• Reliance Standard Disability Overview of Denials, Appeals, Applications & Lawsuits
  • Reliance Standard Disability Lawsuit and Claim Denial Options with a Disability Lawyer
  • How to File a Reliance Standard Disability Appeal Following a Long Term Disability Benefit Denial
  • Reliance Standard Life Insurance - Disability Benefit Claim Attorneys-Appeals, Lawsuits and Claims
  • Reliance Standard Disability Insurance Claim Denial ERISA Appeal Tips
  • Reliance Standard Denial of Disability Benefits for an Attorney Reversed by Kansas Judge

Reliance Standard Wrongfully Denies Life Insurance Waiver of Premium and Must Pay $188,000

In Jody Rizzo v. First Reliance Standard Life Insurance Company, plaintiff’s late husband, Angelo Rizzo, participated in a group life insurance policy provided as a benefit by his employer, Barnes & Noble, where he was employed as an assistant store manager. The policy was issued by Reliance Standard. On about November 12, 2012, Mr. Rizzo stopped working due to his multiple medical problems. He died approximately 15 months later at the age of 42.

The life insurance policy had a “waiver of premium” (WOP) clause which paid a plan participant’s premiums if that person became totally disabled. Total disability was defined as a “complete inability to engage in any type of work for wage or profit for which he/she is suited by education, training or experience.”

On March 1, 2013, Reliance Standard wrote to Mr. Rizzo informing him of how to apply for WOP benefits, and explained to him that his life insurance coverage policy could only be maintained if his employer paid for seven more months of benefits. Reliance told him since he was no longer working, he could only maintain the policy if his WOP application was approved, or he converted the group policy to an individual policy within 31-days of a denial of his WOP application.

Mr. Rizzo timely applied for WOP benefits, but On October 9, 2013, 203 days after his application, Reliance sent a letter denying his application on the grounds that he was not totally disabled under the terms of the policy. Reliance alleged that between November 8, 2012, and November 1, 2013, Mr. Rizzo could perform a sedentary occupation, and identified four such occupations which it believed Mr. Rizzo could perform.

The October 9, 2013 letter also informed Mr. Rizzo that he had 180 days from the date of the letter to appeal the denial of WOP benefits. Meanwhile, on February 24, 2014, Mr. Rizzo died.

Mrs. Rizzo alleged that she did not receive the WOP denial letter until after Mr. Rizzo’s passing, and she contacted Reliance. Then, she only received it on March 6, 2014 after she requested it.

Mrs. Rizzo ultimately filed this ERISA lawsuit alleging that Reliance wrongfully denied her late husband’s WOP application and she was therefore entitled to the benefits of the policy. Reliance moved to dismiss the lawsuit on the grounds that Mr. Rizzo failed to exhaust his administrative remedies and therefore, the lawsuit was time-barred.

The United States District Court for the District of New Jersey held since Reliance failed to comply with timelines established by ERISA and case precedent, it deemed Mrs. Rizzo to have exhausted her administrative remedies. It further ruled in Mrs. Rizzo’s favor and awarded her the $188,000 life insurance policy that had been offered to Mr. Rizzo.

Exhaustion of Administrative Reasons

The Court noted that although ERISA does not specifically require a plaintiff to exhaust internal review procedures before filing a lawsuit, courts have read an exhaustion of remedies requirement into the statute. On the other hand, there are exceptions. One exception is “where a plan expressly requires exhaustion but fails to establish or follow claims procedures consistent with the applicable ERISA regulatory requirements, permitting a court to deem claimant to have exhausted their administrative remedies.”

In the Rizzo case, according to ERISA rules, Reliance was required to inform Mr. Rizzo that it had denied his WOP application within 90 days of his application. The denial letter it claimed to have sent on October 9, 2013 was sent 230 days after the application was submitted, 113 days after the expiration of the 90-day requirement. Since Reliance failed to comply with the statutory requirement, the Court held that “Plaintiff’s administrative remedies were deemed exhausted upon the expiration of the 90-day adverse determination period, and she was free to bring this lawsuit at any time thereafter.”

Denial of Benefits was Arbitrary and Capricious

The Court weighed several factors in determining that Reliance’s action in denying WOP benefits to Mr. Rizzo was arbitrary and capricious.

The Court balanced all factors and held that Reliance’s “denial of Mr. Rizzo’s WOP application was arbitrary and capricious. The Court gave significant weight to the fact that Defendant failed to consider medical information available for its review before making a benefit determination.”

The Court continued, finding that Reliance “seemingly turned a blind eye to information that was, or could have been made, available to it between Dr. Riss’s April 25, 2013 Attending Physician Statement and its October 9, 2013 denial.” Taking all factors into consideration, the Court determined that Reliance’s “decision to deny Mr. Rizzo’s WOP application was not the product of reasoned decision-making and substantial evidence. Thus, the Court concludes that Plaintiff is entitled to the $188,000.00 in which the life insurance policy at issue in this case offered Mr. Rizzo.”

This case was not handled by our office, but if you have any questions about this, or any question concerning your disability claim or waiver of premium benefits claim, contact one of our attorneys at Dell & Schaefer for a free consultation.

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We represent Reliance Standard clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Reliance Standard disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Reliance Standard. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Reliance Standard.

How do you help Reliance Standard claimants?

Our lawyers help individuals that have either purchased a Reliance Standard long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Reliance Standard:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
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Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

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Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

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No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

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Dell & Schaefer Client Reviews   *****

Patricia T. (Florida)

If you think the insurance company is going to be FAIR, you are WRONG! Get an attorney, I recommend Dell & Schaefer. They entered my life approximately 4 years ago. I was in the mid years of my life, moving along routinely finishing up my 29th year of continuous employment as a professional Acute Care Registered Nurse, looking ahead to planning my future and possibilities ahead of me. I had planned to work at least another 15 years and maybe more if I could. I was hitting the peak of my value in the health system that employed me and I loved my job. Income was never an issue for me, as in my profession I could always find work and make as much income as I needed raising a family etc… But just incase, my father always taught me to have a safety net. So every year for 29 years, around benefit time I would fill out the forms and check the boxes for STD and LTD and pay the monthly dues for those policies in case I would ever need them, never expecting to use them. Well life had other plans for me.

My illness began slowly, I made adjustments to my work schedule and life schedule hoping that would allow me to stay employed. I didn’t want to give up the money, my benefits, the years experience I had, the value I had to contribute etc… That lasted for about a year and half then suddenly my body just couldn’t do it anymore. My illness exacerbated, necessitating me to leave work. I went out on my STD policy and initially Aetna the carrier of the policy was cooperative and approved my claim. After several months when I didn’t improve my STD policy was over and it was time to begin my LTD. At this point Aetna suddenly switched and began to deny all my claims for the same illness they had previously approved. I was shocked and bewildered, I could not believe how Aetna could be doing such a thing. What was happening, how could they just say NO! This wasn’t fair, I paid into this for 29 years… and was lost as to what to do.

I did some research on line, and found out this was a common thing all insurers were doing to people who had these kind of policies. What a rip off I thought. Here I thought I had a safety net. I was so angry and realised I was disillusioned about this system and having a safety net. I sat and cried fluctuating between anger, sadness, worry, the gamut of feelings. What should I do I thought, I need help and help fast. I couldn’t live without income. I did some more research and found Dell & Schaefer, I went through their website reading all the information and decided I need to call them to see if they could help me. My illness was not listed as a common illness for disability approval.

When I called them, they put me through immediately to someone and took some information. Later that day an attorney called me back and went through my situation explaining to me all my options and that they could help me. I wasn’t ready to make a decision on the spot, so I told them I would call them back. I was skeptical because at this point I didn’t trust anyone for numerous reasons and felt like all the systems I had faith in were failing me. Is this going to be another rip off, I thought?

After thinking about it for a day or two and consulting friends and family, I nervously called back Dell & Schaefer and I told them my concerns, we talked some more they never pressured me. I reluctantly agreed, not because of something they said, it was my own issue with trust now clouding my decision. Reflecting back that was the best decision I ever made. My attorney in the firm was Alex Palamara, I dealt with him exclusively and he always called me back, emailed me and let me know what was happening promptly. Nothing was ever too small for him to answer and he had compassion when I would complain about how unfair Aetna was being with their denial of my case. And YES, they did deny, and are still trying to find ways to deny me to this day 4 years later. Through the hard work and timely action taking by the attorney my appeal was reversed and my claim continues to be approved with the help of the attorney. I no longer have random calls from Aetna asking me repetitive questions that I already answered numerous times and the firm continues to coordinate the yearly reviews with Aetna and my physicians. I faced another denial at the two year mark when the policy changes the definition of gainful employment. Yea isn’t that beauty they sneak into the policy that you have really don’t understand. Alex anticipated that fought that and I have had a seamless benefit check now for 4 straight years.

I will not give up my representation, as educated as I am, in no way am I versed in disability law and the new ways insurance companies try to get out of paying the policy we have paid our hard earned money into for a safety net. I know things will not be easy and I will have to fight to continue my benefits, having Dell & Schaefer gives me security that someone will be there fighting for me and my benefits. I can’t thank them enough, I find them to be prompt, compassionate, knowledgeable and very fair with their fees. If you are thinking about hiring an attorney for representation you will be pleased with this firm. As a side note, my last years of employment I worked for a large hospital system, my job was coordinating with the hospital, physicians and Insurance companies to make sure the hospital would get paid. Specifically, I worked on denials of patients inpatient hospital bills. The insurance company would deny claims for the most unbelievable reasons. They know some people will just give up and not fight, that’s what they are counting on. I didn’t think they would do the same thing with STD and LTD policies, I was wrong and naive. Do yourself a favour, HIRE an attorney immediately from the beginning, otherwise the carrier will jerk you around till you give up, and you may inadvertently say or fill out a form wrong or miss a date and boom you are denied. You will never get your benefit you paid into. Hire Dell & Schaefer.

***** 5 stars based on 202 reviews

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