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.”
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.
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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I’m extremely satisfied with the experience I have had with this firm from day one. The lawyer who has handled my case, Alex, is very efficient and attentive to all my questions and concerns. They are always aware of how my case has gone and they care about my health. I feel optimistic with them because they are very attentive during the process of my claim. I would not hesitate to recommend families and friends if in any situation they need their services. Kathleen as well has been very well and assisted me with this case. I highly appreciate everything they have done for me.
It’s unfortunate when disability insurance companies come after older disabled policyholders just to help their bottom line. It can be a living nightmare the damage they can do to a family. Dell Disability Lawyers are polite, understanding and knowledgeable. They call you back and answer any question you have no matter how unimportant it can be. The amount of stress they took off of myself and family was incalculable. I recommend them highly to take care of any disability case whether it be filing for benefits or reversing a claim decision. They are outstanding.
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Mr. Symonds and Sonia as well as everyone else we have worked with throughout this process have been very helpful, professional and caring to our situation. We are very thankful to have this great team on our side.
Without them my LTD company was dropping my plan with me still suffering from my accident, even with doctor’s statements I’m still disabled. The LTD company didn’t want to advance my policy to the next stage of years of pay. Dell Disability Lawyers saved my policy, and helped to enforce the LTD company’s own policy (for its policy holder, me) that I would be covered still under the LTD policy I had paid for at my previous job, when my accident occurred. These lawyers know what they are doing and can help you too. LTD companies will try to drop you when you still need coverage just because they don’t want to pay on your policy anymore. Don’t let them break contract with ya because they are trying to get out of it. Hit em with legal action to ensure the continuation of your policy you paid for. Dell Disability worked very well for me and continue to do so.
I was denied long term disability benefits from The Hartford after being on it for years. I found Dell Disability Lawyers after doing research online. In a matter of days they responded and explained to me everything that would be done. Dell Disability Lawyers were able to settle my suit against The Hartford very quickly and responded to me quickly. I would definitely recommend this team of lawyers for anyone that is fighting for their disability insurance.
I have had nothing but a great experience with Dell Disability Law Firm. Mr. Alex Palamara and his team went above and beyond my expectations. They will respond to emails and phone calls in a timely manner. Thank you once again for taking my case.
This law firm is the best so far. MetLife denied me two times, they appealed two times for me and they won of course. So if you are on disability and want a chance at winning your case use this firm Dell disability lawyers, kind courteous understanding and they get the job done. You won’t be disappointed.