Articles Posted in Termination of long term disability benefits

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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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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.

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O’Ryan Law Firm, on behalf of our client, Deborah P., recently filed a lawsuit against Madison National after they wrongfully terminated her disability benefits. Our client was employed as a Teacher with the Hanover Community School Corporation, which made her eligible for disability benefits offered through the Hanover Community School Corporation employee benefit plan.  Madison National is often times the insurance company for long term disability coverage offered to most teachers.

Deborah began her teaching career in 1984. After 30 years of teaching, Deborah was forced to stop working in December 2014 due to infiltrating ductal carcinoma, hypothyroid, chronic fatigue syndrome, GERD, neuropathy, knee pain, chest pain, shortness of breath, weakness, edema, nausea, palpations, cardiomyopathy, Hashimoto’s thyroiditis, migraines, and insomnia.

In October 2013, Deborah received a devastating diagnosis of invasive ductal carcinoma stage 2. Her life became overfilled with treatments, doctor visits, tests, decisions on treatments, etc. Since the tumor was almost 5cm, Deborah underwent chemotherapy first to see if the tumor would shrink and offer her more options. Deborah underwent extremely aggressive chemotherapy and continued to teach during treatments in hopes of beating the cancer and returning to teaching full time. Deborah began experiencing pain in her joints, profound fatigue, and was nauseous all the time. In March 2014, Deborah underwent a lumpectomy. Since 3 out of 5 lymph nodes were removed and tested positive, Deborah lives in daily fear that her cancer will return. In addition to chemotherapy and surgery, Deborah also underwent proton radiation. Deborah has tried to return to work, but became too profoundly fatigue to make it through a normal school day.

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O’Ryan Law Firm, on behalf of Plaintiff, Dave C., recently filed a lawsuit against a Cigna subsidiary, Life Insurance Company of North America (LINA), after they wrongfully terminated our client’s long term disability benefits which were paid under a Cigna disability policy.  Dave worked for Purdue University as a Health Desk Technical Support Supervisor until he became disabled and eligible for disability benefits under the Cigna policy.

Facts of the Case Against Cigna

After over 18 years of employment at Purdue University, Dave was forced to stop working when he became totally disabled due to Seizure Disorder and the resulting symptoms from this disorder.  As you can imagine, seizure disorder can be difficult to prove with objective tests because there are very little signs of the seizures unless they are actually occurring.  However, Dave’s treating physicians provided objective medical proof that he was unable to continue working due to his seizure disorder.

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The O’Ryan Law Firm has represented numerous employees of Indiana University (“IU”) who have become disabled because of serious illnesses such as chronic pancreatitis, lymes disease, degenerative disk disease, ovarian cancer, and osteoarthritis. A large number of those clients were employees who had worked for Indiana University for many years, some even decades, before reaching the point where they were no longer able to work because of their medical conditions.

Indiana University’s Long Term Disability Plan is an income replacement plan for IU employees who become disabled due to an illness or accident[1].  The following are the general terms of the long term disability coverage provided to IU employees:

  • With claim approval, the plan pays a regular monthly income when an enrolled employee becomes disabled.
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