Articles Posted in Termination of long term disability benefits

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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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Earlier this month, Judge Richard Posner abruptly announced his retirement from the United States Court of Appeals for the Seventh Circuit after more than 35 years on the bench, effective the following day. Judge Posner, a prolific writer and author of more than 3300 judicial opinions and nearly 40 books, was one of the most prominent appellate judges in the United States and the most-cited legal scholar of the 20th century, according to a survey by the Journal of Legal Studies. He carefully drafted his legal opinions to be easy to read and understand, and his signature concise, frank, and often humorous writing style helped to modernize the discipline of legal writing, presenting a stark contrast from the overly formal, long-winded “legalese” that had long dominated the legal field.

Just over three months prior to his retirement, Judge Posner authored an opinion, Kennedy v. The Lilly Extended Disability Plan, 856 F.3d 1136 (7th Cir. 2017), awarding substantial long term disability benefits to Cathleen Kennedy, an O’Ryan Law Firm client who had been forced to stop working in her position as an HR executive for Eli Lilly & Company as a result of severe fibromyalgia, a nightmarish condition characterized by chronic widespread musculoskeletal pain and fatigue that often presents with psychosomatic symptoms such as sleep and memory issues, anxiety, and depression. Unfortunately, because many of the primary symptoms of fibromyalgia – especially pain and fatigue – are difficult to objectively measure, the condition has historically been misunderstood and often goes undiagnosed due to the lack of a reliable means of testing for it. As a result, those who suffer from fibromyalgia also frequently must deal with the frustration caused by doubts about the validity of their condition and symptoms by friends, family, and sometimes even their healthcare providers.

Fortunately, recent scientific advances in the understanding of fibromyalgia have led to increasing acceptance of the validity of the condition and its profound impact on the lives of those who suffer from it. Judge Posner recognized this in his opinion, noting that Lilly itself markets a treatment for fibromyalgia and has been advised by one of its own physicians that fibromyalgia “is not only very common but is typically also very disabling” and that many victims of fibromyalgia “end up needing to stop working because of this condition.” Nonetheless, Lilly had terminated Ms. Kennedy’s long term disability benefits after she had been disabled for nearly four years due to fibromyalgia, despite the fact that her primary treating physicians had declared her to be permanently disabled, largely because there was no objective laboratory data proving the validity of her symptoms. Lilly claimed that although Ms. Kennedy was unable to work full time in her previous executive-level position, she could still work part time in one of “various non-executive positions” in her field.

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O’Ryan Law Firm, on behalf of our client, Jeremy C., recently filed a lawsuit against Liberty Life Mutual after they wrongfully terminated Jeremy’s disability benefits. Our client was employed as a Store Manager with Wal-Mart, which made him eligible for disability benefits offered through the Wal-Mart Stores, Inc. employee benefit plan.  Liberty Mutual is actually the insurance company for the long term disability coverage offered to Wal-Mart employees.

Jeremy worked for many years at Wal-Mart, the last several years as a Store Manager, until he was forced to stop working in March 2015, because of his medical conditions the worst of which was Sjogren’s Syndrome.  Sjögren’s is a systemic autoimmune disease that affects the entire body. The symptoms from this disease include profound fatigue, memory loss, recurrent sinusitis, difficulty with speech, reflux, esophagitis, muscle pain, upset stomach, irritable bowel, peripheral neuropathy and many more.

As a result of Sjogren’s Syndrome, our client suffered specifically from gait instability, memory loss, episodes of dysarthria and slurred speech, overall weakness/fatigue, numbness and tingling in the right arm and right leg, tremors after physical activity, abdominal pain, acute sinusitis, colon polyps, gastroesophogeal reflux disease with esophagitis, exhaustion, and continuous headaches.  The multitude and severity of these symptoms made it impossible for our client to continue handling the responsibilities of a store manager at a large Wal-Mart store located in Lebanon, Indiana.

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O’Ryan Law Firm, on behalf of a former employee of Purdue University recently filed a lawsuit against Cigna for wrongfully denying the former Purdue employee’s disability claim.  The plaintiff had was a long time employee of Purdue, worked at Purdue for over 32 years, until he became unable to continue working in May 2013 due to chronic respiratory failure, cardiomyopathy,  recurrent pneumonia, atrial fibrillation, bronchial asthma, and osteoarthritis.  The Purdue employee’s treating physicians provided objective medical proof that the Plaintiff was unable to continue working due to these this combination of symptoms.  Cigna originally approved the claim but then terminated his benefits contending that the Plaintiff could return to work.

Prior to Cigna’s termination of the Plaintiff’s long term disability, a Functional Capacity Evaluation was performed that actually showed that he was unable to return to work. The functional capacity report states, “Mr. R has been off work since 2013 after developing problems with lung infections and difficulty breathing. He shows fair static muscle strength in the lower extremities when seated, however, is unable to functionally use his legs on stairs, working off the floor, getting to the floor, sustained walking and standing. Mr. R. showed a consistent standing limit to 2 minutes at a time.” Throughout the exam, Mr. R demonstrated using a cane to walk, labored breathing and slight wheezing, along with needing to rotate positions and taking multiple breaks. The physical ability assessment concluded Mr. R is only able to stand two minutes at a time, rarely able to walk, and rarely able to lift/carry 0-10lbs.

Under video surveillance conducted by Cigna on 3 separate days, there was no activity on the 1st and 3rd days, and when the Plaintiff was observed, he used a cane when walking

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O’Ryan Law Firm recently settled a lawsuit against American United Life Insurance Company (“AUL”) on behalf of a client whose long term disability benefits were prematurely terminated by AUL.   AUL is headquartered in Indianapolis and has their main office in downtown Indianapolis in the AUL building.  The client, Candace, is actually a New Jersey resident so naturally it would make sense to file the claim in New Jersey.  However, the O’Ryan Law Firm was able to represent Candace in Indiana because of the fact that AUL is incorporated under Indiana law.  As a result, AUL may be sued in Indiana and the lawsuit was therefore filed in the federal district court for the Southern District of Indiana.

Case Against AUL

Candace was employed as an accounts manager for an insurance brokerage company from 2008 until she became disabled in December 2012.  She became unable to work due to lumbar radiculopathy and moderately severe cervical stenosis, both of which resulted in chronic pain and fecal incontinence. Her treating physicians provided objective medical proof that the she was unable to continue working due to these medical impairments.

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O’Ryan Law Firm, on behalf of Plaintiff Jo Ellen W., recently filed a lawsuit against Sedgwick Claims Management Services, Inc. (“Sedgwick”). The Plaintiff was employed as a Labor and Delivery Clinical Nurse with Franciscan Alliance which made her eligible for disability benefits under the Franciscan Alliance, Inc. Short-Term and Long-Term Disability Benefit Plans (the “Plan”).

In Jo Ellen W. v .Franciscan Alliance, Inc. Short-Term and Long-Term Disability Plans and Sedgwick Claims Management Services, the Plaintiff filed a lawsuit to gain the long term disability benefits she was entitled to under the terms of the Franciscan Alliance Plan.

Facts of the Case

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At the O’Ryan Law Firm, we represent numerous clients who have become disabled and their disability claim was denied by their insurance company. We then represent the clients in the appeal process to appeal the denial of their disability benefits.  Lately, many of the insurance companies have be issuing late determination decisions on the appeals that we submit to those companies.  By law, an insurance company is required to issue a decision within 45 days of the date of receipt of the appeal unless an extension is warranted due to “special circumstances” but even then, a decision on the appeal must be rendered within 90 days at the latest.

The Supreme Court in Firestone Tire & Rubber v. Bruch, 489 U.S. 101, 115 (1989) held that de novo adjudication of employee benefit claims is the norm. Because the de novo standard of review is the default standard in an ERISA employee benefits case, the plan administrator or insurance company bears the burden of showing that the more deferential standard should apply. Fay v. Oxford Health Plan, 287 F.3d 96, 104 (2d Cir.2002); Marguez-Massas v. Squibb Mfg., Inc., 344 F.Supp.2d 315, 320 (D.P.R. 2004); McDonald v. Timberland Co. Group LTD Coverage Program, 2002 WL 122382, at *3 (D.N.H. Jan.23, 2002). Accordingly, once in litigation, a disability insurance company bears the burden of proving that their decision is entitled to deferential review by the Court.

The regulations governing ERISA disability claims require insurance companies to issue a decision on a claimant’s appeal within 45 days of the date that the insurance company received the appeal unless “special circumstances” warrant an extension of time for an additional 45 days; however, in “no event” shall the extension of time exceed 45 days. 29 C.F.R. §2560.503-1(i)(1), (i)(3), (i)(4).

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