Articles Tagged with “disability benefits”

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.

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.

O’Ryan Law Firm, on behalf of Plaintiff Shane C., recently filed a federal lawsuit against The Prudential Insurance Company of America (“Prudential”). The Plaintiff was employed as Senior Vice President Regional Manager with Custard Insurance Adjusters, Inc. which made him eligible for disability benefits under the Custard Insurance Adjusters, Inc. Long Term Disability Plan (the “Plan”).  As a Regional Manager, Shane was required to travel to 9 different offices throughout the Midwest to oversee and supervise these 9 offices.

In Shane C. v. The Prudential Insurance Company of America and Custard Insurance Adjuster, Inc. Long Term Disability Plan, the Plaintiff filed a lawsuit under ERISA to gain the long-term disability benefits he was entitled to under the terms of the Prudential policy.

Facts of the Case Against Prudential

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 Dow Chemical Company is a multinational chemical corporation headquartered in Midland, Michigan.  Dow manufactures plastics, chemicals, and agricultural products. With a presence in about 160 countries, it employs about 54,000 people worldwide.  Dow Chemical also has a large complex on the northwest side of Indianapolis.

Liberty Mutual provides disability insurance to employees of Dow.  Liberty Mutual Insurance is an American diversified global insurer, and the second-largest property and casualty insurer in the  world.   Based in Boston, Massachusetts, it employs over 50,000 people in more than 900 locations throughout the world.

In the disability policy provided to Dow employees, Liberty Mutual defines disability as follows:

The University of Notre Dame is a Catholic research university located near South Bend, Indiana. Notre Dame’s Catholic character is reflected in its commitment to the Catholic faith, numerous ministries funded by the school, and the architecture around the campus. Notre Dame rose to national prominence in the early 1900s for its Fighting Irish football team, especially under the guidance of the legendary coach Knute Rockne and is well known for “Touchdown Jesus.”

Cigna is an American worldwide health services organization, whose policies are underwritten by Life Insurance Company of North America (“LINA”). Cigna’s insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and services, the majority of which are offered through employers and other groups.

In June 2015, U.S. health insurer Anthem Inc. announced an offer to acquire Cigna for more than $47 billion in cash and stock. Anthem confirmed it had reached a deal to buy Cigna on July 24, 2015.

Cigna/LINA provides disability coverage to Notre Dame University employees. Cigna disability claims by Notre Dame employees are exempt from the Employee Retirement Income Security Act because the disability plan is considered a “church plan”; therefore, the lawsuit is filed under state law with breach of contract and bad faith counts.
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O’Ryan Law Firm, on behalf of Plaintiff Laura McKenzie, recently filed a federal lawsuit against Life Insurance Company of North America (“LINA”), which is a subsidiary of Cigna Corporation. The Plaintiff was employed as a Registered Nurse with Allied Physicians, which made her eligible for disability benefits under the Allied Physicians, Inc. Long Term Disability Plan (the “Plan”).

In Laura McKenzie v. Life Insurance Company of North America and Allied Physicians, Inc. Long Term Disability Plan, the Plaintiff filed a lawsuit to gain the long-term disability benefits she was entitled to under the terms of the Plan.

Facts of the Case Against LINA

Plaintiff was employed by Allied Physicians, Inc. as a Registered Nurse until she became disabled in 2009 due to the disabling effects of cervical and lumbar spondylosis and other serious medical conditions. Plaintiff filed an application for long term disability benefits and was paid disability benefits by the Allied Physicians, Inc. Long Term Disability Plan from October 2014 to October 2016. LINA issued the disability policy that provided disability coverage to the employees of Allied Physicians.
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O’Ryan Law Firm, on behalf of Plaintiff, Jilian F., recently filed a federal lawsuit against Metropolitan Life Insurance Company (“MetLife”) in an attempt to reinstate the Plaintiff’s disability benefits claim. The Plaintiff was employed as a Marketing Communication Specialist with Landis + Gyr, which made her eligible for disability benefits under the Cellnet + Hunt Employee’s Welfare Benefit Plan (the “Plan”). In Jilian F. v. Metropolitan Life Insurance Company and Cellnet + Hunt Employee’s Welfare Benefit Plan, the Plaintiff filed a lawsuit to gain the long-term disability benefits she was entitled to under the terms of the MetLife policy.

Facts of the Case Against MetLife

Plaintiff was employed by Landis + Gyr until she became disabled in 2011 due to the disabling effects of Thoracic Outlet Syndrome, cervical degenerative disc disease and cervical radiculopathy, severe neck pain, fibromyalgia, carpal tunnel syndrome, and paresthesia.

Plaintiff filed an application for long term disability benefits and was paid disability benefits by MetLife from August 2013 to September 17, 2014.

MetLife Terminates Long-Term Disability Benefits

On September 17, 2014, MetLife wrongfully terminated the Plaintiff’s long-term disability benefits. Plaintiff, represented by the O’Ryan Law Firm, then filed an administrative appeal with MetLife challenging the termination of her disability benefits. With this appeal, the Plaintiff included significant medical evidence to prove that she continued to meet the definition of Disabled under the MetLife policy. However, MetLife refused to overturn their decision to terminate the benefits. As a result, the Plaintiff was forced to file a lawsuit under ERISA in federal court against MetLife to obtain the benefits due her under the MetLife policy.
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The O’Ryan Law Firm, on behalf of the Plaintiff, Doug. S., filed a lawsuit in Marion County Indiana against the Indiana State Teachers Association Insurance Trust (“ISTA”) for unpaid disability benefits. The Plaintiff, Doug S., was employed as a shop teacher with the Michigan City Area Schools for many years, which made him eligible for disability benefits under the Long Term Disability Income Benefit Plan sponsored by ISTA.

In Douglas S. v. Indiana State Teachers Association Insurance Trust, the Plaintiff filed a lawsuit to gain the long-term disability benefits he deserved under the terms of the Plan.

Facts of the Case Against ISTA

Plaintiff was employed by the Michigan City Area Schools until he became disabled in 1993 due to the disabling effects of complications from hip fusion reversal, spinal stenosis, scoliosis of the lumbar spine, and cervical spondylosis. When he first became disabled, Doug S. filed an application for long term disability benefits and was paid disability benefits by the ISTA Insurance Trust for 20 years.

ISTA Terminates Long-Term Disability Benefits

On August 1, 2013, ISTA wrongfully terminated the Plaintiff’s long-term disability benefits claiming that the Plaintiff had miraculously recovered from his degenerative issues after 20 years. The Plaintiff then filed an administrative appeal challenging this denial. With this appeal, Plaintiff included significant medical evidence to prove his condition and disability including a report from an Independent Medical Examination by a physician board certified in Occupational Medicine. This report confirmed that Doug S. was disabled. Despite this information, ISTA denied the appeal and the Plaintiff was forced to file a lawsuit to obtain the rest of his disability benefits.
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Founded in 1820, Indiana University has eight campuses in the State of Indiana and is a world leader in professional, medical and technological education. With over 17,000 employees state-wide, IU offers a generous benefit package which includes long term disability coverage through Standard Insurance. At the O’Ryan Law Firm, we have represented numerous IU employees who have become disabled and have been denied their long term disability benefits by Standard Insurance. We have represented professors, Human Resources professionals, and IT professionals, among others, employed at IU who applied for disability benefits with Standard, after their medical conditions made it impossible for them to continue working, and Standard Insurance denied those benefits.

“Disabled” or “Disability” is defined for IU employees in the Standard Insurance Policy as:

You are Disabled if you meet one of the following definitions during the period it applied: A. Own Occupation Definition of Disability; B. Any Occupation Definition of Disability; or Partial Disability Definition
A. Own Occupation Definition of Disability
During the Benefit Waiting Period and the Own Occupation Period you are required to be Disabled only from your Own Occupation. You are Disabled from your Own Occupation if, as a result of Physical Disease, Injury or Pregnancy or Mental Disorder, you are unable to perform with reasonable continuity the Material Duties of your Own Occupation.

B. Any Occupation of Disability
During the Any Occupation Period you are required to be Disabled from all occupations.
You are Disabled from all occupations if, as a result of Physical Disease, Injury, Pregnancy or Mental Disorder, you are unable to perform with reasonable continuity the Material Duties of Any Occupation.

Any Occupation means any occupation or employment which you are able to perform, whether due to education, training or experience, which is available at one or more locations in the national economy and in which you can be expected to earn at least 80% of your Indexed Predisability earnings within twelve months following your return to work, regardless of whether you are working in that or any other occupation.
Material Duties means the essential tasks, functions and operations, and the skills, abilities, knowledge, training and experience, generally required by employers from those engaged in a particular occupation that cannot be reasonably modified or omitted. In no event will we consider working an average of more than 40 hours per week to be a Material Duty.

C. Partial Disability Definition During the Benefit Waiting Period and the Own Occupation Period, you are Partially Disabled when you work in your Own Occupation, but as a result of Physical Disease, Injury, Pregnancy, or Mental Disorder, you are unable to earn 80% or more of your Indexed Predisability Earnings, in that occupation.

To deny these claims under the policy, Standard Insurance routinely utilizes their in-house physician, Dr. Richard Handelsman, to review the medical records and opine that the IU employee is not disabled. Dr. Handelsman is the Medical Director for Standard Insurance and a salaried employee of Standard. Dr. Handelsman never examines the claimant and bases his opinion solely on medical records; therefore, his opinion is limited to only a review of the medical records. Also, we have found that Dr. Handelsman’s reports oftentimes fail to address important symptoms, like chronic pain, which are critical components to the disability claim.
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