Another long term disability claim is reinstated after Disability Attorney Alexander Palamara successfully argues The Standard mishandled preexisting condition investigation
Insurance companies often deny benefits based on an inability to complete a preexisting condition investigation without any consideration to the merits of the disability claim. Unfortunately, an insurance company’s inability to complete a preexisting investigation is often due to its own mismanagement of the claim file and lack of due diligence.
Prior to becoming disabled, our client worked as a Police Officer for the Metropolitan Police Department (Government of the District of Columbia). Unfortunately for our client, after being involved in a motor vehicle accident and suffering from ongoing back, neck, and shoulder pain, he was denied benefits based on the insurance companies alleged inability to complete its preexisting condition investigation. The Standard denied the claim despite acknowledgement by its medical reviewer that limitations and restrictions were in place that would prevent our client from performing the duties of his own occupation.
Like most group disability insurance policies, our client’s insurance policy provides an exclusion for preexisting injuries which states that there is no coverage for a disability that is caused or contributed to by a preexisting condition. When our client filed his claim, the Standard initiated a customary investigation into any preexisting conditions which included a request for certain pharmacy records and records from a certain physician regarding a recommended diagnostic test.
Unfortunately for our client, despite providing the Standard with the release for the pharmacy records and advising the claims handler that he never underwent the recommended diagnostic test, his claim was denied.
Alexander Palamara of Dell Disability Lawyers Files Appeal
After speaking with the client, it was readily apparent to Attorney Palamara that the Standard’s decision to deny benefits was incorrect. It was clear that our new client was not capable of performing the material duties of his own occupation, he did not have a preexisting condition, and the Standard’s denial for being unable to complete its preexisting condition was improper, likely a mismanagement of the claim investigation.
After gathering The Standard’s claim file and updated medical records from our client’s treating physicians, an administrative appeal was drafted to challenge the denial. Our appeal highlighted the errors in the handling of the preexisting condition investigation, presented all of the information necessary for the Standard to complete its preexisting condition investigation, and presented all of the medical information supporting our client’s restriction and limitations.
A few months after the appeal was filed, our client, was approved for benefits and continues to receive benefits to this day. Although our client was without benefits for nearly a year, he is happy to be on claim. He also knows that he can trust Dell Disability Lawyers to keep him on claim until he is able to return to work or until his policy expires.
If you have been denied disability benefits by the Standard or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell Disability Lawyers for a free consultation.
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Standard Reviews
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Standard insurance just dropped me with no communication with me.
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Standard is one of, if not the worse, company in the industry now
The Standard changed after the company was acquired by Japanese based Meiji Yasuda Life Insurance Company in 2016 and subsequently being delisted from the US stock exchang... read more >
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Standard is one of, if not the worse, company in the industry Standard hasn't approved or denied my claim in over a year. They keep promising to look at it 'next week'
My husband is covered by a Standard STD/LTD non-ERISA plan. He has a very rare neuromuscular disorder and was hospitalized in intensive care, was off work for 6 weeks (wai... read more >
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Standard
I waited 5 weeks just to be told I can't receive benefits
After working overtime and stressing behind my job for the past 5 years, it resulted in me being diagnosed with retinopathy hypertension, at the age of 29, on 12/10/2018. ... read more >
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The Standard will threaten to withhold your pay until you sign every document that they send you. The worst part is when they consider back payment for SSDI benefits
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Standard has keep me jumping through hoops for years
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Mental health LTD should be covered under the Mental Health Parity Act
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Answered Questions by Our Lawyers
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Showing 8 of 28 Answered Questions
Q: Do I have to pay back LTD after receiving SSDI?
A: Hello. In most group disability policies there is offset language which states you must pay back any LTD that ... Read More >
Q: Non-taxable benefits have become taxable.
A: I am sorry to hear what you are going through. We have seen you exact fact pattern with tax on ssdi when you w... Read More >
Q: How do I ensure Standard makes a timely decision with regard to my claim?
A: Matthew, we are sorry to hear that you are having difficulty with your claim. While the insurance company does... Read More >
Q: Why can my employer hold my disability check after The Standard sends it to them? Can I file a grievance with them?
A: Lucas, it sounds like your claim for STD benefits is under a policy that is self-funded by your employer. Thus... Read More >
Q: Should I contact you before submitting my application for a private disability benefit?
A: It is in your best interest to contact us as early as possible if you think you are going to need to file a lo... Read More >
Q: Is there any case law in which a state government employee LTD plan decided to drop the 24 month mental health limitation? Has there been any success against a state government and Standard using ADA Title I (employee) and 3 (insurance company) from a discrimination basis?
A: Marie, thank you for your compliments on our website. We strive very hard to get as much information out there... Read More >
Q: How can Standard deny my claim and expect me to work when I am disabled?
A: Debbie, unfortunately this situation occurs often as there are two different departments reviewing your claim ... Read More >
Q: I'm waiting to hear back about my appeal. Should I hire an attorney?
A: Pam, if an appeal has already been submitted there may be very little an attorney could do at this point until... Read More >
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