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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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.

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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.

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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.

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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.

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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.

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Michael F.

Having had several lung surgeries including a wedge resection, lobe removal and pleurodesis as well as MAC lung disease, I was diagnosed with stage vi (end stage) COPD in October 2012. With my lung function at 23% it was becoming very difficult to manage my daily life let alone continue working in my management role at a large healthcare company. After meeting with my primary physician and my pulmonologist, it was agreed that I should stop working and submit a claim for disability. I was 52 at the time. My short term disability plan with Mutual of Omaha paid my claim for 3 months at which time it was converted to my long term disability plan with no issues. I continued to collect my LTD benefit from February 2013 until November 20th 2014 when I received a letter saying I could return to my previous position and there was nothing in my medical records to indicate disability. I was shocked to say the least, as my condition is chronic and progressive and in fact my condition had continued to decline. I didn’t know what to do and knew I did not have the knowledge or experience to appeal their decision. I was very afraid as we depended on this income to pay our bills, that’s why I held the policy for many years, to protect my family. I want to add that I applied for and was approved for Social Security disability benefits shortly after diagnosis.

I immediately started to search for attorneys that handle disability claims and found literally hundreds that handled SSDI claims, but few that handled employer/private policies. I found Dell & Schaefer and filled out their quick online form and almost immediately received a reply from Gregory Dell (yes, an actual person responded!) who let me know that he asked Rachel Alters to call me. I don’t think it was more than a half hour before I received a call from her. I immediately felt a sense of relief as she explained the process and what she would be doing for me.

From that day forward, I have been met with OUTSTANDING customer service from Rachel Alters and Kathleen Bordes. Any time I reached out with questions or concerns they were very responsive and always left me feeling satisfied that I had the best in my corner. The process took many months and a lot of leg work on Rachel and Kathleen’s part. When I was finally sent a draft of the appeal, I completely understood why it takes so long. The level of detail was unbelievable. I actually feel like I better understand my disease after reading it! The appeal was filed timely and my denial was overturned very quickly. When I learned it was overturned, I have to admit I had tears in my eyes. I want to add, that even if the appeal didn’t have the positive outcome that it did, I would feel exactly the same about the exceptional job done on my case. I’m not sure I can ever truly express how grateful I am, and how blessed I feel to have found Dell & Schaefer and especially Rachel and Kathleen!

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