Reliance Standard denies Diversified’s Director of National Account Sales long-term disability benefits despite long history or cardiac problems

Arthur “Skip” Cross was the Director of Diversified’s National Account Sales. Because of an aortic valve abnormality and problems stemming from that abnormality, Mr. Cross’s doctor indicated on April 3, 2002, that Mr. Cross was never expected to return to full- or part-time work. His cardiologist, in a letter to Reliance dated June 23, 2004, stated that Mr. Cross was permanently disabled.

Reliance then had its own cardiologist review Mr. Cross’s medical records. This cardiologist concluded that there had been no change in Mr. Cross’s cardiac condition that would have caused him to be disabled in June 2004, and denied Mr. Cross’s claim on September 24, 2004.

Mr. Cross appealed this decision, but Reliance made a final decision that he was not entitled to long-term disability benefits. This decision was based on a number of factors. One, Reliance concluded that the significant job stress caused by Mr. Cross’s boss did not cause him to be unable to physically perform his job, even if it did cause high stress. Two, Mr. Cross went nearly six months between visits with his cardiologist. Three, Mr. Cross was continuing to look for gainful employment during his period of total disability, and sent his last resume on June 22, 2004, the day before his cardiologist declared him totally disabled.

The court held that Reliance’s decision was not arbitrary and capricious, and had reasonably relied on the information available to it in Mr. Cross’s administrative record. Moreover, the facts in the record did not support Mr. Cross’s argument that Reliance was acting under a conflict of interest when coming to its decision to deny Mr. Cross long-term disability benefits.

See Cross v. Reliance Std. Life Ins. Co., No. 07-30473, 2008 U.S. App. LEXIS 294 (5th Cir. January 8, 2008).

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