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Court Upholds Standard’s Termination of Long-Term Disability Benefits

In Lopez v. Standard Insurance Company, the U.S. Court of Appeals for the Eleventh Circuit upheld Standard’s termination of long-term disability benefits to Plaintiff who, according to Standard, was not disabled from performing “any occupation.”

Plaintiff went to work as a sheetrock applicator for Palm Harbor Homes, Inc. in May 2003. In late September 2005, he had to leave work due to groin pain and cramping. He returned to work for one day in November 2005 and then was terminated.

Almost a year later, on October 13, 2006, he filed a claim for long term disability benefits with Standard, claiming he was injured June 1, 2005, while working for Palm Harbor Homes, Inc. After several denials and appeals, Standard finally awarded him long-term disability benefits, finding him disabled from performing the duties of his own occupation.

After two years, the definition of disability changed, requiring Plaintiff to be disabled from working in any gainful employment for which he was qualified. After several professionals reviewed his medical records, and a report from a vocational consultant, Standard determined that he could work in a sedentary position and terminated his disability benefits.

Plaintiff disagreed. After exhausting his administrative appeals, he filed an ERISA lawsuit in a Florida Federal Court, which agreed with Standard. Plaintiff appealed.

Policy Language Defining “Any Occupation”

According to Standard’s disability insurance policy, after two years of receiving benefits due to being unable to perform the duties of his own occupation, the policy required proof that Plaintiff was unable to perform the duties of “any occupation or employment…in which you can be expected to earn at least 60% of your Indexed predisability earnings…”.

The vocational consultant used the 2013 wage data from the Bureau of Labor Statistics (BLS) that determined Plaintiff would actually make more per hour in the consultant’s suggested sedentary occupations than he made while working as a sheetrock applicator.

Plaintiff objected, and in his ERISA lawsuit, he claimed that it was an error for Standard to use 2013 wage data when the analysis should have been based on his eligibility for benefits under the “any occupation” standard beginning in 2007, not 2013.

Standard provided the court with relevant data from 2007, showing the same result as its analysis based on 2013 data. Plaintiff then claimed it was wrong for the district court to use information that was not part of the administrative record and submitted for the first time in court. The court ruled any error was harmless and Plaintiff had not sustained his burden of proof, so Plaintiff appealed.

Appellate Court Agreed with Standard and the District Court

The one issue raised by Plaintiff on appeal was that the district court should not have considered evidence concerning the 2007 analysis since it was not part of the administrative record when the plan administrator “made its final decision to deny disability benefits.”

The appellate Court noted that “the analysis turned out the same no matter which data was used” and concluded that it agreed with Standard that Plaintiff “did not meet his burden of showing that he was disabled from performing any occupation because he could perform sedentary work.”

This case was not handled by our office, but we think it can be helpful to those who need to prove they are unable to perform the duties of any occupation. If you have a question about this or any other aspect of your disability claim, contact our disability attorneys at Dell & Schaefer for a free consultation.

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FAQ

Do you help Standard claimants nationwide?

We represent Standard clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Standard disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Standard. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Standard.

How do you help Standard claimants?

Our lawyers help individuals that have either purchased a Standard long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Standard:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

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