After sending claimant to a psychiatric IME, Reliance Standard realizes its decision to deny benefits was incorrect
Author: Attorney Rachel Alters
Reliance Standard Incorrectly Denies Benefits
The claimant had been suffering from severe depression and anxiety due to many stressors in his life including a child custody battle which threw him into major depression and severe anxiety preventing him from being able to work in his occupation as an engineer. The claimant contacted the law firm of Dell & Schaefer to assist him with his appeal as he did not believe he would be able to beat Reliance Standard on his own. As his attorney, Rachel Alters worked with his physicians, reviewed his medical records and appealed his claim demonstrating how Reliance Standard was arbitrary and capricious in denying his claim. The medical records clearly supported that the claimant was unable to work due to symptoms of anxiety, depression, inattention, distractibility, disorganization, worrying and sleep disturbance that result from his preoccupation with the well-being of his children and his lack of involvement in their lives. He continued to experience chronic stressors due to his separation from his children (no visitation), his involvement in a bitter divorce, and significant financial strain due to legal bills and associated financial obligations. Until these identified stressors remit, the claimant would continue to be unable to perform his work-related responsibilities.
Since the inception of his claim for disability benefits, all of the claimant’s treating physicians consistently provided information to Reliance which documented the clinical findings on exam and supported the medical opinions that he was is incapable of performing the material duties of his regular occupation. Moreover, his treating physicians continued to provide the opinion that he was unable to work due to his disabling symptoms.
In reaching its decision to deny LTD benefits, Reliance relied on a peer review report by their hired physician. Reliance’s peer review physician noted the claimant’s symptoms of depression, anxiety, worrying, feelings of sadness and helplessness and sleep disturbances are supported by the objective findings of depressed and anxious mood. However, she disregarded his symptoms of inattention, distractibility and disorganization, despite that these symptoms were consistently reported by all of his treating physicians, due to a purported lack of objective testing.
The LTD Plan specifically provides that Reliance retains the right to have the claimant examined physically, psychologically and/or psychiatrically to determine the existence of any Total Disability which is the basis for a claim. However, Reliance failed to perform any such examination in its initial evaluation of his claim for benefits, even though a clear dispute existed between Dr. Acenas and the treating physicians regarding his symptoms of inattention, distractibility and disorganization. It is these symptoms primarily which render him unable to perform his occupation. Reliance failed to perform a full and fair review of his claim when they chose to rely solely on the paper review performed by their peer review physician instead of conducting a psychological or psychiatric examination of the claimant pursuant to the provisions of the LTD Plan.
IME Performed by Reliance Doctor Finds Claimant Disabled
After receiving the appeal from Rachel Alters of Dell & Schaefer, Reliance finally requested the claimant undergo an independent medical examination with a psychiatrist. After an extensive interview and examination, the IME physician determined that the claimant was unable to work in his occupation as his physicians stated all along. Reliance reversed its decision to deny benefits, paid the claimant his past benefits owed and put him on claim. Rachel Alters will manage the claimant’s claim until he is able to return to work.