studies and photos of Shauna’s feet showing the extreme degree of swelling that she experienced 24 hours after attempting to sit without elevating her feet for just two hours.

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.

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.

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.

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.