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Reliance Standard Overturns Denial of Benefits on Appeal After Claiming It Failed to Receive Medical Records

Attorney Cesar GavidiaAuthor: Attorney Cesar Gavidia

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 her as legally blind.

Ms. L had no other choice but to stop working as a registered nurse and contact Reliance Standard to initiate a short-term disability claim. After being notified, Reliance Standard gathered all of the necessary medical records and promptly approved Ms. L’s short-term disability benefits. Following 26 weeks of short-term disability payments Ms. L’s claim was to transition into long-term disability, however, what she quickly encountered was a less accommodating and understanding Reliance Standard. Instead of seamlessly transitioning her claim from short-term term to long-term disability, and despite having received all of her medical records proving Ms. L’s blindness in her short-term disability claim, Reliance Standard denied Ms. L’s long-term disability benefits stating that she failed to furnish proof of loss. Reliance Standard gave Ms. L 180 days to appeal its decision.

Ms. L contacted Attorneys Dell & Schaefer and retained Attorney Cesar Gavidia to represent her with her appeal of benefits. Attorney Gavidia and his team began the process of gathering all of Ms. L’s medical records, even ones that Reliance Standard had already previously received in the short-term disability review. Attorney Gavidia conferred with Ms. L’s treating physicians, obtained testimonials and statements from Ms. L, her friends and family members, and methodically picked apart Reliance Standard’s internal medical assessment, all in preparation of Ms. L’s appeal.

Within a month of receiving the appeal Reliance Standard communicated its approval of benefits to Ms. L’s counsel and issued a benefit payment for all benefits owed and placed Ms. L on claim.

Ms. L is currently on claim and receiving long-term disability benefits from Reliance Standard. Attorney Gavidia and his team at Dell & Schaefer continue to monitor Reliance Standard’s actions, and ensure that all requests for medical documentation and claimant updates are addressed promptly and accurately.



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