O'Ryan Law Firm represents Don Fessenden who was a software engineer manager for Oracle until he became disabled from the severe symptoms of Myalgic Encephalomyelitis more commonly known as Chronic Fatigue Syndrome. Reliance Standard denied Don Fessenden's claim for disability benefits and then hired O'Ryan Law Firm to represent him in the appeal process with Reliance Standard. O'Ryan Law Firm filed a 500 plus page appeal for Fessenden hoping Reliance Standard would reverse their decision to deny Fessenden's long term disability benefit claim. However, Reliance Standard did not issue a timely decision on the appeal. The ERISA regulations require Reliance Standard to issue a decision within 45 days, with a possible extension of 45 days, but in no event could Reliance Standard go past the 90 days. After 90 days passed without a decision from Reliance Standard, O'Ryan Law Firm filed a lawsuit against Reliance Standard on behalf of Fessenden. The parties briefed the issue of whether Reliance Standard maintained discretionary authority despite blowing the regulatory deadline. The district court ruled that under the "substantial compliance" doctrine, Reliance Standard substantially complied with the regulatory deadline and therefore they retained discretionary authority.
On appeal to the Seventh Circuit, the court in a breakthrough opinion held that insurance companies could not utilize a "substantial compliance" defense to blown deadlines. If the insurer blows the regulatory deadlines, no discretion is given the opinions of the insurance companies in their denial of benefits. This greatly benefits claimants in ERISA governed disability benefits where the insurer has granted themselves discretionary authority in the policy to determine who receives benefits. Under this standard, the claimant is forced to prove that the insurer was "arbitrary and capricious" in denying the claim which can be a hard standard to meet when the insurer hires record reviewing physicians to review the medical records and conclude that the client is not disabled. The Fessenden opinion provides a significant opportunity for claimants to obtain de novo review of their claim or "a fresh look" in court.
Garner v. Aetna
Kimberly Garner was forced to leave her job as an Amazon fulfillment center associate after complications from surgery left her with severe and persistent urinary incontinence. 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.
Aetna denied Ms. Garner’s claim based on a review of her medical records by an in-house Aetna nurse. When Ms. Garner appealed the denial of her claim, Aetna denied the appeal based on an “independent” medical review by Dr. Stuart Fine, a urologist consultant it hired to issue an opinion that misrepresented the records and conclusions of Ms. Garner’s treating physicians in order to reach the conclusion that her incontinence was not actually disabling.
O’Ryan Law Firm filed suit against Aetna on behalf of Ms. Garner, pointing out that Aetna’s record reviewing physician had falsely represented that no further surgical procedures had been recommended and ignored the objective diagnostic testing that confirmed the severity of Ms. Garner’s incontinence as well as the conclusions of Ms. Garner’s primary care physician, who repeatedly and consistently concluded that her incontinence was so severe as to be completely disabling. The court agreed with O’Ryan Law Firm’s arguments that Aetna’s decision was impermissible because it was not supported by substantial evidence and instead relied on the critically flawed opinion of Aetna’s reviewing physician. As a result, the court remanded the claim back to Aetna for a determination that properly accounts for the objective evidence and treating physicians’ records and conclusions supporting Ms. Garner’s disability.
Kennedy v. the Lilly Extended Disability Plan
Cathleen Kennedy was 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 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. Nonetheless, Lilly 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.
O’Ryan Law Firm filed a lawsuit successfully challenging the termination of Ms. Kennedy’s benefits, and the court issued an order awarding Ms. Kennedy more than $500,000 in past benefits and ordering Lilly to reinstate her monthly benefit payments. Lilly appealed the decision, and O’Ryan Law Firm represented Ms. Kennedy on appeal to the Seventh Circuit Court of Appeals, where legendary judge Richard Posner, in one of his final opinions before his retirement, rejected Lilly’s arguments and upheld the District Court’s judgment. In reaching this conclusion, he noted that Lilly’s investigating physicians had disregarded the serious symptoms set forth in Ms. Kennedy’s primary physicians’ records as well as the fact that she experienced frequent but unpredictable periods of worsened fibromyalgia symptoms known as “flares” that would keep the client out of work for one or two days a month and made a regular employment schedule impossible. In his trademark concise style, Judge Posner needed only a single sentence to reject Lilly’s argument that it was not obligated to pay disability benefits because there was no laboratory data confirming Ms. Kennedy’s symptoms, stating simply that “it is error to demand laboratory data to credit the symptoms of fibromyalgia – the crucial symptoms, pain and fatigue, won’t appear on laboratory tests.”
McKnight-Cameron v. Boston Mutual et al.
Bridget McKnight-Cameron was a vice president at Firefighters Credit Union League (“FCU”) until she was forced to stop working at age 44 due to a variety of disabling medical conditions, including scleroderma, CREST syndrome, fibromyalgia, depression, insomnia, irritable bowel syndrome (“IBS”), temporomandibular joint disorder (“TMJ”), and Raynaud’s phenomenon. These conditions caused her to suffer extreme fatigue; loss of motor strength; chronic pain in her hands, joints, face, head, jaw, feet, hip, elbow, wrists, and shoulder; and gastrointestinal problems including gastroesophageal reflux disease (“GERD”), nausea, vomiting, and constipation.
Ms. McKnight-Cameron applied for disability benefits through Social Security and the Boston Mutual long term disability (“LTD”) insurance policy provided by her employer. She was awarded Social Security Disability benefits less than two months after applying, and Boston Mutual awarded her benefits under the LTD policy. Several months after it awarded her benefits, Boston Mutual began reviewing Ms. McKnight-Cameron’s claim, eventually hiring an investigator to perform surveillance of Ms. McKnight Cameron. When the surveillance video revealed Ms. McKnight-Cameron walking with a limp, carrying a purse and a shopping bag, eating lunch with her mother at Panera, and cutting roses from a rose bush at her home, Boston Mutual terminated her benefits, arguing that the surveillance proved that she was not actually disabled.
Ms. McKnight-Cameron appealed the termination of her benefits twice, but Boston Mutual denied both appeals. Ms. McKnight-Cameron then hired O’Ryan Law Firm to file suit against Boston Mutual in federal court. Ultimately, the court determined that Ms. McKnight-Cameron’s minimal activities observed in the surveillance video were not inconsistent with her reported disability, and Boston Mutual acted unreasonably in disregarding the overwhelming medical evidence that proved she was disabled. The Court ordered Boston Mutual to reinstate Ms. McKnight-Cameron’s benefits and pay her back benefits, with interest.
Maiden v. Aetna
Andrew Maiden was denied benefits under a long term disability policy provided by Aetna through his employer after he was forced to stop working as a lab technician for Evonik due to the debilitating effects of spinal stenosis, arthritis, diabetes, sleep apnea, and bipolar disorder. In denying his claim, Aetna failed to comply with its legal obligation to provide Mr. Maiden with adequate information as to why it was denying his claim and what information he could provide to support his claim on appeal. Although Mr. Maiden submitted substantial medical evidence supporting his disability on appeal, Aetna nonetheless denied his appeal.
O’Ryan Law Firm filed suit against Aetna on behalf of Mr. Maiden. The court recognized that Aetna had failed to properly account for the numerous physicians’ opinions stating that Mr. Maiden was disabled due to his medical conditions, and concluded that Aetna had acted unreasonably by failing to provide adequate notice of the reasons for its denial of benefits and by disregarding substantial medical evidence that Mr. Maiden was disabled. As a result, the court ordered Aetna to reevaluate Mr. Maiden’s claim and give proper weight to the substantial medical evidence supporting Mr. Maiden’s claim.
Holzmeyer v. Walgreen Income Protection Plan for Pharmacists and Registered Nurses
Michael Holzmeyer was a pharmacist and retail pharmacy manager for Walgreens, and was covered by Walgreens’ self-funded employee benefits plan administered by Sedgwick Claims Management Services, which provided both short term and long term disability benefits for eligible participants. Mr. Holzmeyer began to experience severe back pain due to exacerbation of injuries he had suffered in a car accident in 1986, and diagnostic imaging revealed significant degenerative changes to his lower spine and hips. He underwent two surgeries that provided some pain relief, but he continued to suffer from chronic degenerative disc disease and scoliosis.
Eventually, Mr. Holzmeyer was forced to stop working due to his back pain, and was approved for short term and long term disability benefits by Sedgwick. However, less than a year later, it terminated his benefits after concluding that the recent surgeries had restored his back to a state in which he was capable of returning to work. Mr. Holzmeyer appealed the termination of his benefits, which Sedgwick again denied, and O’Ryan Law Firm filed suit on his behalf to challenge the termination of his benefits. The court found that Sedgwick had unreasonably discounted the opinions of Mr. Holzmeyer’s treating physicians that he was disabled, failed to provide a sound basis for its decision to terminate the benefits. The court ordered Sedgwick to reevaluate the claim and properly account for the opinions of the treating physicians.
Hannon v. Unum et al
Janice Hannon worked as a registered nurse at Pitt County Memorial Hospital in North Carolina until she became disabled due to joint pain caused by Ehler-Danlos syndrome, a disorder that affects the connective tissues, primarily the skin, joints, and blood vessel walls. She was approved for disability benefits under a plan issued by Unum through her employer. Several years later, she moved to Indianapolis and began working part time as a seamstress for a local theatre. After learning that Ms. Hannon had begun working part time, Unum reviewed her file and terminated her benefits, arguing that she was no longer considered disabled under the policy.
O’Ryan Law Firm sued Unum on Ms. Hannon’s behalf to challenge the termination of her benefits. O’Ryan Law Firm cited extensive evidence in the form of medical records, test results, and treating physicians’ opinions supporting Ms. Hannon’s disability. Ultimately, the court agreed that Unum had acted unreasonably in terminating Ms. Hannon’s benefits and ordered it to reconsider her claim, giving proper consideration to the extensive medical evidence supporting her disability. The court also ordered Unum to pay almost $55,000 in attorneys’ fees.
Kirkpatrick v. Liberty Mutual
Leona Kirkpatrick was a claims specialist with Liberty Mutual and its subsidiaries for more than fourteen years until she became disabled due to systemic lupus erythematosus (“SLE”) and kidney disease, which caused her to suffer symptoms including joint pain and swelling, muscle pain, stiffness, and fatigue. She also suffered from diabetes and life-threatening pulmonary emboli in both lungs. She filed claims for short term disability and long term disability benefits through policies provided by Liberty Mutual, and both of her claims were denied despite substantial medical records and supportive statements from her treating physicians confirming her conditions.
O’Ryan Law Firm filed suit on behalf of Ms. Kirkpatrick against Liberty Mutual in federal court, challenging its denials of her disability benefits claims. After extensive litigation, O’Ryan Law Firm successfully argued that Liberty Mutual had acted unreasonably in denying Ms. Kirkpatrick’s claims, and the court ordered Liberty Mutual to reevaluate the claims and properly account for the substantial medical evidence supporting her disability. The court also ordered Liberty Mutual to pay more than $36,000 in attorneys’ fees.
Eberle v. Prudential
In a lawsuit filed by O’Ryan Law Firm challenging Prudential’s denial of long term disability benefits to a disabled Purdue University employee, Prudential refused to answer discovery requests served by O’Ryan Law Firm or allow its employees’ depositions to be taken, and filed a Motion for Protective Order seeking permission from the court to disregard these request. O’Ryan Law Firm successfully argued against the motion and won a ruling from the court that Prudential was required to provide any relevant information in response to the discovery requests and make its employees available for depositions.
Stone v. Clarion Health Partners, Inc. Employee Benefit Plan
Elizabeth Stone was a registered nurse at Methodist Hospital until she was forced to stop working due to degenerative joint disease, spondylosis, osteoarthritis, fibromyalgia, hypertension, glaucoma, irritable bowel syndrome, and hyperthyroidism. When filed a claim for short term disability (“STD”) benefits under the policy provided by her employer through Life Insurance Company of North America (“LINA”), LINA denied her claim on three separate occasions.
Ms. Stone also filed a claim for long term disability (“LTD”) benefits under the policy, but was notified that LINA had suspended its evaluation of this claim after O’Ryan Law Firm filed a lawsuit challenging the denial of the STD claim. Upon receiving this notice, O’Ryan Law Firm incorporated the LTD claim into its lawsuit. The benefits provider asked the court to dismiss the claim regarding the LTD benefits and allow LINA to make its decision before the claim could be litigated. In response, O’Ryan Law Firm successfully argued that the LTD claim decision deadline had passed and the court was entitled to decide the LTD benefits claim at the same time as the STD benefits claim. The court agreed and denied the motion.
Durham v. IDA Group Benefit Trust
Julie Durham was denied coverage for medical expenses submitted to the healthcare benefits provider that provided coverage to her family through her husband’s employer. O’Ryan Law Firm filed suit against the benefits provider on behalf of Mrs. Durham. When O’Ryan Law Firm requested that the benefits provider produce documents and information necessary to the litigation, the benefits provider claimed that the language of its benefits plan allowed it to refuse to respond to O’Ryan Law Firm’s requests. O’Ryan Law Firm filed a Motion to Compel, and the granted the motion, ordered the benefits provider to produce the requested information, and held that the benefits provider’s decision was not entitled to any deference in the litigation.
Gessling v. Group Long Term Disability Plan for Employees of Sprint/United Management Company
Robert Gessling was an account executive for Sprint until he was forced to stop working due to severe chronic neck pain and headaches resulting in part from a past auto accident. He was awarded long term disability (“LTD”) benefits under a policy from Hartford Life issued through his employer. However, while Hartford was paying his benefits, it also hired an investigator to perform surveillance on Mr. Gessling. The surveillance videos revealed approximately eight minutes of very light activity, including dropping his daughter off at daycare and wiping a few spots on his car with a cloth after going through a carwash. Despite strong opinions from his treating physicians that he was disabled from returning to work, Hartford terminated his benefits less than a year after they took effect.
Mr. Gessling hired O’Ryan Law Firm to file suit in federal court challenging Hartford’s decision to terminate his benefits. After more than three years of hard-fought litigation, O’Ryan Law Firm was able to secure a favorable decision from the court. Finding that Hartford had acted unreasonably in terminating Mr. Gessling’s benefits, the court ordered Hartford to reinstate Mr. Gessling’s benefits and repay his back benefits with interest.
Franklin v. H.O. Wolding, Inc., Group Health and Welfare Plan et al
Phyllis Franklin needed a life-saving liver transplant after contracting hepatitis C through a blood transfusion, but her health insurance provider refused to pay for it and she was not allowed to take a spot on the transplant waiting list until she provided assurance that she could pay the hundreds of thousands of dollars that the procedure was expected to cost. O’Ryan Law Firm sued the insurer on behalf of Ms. Franklin, uncovering evidence that its criteria for approving payment for a liver transplant were so strict that patients would be forced to wait so long for approval that their risk of death would increase dramatically. Within two weeks, the insurer agreed to cover the transplant. Finding that the insurer and its attorneys had acted unreasonably during the litigation, the court also ordered them to pay $40,538.15 in attorneys’ fees. Ms. Franklin received the transplant necessary to save her life.
Fleet v. Independent Federal Credit Union Employee Benefit Plan
Glee Fleet was a vice president at Independent Federal Credit Union until she was forced to stop working due to a disability. She applied for both short term disability (“STD”) and long term disability (“LTD”) benefits under her employer’s benefit plan (the “Plan”), but both applications were denied by CUNA Mutual Insurance Society, the administrator of the benefit plan. She appealed the denials of both the STD and LTD benefits, and CUNA denied her appeal. When O’Ryan Law Firm filed suit on behalf of Ms. Fleet in federal court, the Plan filed a Motion to Dismiss, falsely arguing that the court was not permitted to address the denial of LTD benefits because Ms. Fleet’s appeal only addressed the denial of her STD benefits.
The court denied the Motion to Dismiss, noting in its opinion that O’Ryan Law Firm’s “response to the motion simply demolished the factual basis for defendant’s motion. Plaintiff came forward with evidence, primarily from defendant’s own employees and records showing . . . (1) plaintiff was asking for long term disability benefits, (2) the Plan knew she was asking for long term disability benefits, and (3) the Plan acted at least some of the time as if it was deciding and denying long term disability benefits.”
Combs v. Lumbermens Mutual
Donna Combs was an offsite radiology technologist at Hancock Hospital until she was forced to stop working due to chronic anemia and severe fatigue resulting from a bone marrow disorder known as myelodysplastic syndrome, as well as fibromyalgia and chronic fatigue syndrome. She applied for long term disability benefits through a Lumbermens Mutual policy provided by her employer, and was awarded benefits for two years after her disability began. However, Lumbermens Mutual terminated her benefits after two years, when the definition of disability under her policy changed to require her to be disabled from performing any occupation as opposed to her own occupation. Ms. Combs appealed the termination of her benefits and provided extensive medical records and supportive statements from her treating physicians, but Lumbermens Mutual nonetheless denied the appeal.
O’Ryan Law Firm sued Lumbermens Mutual on behalf of Ms. Combs and cited evidence that Lumbermens Mutual’s claims evaluation practices were designed primarily to increase the company’s profitability by denying as many claims as possible. After a five day jury trial, O’Ryan Law Firm won a $1,522,583.75 verdict for Ms. Combs, plus an order that required Lumbermens Mutual to pay $507,527.91 in attorney’s fees.
Lumbermens Mutual appealed the verdict to the Indiana Court of Appeals. O’Ryan Law Firm successfully argued that the jury verdict should be upheld, and the Indiana Court of Appeals agreed, issuing an opinion affirming the verdict in Ms. Combs’ favor.
Life Insurance Company of North America
Lienhoop v. ISTA et al
When Deborah Lienhoop became disabled from her job as a kindergarten teacher for Bartholomew Consolidated School Corporation in Columbus, IN, she submitted a claim for long term disability benefits from the Long Term Disability Income Benefit Plan (the “Benefits Plan”) provided to her by the Indiana State Teachers’ Association (“ISTA”). However, ISTA denied her claim, arguing that she had failed to comply with the Benefits Plan’s claims procedure.
O’Ryan Law Firm filed suit against ISTA on behalf of Ms. Lienhoop, arguing that its denial of her benefits was improper and seeking reinstatement of her claim. ISTA filed a motion asking the court to enter judgment on its favor, arguing that Ms. Lienhoop had no valid legal claim. O’Ryan Law Firm successfully defended against the motion, and the court entered an order allowing Ms. Lienhoop’s claim to proceed.