Articles Posted in Long Term Disability

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.

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.

Kirsti K was an Administrative Assistant for a large manufacturing company for several years until late 2016, when she was in a severe car accident in which a semi tractor-trailer ran a red light and struck her vehicle, ejecting her several feet from the vehicle onto the roadway. As a result of the accident, Kirsti suffered severe and debilitating injuries, including a broken wrist that required surgical repair.

Kirsti missed almost three full months of work after the accident and subsequent surgery, but was able to return to work late in 2016. However, upon returning to work, Kirsti struggled to maintain her previous levels of productivity. Over the next few months, she also began to develop increasingly severe lower back pain, a large lumbar hematoma, painful keloid scarring from her wrist surgery,[1] and psychological impairments including depression, anxiety, and post-traumatic stress disorder (PTSD).

By May of 2017, Kirsti’s condition had deteriorated to the point that she was forced to once again leave work. She underwent numerous injections to treat her lower back pain, but experienced little meaningful relief. She also underwent extensive psychological counseling and therapy, in addition to physical therapy. Unfortunately, her conditions remained severe and continued to prevent her from returning to work.

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.

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.