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Attorney Representation for Your Reliance Standard Disability Insurance Lawsuit

Prevailing in an ERISA federal lawsuit against Reliance Standard is a very difficult challenge due to the inherently unfair nature of ERISA litigation, but our disability attorneys have decades of combined experience in representing insureds against Reliance Standard in court.

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When taking Reliance Standard to court to secure your benefits you need to know:

  • You are not entitled to a Jury trial. Your case will be decided solely by a Federal Judge.
  • After a final denial of benefits you are not allowed to add any new information to your case for a Judge to consider.
  • There is no live testimony in court. Neither you nor your doctors will be allowed to advocate for your disability benefits.
  • The standard of review the federal judge has to use in deciding who wins your case favors Reliance Standard.
  • Even if you win in court Reliance Standard only has to pay you your back benefits and put you back on claim with no guarantee from the court that they won’t deny your claim again. Reliance Standard will not be held financially responsible for any hardship you endured while not receiving your monthly benefit.

In the video below we discuss why winning a lawsuit under ERISA is an uphill battle:

What happens after the final denial of my disability benefits?

Like most disability carriers, Reliance Standard only provides one level of administrative appeal following a denial of benefits. This means you only have one opportunity before filing a lawsuit to prove to Reliance Standard that their denial of your claim was wrong and that your benefits should be reinstated. However, in the event Reliance Standard denies your appeal your only option is to then file a civil lawsuit in federal court under ERISA. As the above video discusses – being in court fighting for your disability benefits is not a place you want to find yourself.

How long do I have to file my lawsuit?

ERISA disability policies are subject to a statute of limitations, or simply put the timeframe with which you have to file a lawsuit, that is typically three years from the date “proof of loss” is required. Despite the fact that ERISA is a federal law that is intended to be uniformly applied across the country, courts will often have varying interpretations as to when your timeframe to file a lawsuit has lapsed. The most important thing to remember is that when your appeal is denied you must act fast in bringing your lawsuit or you could be forever barred from suing Reliance Standard. Federal courts enforce statute of limitations issues in a very cold and methodical manner and no matter how strong your case or how badly Reliance Standard acted through the processing of your claim – if you do not file your lawsuit before the statute of limitations ends your rights to go after Reliance Standard for your benefits is lost.

Will a jury decide my case? 

No. Under ERISA, you are not entitled to a jury trial. Instead, a federal judge will be the ultimate decider of who “wins” the case. This is a very large departure from most areas of the law as well as what most people think of when they think of “going to court.” If ERISA allowed a jury of your peers to determine if you are disabled your odds of success in court increase, and very likely the incidences of Reliance Standard denials would decrease.

Will I or my doctors be allowed to testify in Court?

Unfortunately, this again is a resounding no. ERISA does not allow for live testimony in court, meaning you will not be able to argue to the judge why your claim should be approved nor will the judge hear from any of your doctors, family, friends, co-workers, etc. to determine if Reliance Standard was right in denying your claim. This is yet another way in which the law protects Reliance Standard from being held fully accountable for denying your benefits.

What information will the Court consider?

After the final denial of your claim by Reliance Standard the Court is only allowed to consider what is in your claim file as of the date of Reliance Standard’s final denial of benefits. The claim file, or administrative record as it is referred to in court, is comprised of all the information you or your doctors provided to Reliance Standard during the course of your claim as well as the information created/obtained by Reliance Standard in administering your claim to include internal notes regarding your claim, any medical reviews conducted on your file, video surveillance information, and any vocational/occupational reviews and reports conducted.

Another important distinction with ERISA lawsuits from other areas of the law is the fact that once Reliance Standard has rendered its final denial of your claim no new information is allowed to be submitted into your claim file for a judge to review. As such the judge can only review the information up to the date of the final denial. This means if you are awarded Social Security after a final denial of benefits, or you had new testing performed that verified all the medical problems supporting your claim for benefits, or any other new information is available that would win your case – a judge cannot consider it. This is why properly preparing your appeal against Reliance Standard is so important – you only get one chance to perfect your claim.

Will the Court decide if Reliance Standard made the right decision in denying my claim?

Yes and no. The majority of employer provided Reliance Standard disability insurance policies will contain what is known as a “discretionary clause.” The discretionary clause provides Reliance Standard the authority to be the sole interpreter of the terms and conditions of its policy. It also affects how the judge will review your claim to determine if you are entitled to additional disability benefits.

With the authority provided by the discretionary clause the court will not only defer to Reliance Standard’s interpretation of its policy, but will also force the court to use what is known as the “arbitrary and capricious” standard of review. The arbitrary and capricious standard of review tasks the Court with a two-step process to determine if Reliance Standard’s decision should be overturned.

First the Court will decide if you are disabled, which will be dependent on several factors, to include:

  • The strength of the medical information contained in your file that supports a medical condition severe enough that it would result in medically necessary restrictions and limitations as they relate to your ability to work, and
  • The definition of disability Reliance Standard was using to review your eligibility for benefits. Depending on your claim this would mean whether the medical information supports the inability to perform the duties of your own occupation or those of an alternate “any” occupation as defined in the policy.

If the judge finds that the medical information available does not support disability as defined under the policy then you lose. If the Court finds that your medical information supports disability under the policy then the judge goes to step two of its analysis. Yes, that is right, if the judge finds you are disabled that does not mean that you have won your benefits with Reliance Standard.

If the judge finds you are disabled then it must conduct the second step of its review – to determine whether Reliance Standard acted arbitrary and capricious in denying your claim. In layman’s term this means – did Reliance Standard have a reasonable basis to deny your claim. If the judge finds that Reliance Standard had a reasonable basis to deny your claim, despite the fact it believes you satisfy the definition of disability in your Reliance Standard policy, the judge must uphold Reliance Standard’s decision.

What constitutes a reasonable basis to deny my claim?

If Reliance Standard can show that it conducted a reasonable review of your claim (note that this does not mean fair) then it can typically prevail on the second step under the arbitrary and capricious standard of review. In denying your decision Reliance Standard is not required to have you physically examined by a doctor and many courts throughout the country hold that simply having your file reviewed by a doctor and relying on that reviewing doctor’s opinion is sufficient to establish a “reasonable basis” to deny your claim. There is no requirement that the judge defer to your doctor’s opinions over Reliance Standard’s nor is there any rule that prevents Reliance Standard from relying on its doctor’s opinions over the opinions of yours. All Reliance Standard has to show is that it provided a reasonable review, regardless how minimal that review may be, for a court to uphold the denial of your claim for benefits.

Is it even worth pursuing a lawsuit against Reliance Standard for denying my disability claim?

In our experience, the answer is without question yes. Although ERISA is an unfair law to the insured if you do not pursue your rights in court against Reliance Standard then they ultimately win. If you find yourself with a final denial of benefits Reliance Standard has already told you they are not going to pay any more money, so there is very little for you to lose.

Our attorneys have handled countless lawsuits against Reliance Standard and know how to maximize our client’s chances of success as well as the value of your claim. If your appeal has been denied by Reliance Standard contact our office today to speak with one of our disability attorneys.