Articles Posted in Termination of long term disability benefits

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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.

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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.

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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.

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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:

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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.

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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:

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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.

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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.

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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).

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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.

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