Standard Overturns Denial of Disability Benefits to Chiropractor
As any chiropractor or anyone who has been to a chiropractor knows – chiropractic medicine is very physically intensive work. The wear and tear a chiropractor can endure over the course of a career often resembles what many patients seek treatment with a chiropractor for. Such was the case with our client, who after 20 years of practice began to succumb to chronic neck pain due to cervical herniations, cervical radiculitis and multiple shoulder problems to include a rotator cuff tear, labral tear, degenerative changes to the AC joint and decreased range of motion. No longer able to meet the physical demands of his occupation as a chiropractor he filed his claim for long term disability benefits with Standard Insurance Company through the policy he had purchased from the Nebraska Chiropractic Physician’s Association (NCPA).
The Denial of Benefits
After many years of faithfully paying his premiums it came as a surprise to our client when Standard notified him that claim was being denied. Concerned by assertions made by Standard as to the nature of his policy and the contents of his denial letter he contacted our Office and spoke with Attorney Stephen Jessup.
In denying our client’s claim for benefits Standard relied on an independent file review conducted by a doctor that never physically examined our client or spoke with any of his treatment providers. Despite years of consistent treatment with medical doctors, chiropractors and objective medical evidence by way of MRIs, Standard’s doctor noted that there was insufficient medical information to support any restrictions and limitations and that our client should be able to return to work full time as a Chiropractor.
Additionally, review of the pertinent information indicated that Standard was erroneously trying to apply ERISA standards to what was an ERISA exempt policy. Attorney Jessup explained how this misapplication could negatively impact our client and how the appeal should be approached in order to protect our client in the event of future litigation.
The Appeal
As Standard was treating our client’s claim as an ERISA based denial of benefits Attorney Jessup remained silent as to the incorrectness of same and moved to quickly secure a complete copy of the claim file from Standard. Upon receipt and review Attorney Jessup discovered that the vocational review conducted by Standard was incomplete and failed to take into account multiple aspects of our client’s occupation as a sole practitioner chiropractor. Furthermore, the review of the medical review evidenced a systematic attempt to downplay our client’s weekly chiropractic treatment and an attempt to require objective medical evidence that does not exist to support our client’s subjective complaints of paint.
After receipt and review of all treatment and medical records Attorney Jessup arranged for additional diagnostic testing, to include a functional capacity examination, in order to better support and bolster the already lengthy history of medical restrictions. With the additional supportive medical information obtained, Attorney Jessup coordinated with our client’s providers to obtain additional supportive letters and forms.
In submitting the appeal Attorney Jessup attacked Standard’s position that the policy was governed by ERISA, as well as undermined both the vocational and medical reviews Standard conducted. Faced with an overwhelming amount of medical evidence and legal argument Standard was left with little choice but to admit its mistake and approve our client’s claim for long term disability benefits.
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Standard Reviews
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Showing 8 of 650 Reviews
Standard
Standard insurance just dropped me with no communication with me.
I was put on Standard insurance by my employer in 2019. I was told by them when I was first on disability that I would be on this for the rest of my life. After 2 years of... read more >
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Standard
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 >
Standard
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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Standard
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
First of all, the worst thing that could ever happen to a hard-working person is a permanent disability. Fighting to secure payment is hard enough when you are well. Let a... read more >
Standard
Standard's sudden denial was inexplicable
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Standard
Standard has keep me jumping through hoops for years
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Standard
Mental health LTD should be covered under the Mental Health Parity Act
My company contracted with Standard for our short and long term disability policies. In Jan 2014 I was on STD, which turned into LTD with a waiting period, which was tough... read more >
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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