How does Reliance Standard deny long term disability benefits after paying for three years?
A former Payroll Manager for Solairus Aviation, a large Private Jet Charter and Aircraft Management Company was significantly injured in a serious motor vehicle accident which occurred on June 26, 2017. This accident changed her life forever. Due to the accident, our now client suffered from a traumatic brain injury which led to diagnoses such a post-concussion syndrome and a Neurocognitive Disorder. It is because of these issues that our client was forced to stop working at Solairus Aviation after over a decade on the job. Thankfully, her employer, provided its employees with coverage under a Long Term Disability (“LTD”) insurance policy fully insured by Reliance Standard Life Insurance Company.
After initially filing her claim for benefits, following a brief delay, LTD benefits were awarded by Reliance Standard as it agreed that she was unable to perform the material duties of her regular occupation. Following this approval, the Social Security Administration also agreed that she was disabled.
Our now client received benefits for over three years under the LTD policy with Reliance Standard, but unfortunately, sometimes good things incorrectly come to an end. Via a March 9, 2021 denial letter, the former Payroll Manager was informed by Reliance Standard that her claim for continued LTD benefits was being denied.
Reliance Standard’s Justification for Denial
As justification for denial, Reliance Standard first noted that the change in definition had recently changed and that in order to now continue to receive LTD benefits, the claimant must prove that she “cannot perform the material duties of Any Occupation.” In addition to the change in definition of disability (which occurs in most group disability insurance policies), Reliance Standard then noted that our now client’s file and her medical records was “reviewed by a member of our clinical staff.” Lastly, in the denial letter, Reliance Standard seemed to stress that her issues were merely self-reported and that the most recently neurocognitive evaluation was completed back in 2018. Feeling armed with enough reasons to deny this claim, Reliance Standard did just that.
The Former Payroll Manager Finds our Firm
Five months after receiving the denial letter, our now client found our firm. Well actually, it was her mother who found our firm as her daughter, our now client, had significant medical and cognitive issues. After a quick call and a review of the denial letter, it was apparent that Reliance Standard treated this claimant terribly. Rather than sending her for additional testing to get a true idea as to whether this lady remained disabled, Reliance Standard did the lazy thing and just denied this claim.
Following our retainment, Attorney Alexander Palamara quickly got to work to prove to Reliance Standard that its denial was faulty. The first thing we did was order a copy of the claim file from the insurance company. Despite the file being 1,260 pages, the clinical staff review was found. This was difficult as it literally was a needle in a haystack as the review was merely a few sentences long. And the review basically stated that “testing is almost two and a half years old and would not reflect current functioning. There is no updated testing received in the file to review to assess current cognitive functioning. If such evaluation is received from the claimant or her providers’ additional review would be warranted.”
What was also noted from our claim file review was the fact that following completion of the clinical staffer’s report, the claim’s analyst reached out to the claimant and simply inquired if an additional neuropsychological test was completed since the one that occurred in November of 2018. When our client confirmed that one had, instead of attempting to get that report, the claim’s analyst quickly put together the aforementioned March 9, 2021 denial letter, despite the claimant offering to submit to any additional testing.
Preparation for Appeal
Prior to filing our appeal, we knew that we needed updated medical support for the claim. We did the obvious thing and sent our client for an updated Neuropsychological Evaluation which occurred in July of 2021. The results were overwhelming supportive of the fact that our client could not perform any occupation due to attention concentration issues, memory issues, processing speed issues and executive functioning impairment. The Clinical Neuropsychologist who conducted the evaluation concluded that “it is the residue of the concussion that prevents her from being able to return to work successfully at this time.”
Armed with the result of independent testing, we knew we had a good shot of getting this client back on claim. However, we know that appeals can be tricky and that overwhelming evidence is needed. Thus, to further strengthen our client’s file, we had an independent expert perform a review of all the available medical evidence. This doctor, Dr. Dilaawar J. Mistry, is currently the head of the Brain Injury Alliance of Colorado. Following his review of the evidence, the independent expert stated he “can unequivocally assert that the toll (her) medical problems, caused by the MVA on June 26, 2017, have taken on her life – professionally, physically, mentally, cognitively, and socially, are immeasurable, when combined within the context of her ‘whole life’ existence when had dramatically changed ever since the MVA on June 26, 2017.” He also concluded that he believed that she was “unable to work at “Any Occupation.”
The Appeal
Armed with the updated testing and the independent expert report, we were able to show that there was no way that the prior denial could be upheld. Additionally, our appeal severely criticized the actions of Reliance Standard in denying this claim based on a mere few sentences by an employee clinical staff review as well as the fact that the claim’s analyst quickly denied the claim when it learned that updated testing had occurred.
Reapproval
21 days after the filing of the appeal, we received a letter that was dated a week prior that informed us that the “claim has been reopened.” Thus, it only took 14 days for Reliance Standard to see the errors in its ways. Unfortunately, our client and her family were suffering for months without benefits, but we are thankful that she is now back on claim. Our client and her family also know that our firm will do whatever it takes to prevent any future denials of this claim until she recovers and is ready to return to work, or until her policy expires.
If you have been denied benefits by Reliance Standard or any disability insurance company, please contact us immediately. We always offer a free consultation and will do whatever it takes to get you any benefits you deserve.
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Reliance Standard Reviews
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57%
1
42%
Timely Payments
1.8out of 5
Handling Claim
1.9out of 5
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Showing 8 of 656 Reviews
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Reliance Standard notified me that my benefits were being stopped with no warning or reason.
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Answered Questions by Our Lawyers
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Showing 8 of 25 Answered Questions
Q: Are VA disability payments considered “other income” by Reliance Standard?
A: The disability policy may allow Reliance Standard to deduct and offset your monthly benefit payment by your VA... Read More >
Q: Denied short term disability and need to file for long term with same insurer
A: We would be more than happy to speak with you and review your denial letter and policy and discuss how we can ... Read More >
Q: Will Reliance Standard reduce my LTD payments due to my pension benefits or rental income?
A: ARH, I am happy to hear of your LTD approval, though I am sorry to hear of your medical conditions. The LTD po... Read More >
Q: Why is Reliance Standard trying to recover payments I was awarded through another company?
A: Dani, your disability plan may contain a provision which allows Reliance to claim and recover an overpayment o... Read More >
Q: Do I have to provide additional proof of my disability that's specifically requested by Reliance Standard?
A: Fred, I am sorry to hear all that you have been through medically and in dealing with Reliance Standard. Unfor... Read More >
Q: How do I access a copy of my STD policy with Reliance Standard?
A: Vicki, I am sorry to hear the trouble you are having with the Standard. It seems they are certainly make thing... Read More >
Q: If I'm not receiving the SSDI benefits for my children from Reliance Standard due to custody, should my SSDI benefits increase?
A: Bill, it depends on terms and conditions relating to “other income benefits” and “offset” under your f... Read More >
Q: How can Reliance Standard not coordinate with both of my disability insurance policies?
A: Jerry, you will need to review your RSL policy to determine what it deems to be a source of “Other Income”... Read More >
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How does Reliance Standard deny long term disability benefits after paying for three years?
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