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O’Ryan Law Firm, on behalf of Plaintiff, Jennifer D., recently filed a federal lawsuit against Life Insurance Company of North America (LINA), a subsidiary of CIGNA.  Jennifer was a classroom teacher, responsible for providing instructional services necessary to educate all students to high standards and ensure that all students meet internationally benchmarked Common Core Standards linked to Indiana’s Academic Standards.  Jennifer was forced to stop working when she became disabled due to chronic pain as a result of occipital neuralgia, trigeminal neuralgia, cervical facet arthropathy, and neuropathic pain.  Trigeminal neuralgia is a hideous medical condition which causes severe facial pain with no known effective treatment.  According to the American Association of Neurological Surgeons[1], trigeminal neuralgia is described as follows:

Trigeminal neuralgia, also known as tic douloureux, sometimes is described as the most excruciating pain known to humanity. The pain typically involves the lower face and jaw, although sometimes it affects the area around the nose and above the eye. This intense, stabbing, electric shock-like pain is caused by irritation of the trigeminal nerve, which sends branches to the forehead, cheek and lower jaw. It usually is limited to one side of the face. 

Jennifer tried pain management, physical therapy, chiropractic care, massage therapy, medication changes, injections, surgeries, etc. to alleviate her pain with no success.  An MRI of Jennifer’s brain showed left occipital craniotomy and mild atrophy of the left cerebellar hemisphere.

The United States District Court for the Southern District of Indiana recently overturned Aetna Life Insurance Company’s denial of long term disability benefits to Kimberly Garner, an O’Ryan Law Firm client who was forced to leave her job as an Amazon fulfillment center associate after complications from surgery left her with severe and persistent urinary incontinence. The Court’s opinion, written by Chief Judge Jane Magnus-Stinson, is the result of several months of zealous litigation by the O’Ryan Law Firm on behalf of Ms. Garner. [1]

After several years of working for Amazon, Ms. Garner underwent a surgical procedure that unfortunately caused her to suffer from severe mixed urinary incontinence – meaning she experienced severe and uncontrolled leakage of urine during physical activity or exertion, and due to involuntary and unpredictable spasms of the bladder muscles. Sophisticated diagnostic imaging and testing procedures confirmed that Ms. Garner’s incontinence was severe and uncontrolled. Although she was prescribed various medications and underwent several follow-up procedures intended to address her profound incontinence, including Botox injections and cystoscopy, Ms. Garner experienced no relief from this incredibly frustrating, embarrassing, and debilitating condition.

Although Ms. Garner attempted to return to work, she found herself unable to make it through the day without numerous emergency trips to the bathroom, and frequently had to leave her work area to change clothes when her leakage came on so quickly and unexpectedly that she was unable to reach the bathroom in time. Ultimately, she was forced to leave her job due to her medical condition, and she applied for disability benefits under the policy that Amazon provided through Aetna. Her primary care physician referred her to urogynecologist Dr. Douglass Hale for a specialist’s opinion, and he suggested an implantation of an InterStim device – a last-resort procedure in which electrodes are implanted on the nerves controlling the bladder, in an attempt to prevent the bladder from involuntarily emptying. Unfortunately, because she lost her health insurance when she was forced to leave her job, she was unable to afford the procedure.

O’Ryan Law Firm, on behalf of Plaintiff, Brooke W., recently filed a federal lawsuit against Life Insurance Company of North America (LINA) (LINA is a subsidiary of CIGNA).  Brooke was an Extension Educator for Purdue University.  Purdue’s main campus is located in West Lafayette Indiana and is one of the premiere educational institutions for higher education.

Facts of the Case Against LINA

Brooke was forced to stop working when she became totally disabled due to multiple diagnoses including Diabetes Mellitus Type 1, small fiber autonomic neuropathy, fibromyalgia, Graves disease, migraines and lupus.  Brooke’s rheumatologist confirmed the diagnosis of lupus SLE based on a positive ANA screen.  She also had an abnormal nerve conduction study of her left ulnar nerve for carpal tunnel syndrome.  Brooke’s occupation required her to travel extensively and her cardiologist restricted her from driving because of the precariousness of her medical condition.  Objective medical proof was provided to LINA by her physicians, and confirmed that Brooke was unable to continue working as an Extension Educator at Purdue due to these serious illnesses.

O’Ryan Law Firm recently filed an appeal for Long Term Disability benefits against Cigna for wrongfully denying a participant’s benefits.  The client was a long-time employee of Toyota, working as a warehouse associate.  She was forced to stop working due to breast cancer, a bilateral mastectomy, and the residual effects of chemotherapy and treatment; including fatigue, migraines, bilateral lower extremity neuropathy and severe pain.

Despite the client’s treating physicians providing objective medical proof that she was unable to continue working due to her condition, Cigna hired a contracted physician to review her claim file.  The contracted physician contended the client could perform a sedentary occupation on a full-time basis even though the client’s own physicians stated she could not work at all.  The treating physicians reported to Cigna that she could not work and never released the client to return to work full-time.

Cigna originally approved the short-term disability and long-term disability claim in full until the time when the definition of Disabled changed to “performing the duties of any occupation.” As soon as this definition kicked in Cigna terminated her benefits.  Cigna’s hired contract physician even agreed with the treatment, limitations and restrictions placed on the client but in order to be hired for another claim file review the contracted doctor opined that the client was able to work a full-time job.  Cigna cited the following definition of “Disability within the long-term disability denial letter:

As a new employee to Ball State University, have you ever questioned whether your insurance carrier will “be there” when you are disabled from an injury or accident?  As a BSU employee, you may make monthly premium payments for long term disability coverage through payroll deduction, only to find out that when you need it, the insurance carrier is putting up road blocks to your rightful and deserved disability benefits.  The consequences of denials or early terminations in disability benefit claims can be devastating.

The O’Ryan Law Firm has represented numerous employees of several universities, including Ball State University, who have become disabled because of serious illnesses such as chronic pancreatitis, Lyme’s disease, fibromyalgia, degenerative disk disease, and cancer. A large number of those clients were employees who had worked for a university for many years, some even decades, before reaching the point where they were no longer able to work because of their medical conditions.

Ball State University’s Long-Term Disability Plan is an income replacement plan for BSU employees who become disabled due to an illness or accident.  The following is general information regarding long-term disability coverage provided to BSU employees:

O’Ryan Law Firm, on behalf of Plaintiff, Kimberly G., recently filed a federal lawsuit against Aetna Life Insurance Company (“Aetna”).   Plaintiff was employed by Amazon Corporation, as a warehouse worker, which made her eligible for Amazon’s employee benefit plan.  Aetna issued the disability policy that provides long term disability benefits to Amazon employees who are unable to return to work due to a serious illness or injury.

Facts of the Case Against Aetna

Plaintiff was employed by Amazon from July 2012 until she became disabled in July 2016.  Plaintiff was unable to work due to significant bladder issues, including incontinence, due mainly to a surgical procedure that compromised her bladder. The Plaintiff’s treating physicians provided objective medical proof that the Plaintiff was unable to continue working due to these ailments.

The O’Ryan Law Firm, on behalf of Plaintiff, Timothy E., recently filed a federal lawsuit against Life Insurance Company of North America (LINA), a subsidiary of Cigna, for their refusal to continue paying disability benefits to a city employee who had been disabled for more than 5 years. The Plaintiff was employed by the City of Bloomington, and became unable to continue working in his extremely physical job from severe back issues and cardiac problems.  He had been employed for the City of Bloomington for more than 20 years when he was forced to stop working because of his medical conditions.  Cigna paid him for 5 years and then abruptly terminated his monthly disability payments saying he had miraculously recovered his ability to return to work, after 5 years.  In the meantime, he had been approved by the Social Security Administration who found him unable to perform any substantial, gainful activity.

Facts of the Case Against Cigna

The Plaintiff was employed by the City of Bloomington from 1987 until he became disabled in June 2010 and unable to work due to coronary artery disease, back pain, COPD, hypertension, fatigue, sleep apnea, and hyperlipidemia. Plaintiff’s treating physicians provided objective medical proof that the Plaintiff was unable to continue working due to these medical conditions.

The O’Ryan Law Firm, on behalf of Plaintiff Sherry M., recently filed a federal lawsuit against Anthem Life Insurance Company (“Anthem”). The Plaintiff was employed with Anthem Life as an Operations Expert, which made her eligible for disability benefits under the Anthem Life Long Term Disability (LTD) Plan (the “Plan”).  Anthem was both her employer as well as the insurance company for her long term disability benefits.  It always is particularly troubling to see an employee, who has worked hard for a number of years for an insurance company, be mistreated when they become disabled by their own employer.

Facts of the Case

The Plaintiff was employed by Anthem Life until she became disabled in 2015 due to the disabling effects of lupus erythematosus.  According to WEB MD, lupus is an autoimmune disease, which means that the immune system mistakes the body’s own tissues as foreign invaders and attacks them. Some people with lupus suffer only minor inconvenience. Others suffer significant lifelong disability. Nine out of 10 people with lupus are women. The disease usually strikes between age 15 and 44, although it can occur in older individuals. There are two kinds of lupus:

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).

The United States District Court for the Southern District of Indiana overturned Life Insurance Company of North America’s (LINA) Termination of long term disability benefits owed to Greg D., an O’Ryan Law Firm client who was forced to leave his job as a maintenance mechanic with Ohio Valley Electric Corporation/Indiana-Kentucky Electrical Corporation (OVEC/IKEC) after he was forced to stop working due to severe back, neck, shoulder, hip, and leg pain. The Court’s opinion, written by District Judge William T. Lawrence, is the result of several months of zealous litigation by the O’Ryan Law Firm on behalf of Greg.

After working for OVEC/IKEC for more than 27 years, Greg underwent shoulder surgery in December of 2006 to locate and repair a tear in his rotator cuff. Unfortunately, his shoulder pain did not subside after the surgery, despite diligent treatment by Greg’s physicians and a rigorous course of more than 50 physical therapy sessions between February and July of 2007. As a result, Greg was unable to return to work in his heavy-duty occupation as a maintenance mechanic. Meanwhile, he also continued to seek treatment for his chronic neck and back pain.

After the shoulder surgery, LINA awarded Greg benefits under the long term disability policy it had issued through his employer. A few months after it began paying Greg’s benefits, LINA hired an investigator to perform surveillance on Greg because they believed he was working while collecting benefits. The investigator’s surveillance revealed no evidence of activity that would be inconsistent with Greg’s disability, and LINA continued paying his benefits for 24 months. After 24 months of benefits, the definition of “disability” under the LINA policy changed to require that Greg be disabled from performing any occupation, not just his own heavy duty occupation. Upon this change in the definition of “disability,” LINA terminated Greg’s benefits, arguing that he could perform some sedentary work.