Reliance Standard Disability Denial Upheld Due to Claimant's Lack of Strong Medical Record Support
In the case of Amy Wright v. Reliance Standard Life Insurance Company (Reliance), Plaintiff was the vice-president of health information services at Integrity Health Care when she stopped working on August 7, 2017. She brought claims for benefits under an LTD insurance policy and a waiver of premiums under a life insurance policy.
In order to be approved for LTD benefits, Plaintiff needed to prove she was unable to perform the material and substantial duties of her own job for 90 consecutive days. She was the vice-president of information services at Integrity Health Care, a job that was deemed to be sedentary.
To be eligible for waiver of premium payments for her life insurance policy, she needed to be unable to perform the duties of “any type of work” for which she was suited “by education, training or experience.” Both policies gave discretionary authority to Reliance to determine eligibility for benefits.
Plaintiff’s claim for benefits under both policies was based on, according to the Appeals Court, a “constellation of health problems” including diagnoses of fibromyalgia, dysautonomia, and Postural Tachycardia syndrome. The Appeals Court did not list all of her symptoms, noting that they had been all thoroughly described in the District Court opinion.
Despite these diagnoses, physical exams found Plaintiff to have “normal strength, range of motion, and neurological and psychological conditions.” She was exercising twice a week and her physician recommended she increase her exercise regimen.
Based on this evidence. Reliance denied both of Plaintiff’s claims. She administratively appealed. During the appeal process, Plaintiff was examined by two independent physicians. One was of her own choosing. This physician diagnosed more than a dozen medical ailments and found her “totally and permanently disabled.”
Reliance’s independent physician examined her and “acknowledged [Plaintiff’s] wide-ranging concerns” but only found some limitations to her range of motion and found she had an unsteady gait. This physician concluded that she was eligible for full-time work.
Reliance had another doctor review Plaintiff’s medical record. That doctor concluded that “with some accommodations and limitations on her physical exertion, [Plaintiff] could work a normal schedule.”
Reliance then upheld its original denial of Plaintiff’s claim. Having exhausted her remedies, Plaintiff then filed an ERISA lawsuit in the U.S. District Court for the District of Florida.
District Court Proceedings
In the District Court, Plaintiff alleged that Reliance acted arbitrarily and capriciously when it denied her claim to LTD benefits and waiver of premiums for her life insurance policy. She also alleged that Reliance had a conflict of interest since it was the entity that determined eligibility for benefits and the one that would pay. She claimed that Reliance ignored relevant medical evidence in favor of its own experts who “misunderstood the standard for disability.”
The District Court surveyed all the medical evidence and found that Reliance “reasonably weighed the competing evidence.” That Court noted that one doctor claimed simultaneously that Plaintiff was “bedridden” at the same time the doctor also recommended a vigorous exercise program.
The District Court also held that there was not a conflict of interest to a degree to render Reliance’s “decision arbitrary and capricious given the ‘overwhelming support in the medical evidence that [Plaintiff’s] condition is not as debilitating as claimed.’”
Plaintiff then filed an appeal with the U.S. Court of Appeals for the Eleventh Circuit.
Circuit Court Proceedings
The run-of-the-mill conflict of interest did not render the decision arbitrary and capricious. The Circuit Court noted that a conflict of interest is a “common feature of ERISA plans.” There must be more in order to establish that the conflict of interest rendered a decision arbitrary and capricious. In one case cited by Plaintiff, the claimant presented “more rigorous evidence” of disability.
In addition, in the case cited, the only doctors who asserted the claimant was not disabled were ones who never examined him. In this case, Reliance based its denial on reliable evidence from a doctor who did treat her in person and concluded she was not disabled.
Finally, the court concluded that “the district court was correct to conclude that Reliance’s denial of [Plaintiff’s] claims weren’t arbitrary and capricious.” Amy Wright v. Reliance Standard Life Insurance Company (Reliance), is a cautionary tale of why without proper documentation from treating physicians the disability insurance company will deny a claim for disability income benefits.
This case was not handled by our office, but we believe it can be instructive to those who are pursuing claims for disability and waiver of life insurance premiums to show the need of presenting strong medical evidence to the disability insurance company to support the claim. If you have questions about this case, or any question about your LTD policy, contact one of our disability attorneys at Dell Disability Lawyers for a free consultation.
Resources to Help You Win Disability Benefits
Disability Benefit Denial Options
Submit a Strong Reliance Standard Appeal Package
We work with you, your doctors, and other experts to submit a very strong Reliance Standard appeal.
Sue Reliance Standard
We have filed thousands of disability denial lawsuits in federal Courts nationwide against Reliance Standard.
Protect Your Benefits
Get Your Reliance Standard Disability Application Approved
We help claimants throughout the entire application process.
Prevent a Reliance Standard Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.
Negotiate a Reliance Standard Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Reliance Standard Reviews
(652)
Policy Holder Rating
5
0%
4
0%
3
0%
2
57%
1
42%
Timely Payments
1.8out of 5
Handling Claim
1.9out of 5
Customer Service
2.2out of 5
Dependable
2.0out of 5
Value
2.0out of 5
Showing 8 of 652 Reviews
Reliance Standard
Short Term Disability Claim/Inconsistent to NO Communication
When I did call & reach a live person they were kind & helpful. The person assigned to my claim left one phone message & I have not spoken to her since. Information she re... read more >
Reliance Standard
Staff Lie
I had my disability cut off the day I was scheduled to find out whether I should have surgery. The claims examiner was aware that I had an appointment on that date and sai... read more >
Reply
Reliance Standard
Reliance Standard denied my LTD benefits because COVID-19 limited my ability to provide proof of continued disability.
Hello, I have a LTD policy with Reliance Standard and it has been paid (considered disabled) for 14 plus years. However, due to limited doctors visits / records this past ... read more >
Reply
Reliance Standard
Reliance Standard cut off my LTD benefits claiming I'm fit enough to work even though I'm more sick than before.
It should be criminal that this company treats sick people like this who just want PTO be left alone! I received a call from Reliance on 7/6/20 cutting me off after 1 year... read more >
Reply
Reliance Standard
Reliance Standard notified me that my benefits were being stopped with no warning or reason.
Horrible company! Phoned me on June 4th to let me know that I would no longer be receiving benefits as of June 3rd. Just like that! No questions asked and no info given!
Reply
Reliance Standard
I was receiving LTD from Reliance Standard due to breast cancer until they suddenly denied me my benefits.
I was diagnosed stage 2 breast cancer June 2015 and went out on std with Reliance. Within 4 months following my status changed to stage 4 with Mets to my spine. STD conver... read more >
Reply
Reliance Standard
Reliance Standard never answers or returns my calls, has not provided me my benefits, and falsely claims I never provided necessary paperwork.
I have been on STDI since April 28th, 2017 and I have only received what they say is a “courtesy payment” because they know the hardship which I am facing. I call mult... read more >
Reply
Reliance Standard
Reliance Standard is unreasonably prolonging the transition from STD to LTD for my boyfriend.
In August 2016 my boyfriend was placed on disability by his family physician. A short background, he is a type I Diabetic since age 4 and had to have multiple lumbar back ... read more >
Reply
Answered Questions by Our Lawyers
(25)
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 >
Helpful Videos
(904)
Showing 12 of 904 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips
How to Apply for Reliance Standard Disability Benefits & Top 5 Reasons for a Claim Denial
At Dell & Schaefer we’ve handled hundreds of long term disability insurance claims against Reliance Standard, and have learned a few things in the process. When you’re experiencing an injury or illness that makes it difficult (or impossible) to work, it can be tempting to file a claim as quickly as possible – but unless a claimant has all their ducks in a row, this could actually delay the ultimate r... Read More >
Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?
When it comes to securing your disability insurance benefits, it's vitally important that your disability insurance lawyer thoroughly understands the symptoms and impact of your disabling condition. Doctors can help you create strong medical records, but they're not accustomed to dealing with the rigorous documentation disability insurance companies require. Lea... Read More >
Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak
If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >
Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company
When you're seeking disability insurance benefits, your medical records and treating physician's statement are two of the most important components of your claim. But because the insurance company has a vested interest in denying your disability insurance claim, it often will rely on tactics like ambushing your doctor with a phone call in an attempt to get them ... Read More >
Disability Benefit Denial Reason #3 - Video & Social Media Surveillance
One thing many disability insurance claimants don't know about (or expect) from the claims review process involves video and social media surveillance. Disability insurance carriers often hire people to follow claimants around with a telephoto lens - or even send social media friend requests from fake accounts - to glean whatever information they can about the c... Read More >
How Do You Fight a Long-Term Disability Denial?
Getting a denial letter from your disability insurance company is one of the ultimate insults. You are sick and not able to work, yet your disability insurance company is telling you to return to work. The disability insurance company has denied your disability benefit claim and is basically calling you a liar. When receiving a disability denial letter or a ph... Read More >
Disability Denial Reason #2 - Change of Disability Definition & Vocational Review
One of the top reasons for terminating a claimant's long term disability benefits involves the change in the disability insurance policy's definition of "disability." This definition change often happens in conjunction with a vocational review, or an analysis of a claimant's medical records that tells the insurance company which jobs the claimant should be able ... Read More >
Disability Denial Reason #1 – Paper Review & IME
At Dell Disability Lawyers, we've seen insurance companies give countless reasons to deny long term disability benefits. However, most disability benefit denials tend to fall into one of a few categories - and one of the biggest ones is the paper review and independent medical exam (IME). Learn more about what this review process entails and what your claim file... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases
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-concussi... Read More >
Reliance Standard overturned its previous denial of long term disability benefits for Texas Retail Store Manager
Our client, Mr. S, formerly worked as a Store Manager for a large national retail chain. In August 2016 Mr. S suffered from multiple Transient Ischemic Attacks (“TIAs”) or mini-strokes which left him with debilitating physical and cognitive impairments. Mr. S made several attempts to return to work failed but continued to suffer slurred speech, headaches, pressure in the back of his head and memory loss, h... Read More >
Reliance Standard overturned LTD denial for Tennessee Technology Sales Consultant
Our client, Mr. L, formerly worked as a Sales Consultant for a global technology company. In September 2014 a number of medical issues following an ischemic stroke forced Mr. L to stop working and submit his claim for disability benefits under his employer's long-term disability (LTD) policy, which was funded and administered by Reliance Standard. Under his employer's disability policy he would be considered t... Read More >
Reliance Standard overturns decision to deny long-term disability benefits to Paediatrician with Ovarian Cancer
Prior to her disability Dr. Julie worked as a pediatric physician for a nationally recognized health system based in Florida. In 2015, Dr. Julie received a diagnosis of ovarian cancer and underwent a total abdominal hysterectomy and chemotherapy. Although the chemotherapy and treatment likely saved her life, she remained suffering from residual neuropathy in her hands and feet, as well as chronic and severe fa... Read More >
Reliance Standard reinstates disability benefits to Project Manager
Our client, a former Senior Project Manager for a national corporation, was receiving long term disability benefits from Reliance Standard due to debilitating chronic pain stemming from a multitude of lumbar and cervical spine disorders. Reliance Standard initially approved his claim for short term disability benefits and without issue approved his claim for long term disability benefits once the period of sho... Read More >
Reliance Standard Reinstates Benefits for Former Employee of Parent Company, Delphi Financial, Following Successful Appeal
Our client, Ms. L, formerly worked as a National Account Manager for Delphi Financial Group, the parent company of Reliance Standard Insurance Company. In 2015, a number of medical issues, namely, chronic daily pain, sleep difficulties, fatigue and cognitive and memory impairments forced Ms. L to stop working and submit her claim for long-term disability benefits. In addition to these symptoms her doctors susp... Read More >
Reliance Standard Overturns Denial of Benefits on Appeal After Claiming It Failed to Receive Medical Records
Ms. L was employed as a registered nurse when she was diagnosed with anterior ischemic optic neuropathy, optic atrophy and visual field defect. Her employer, a large medical healthcare system, provided Ms. L and its other employees group long-term disability insurance through Reliance Standard Life Insurance Company ("Reliance Standard"). In 2014 Ms. L's vision degraded so severely that her doctors diagnosed h... Read More >
After sending claimant to a psychiatric IME, Reliance Standard realizes its decision to deny benefits was incorrect
Reliance Standard Incorrectly Denies BenefitsThe 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 Dell Disability Lawyers to assist him with his appeal as he did not believe h... Read More >
Disability Lawsuit Stories
(765)
Reviews from Our Clients
