Lois M was a factory worker for a large manufacturing company. By June of 2017, decades of working in very heavy duty manufacturing jobs had taken their toll on her body, leaving her unable to continue working due to severe and debilitating degenerative joint disease in her left hip, mild scoliosis, severe multilevel degenerative disc disease, bulging discs, facet arthrosis of the lower spine, and osteoporosis.
When she was unable to continue working, Lois filed a claim for short term disability (“STD”) benefits under a disability benefits plan provided by her employer and administered by Life Insurance Company of North America (“LINA”), a subsidiary of Cigna. Despite significant supportive medical records and strong statements from her treating physicians in support of her claim, LINA denied Lois’ claim based on a review by a nurse case manager.
After her claim was denied, Lois hired O’Ryan Law Firm to represent her to appeal the denial of her STD claim and assist her in filing a claim for long term disability (“LTD”) insurance benefits. We helped Lois gather substantial additional supportive medical evidence, including strong supportive statements from multiple treating physicians, and compiled an appeal of LINA’s denial of her STD benefits. Unfortunately, Lois’ employer continued to refuse to pay her STD benefits despite overwhelming evidence that she was truly disabled from performing her heavy duty manufacturing occupation.
Meanwhile, O’Ryan Law Firm helped Lois file a claim for LTD benefits under the LINA insurance policy provided by Lois’ employer, using the substantial medical evidence of Lois’ disability gathered in the STD appeals process to support the claim for LTD benefits. When LINA failed to issue a decision on Lois’ LTD claim within the 45 day deadline set forth by the Employee Retirement Income Security Act of 1974 (“ERISA”), we filed a lawsuit on behalf of Lois against LINA, challenging its denial of her STD claim and its failure to respond to her LTD claim.
Shortly after O’Ryan Law Firm filed the lawsuit against LINA, Lois received notice that LINA had approved her LTD claim and would begin paying her LTD benefits immediately. However, her employer continued to refuse to pay her STD benefits, despite LINA’s determination that Lois was completely disabled from performing her own occupation. O’Ryan Law Firm dismissed the lawsuit against LINA and filed a new lawsuit against Lois’ employer seeking to recover the unpaid STD benefits. Within a few months, the employer agreed to settle the lawsuit for unpaid STD benefits.
If you are disabled and have been denied benefits by an employer or an insurance company, please contact the O’Ryan Law Firm for a free consultation.