California disability attorney sues Standard Insurance Company for denial of long term disability benefits payments to paraplegic
In the case of D. Nielsen Pollock Vs Standard Insurance Company, filed at the District Court for the Southern District Of California, the plaintiff complained that the Standard Insurance Company (Standard Insurance) have breached the Employee Retirement Income And Security Act Of 1974 (ERISA) and suing for the recovery of disability benefits under the terms of an employee benefit plan for which Standard Life is the insurer of benefits under the “DILLINGHAM CONSTRUCTION HOLDINGS INC. GROUP LONG TERM DISABILITY INSURANCE POLICY.”
The Nature of the Complaint Against Standard Insurance Company
The plaintiff was formerly employed as an estimator and Project Manager for the Dillingham Construction Company. By virtue of his employment, the plaintiff is a beneficiary under the DILLINGHAM CONSTRUCTION HOLDINGS INC. GROUP LONG TERM DISABILITY INSURANCE POLICY (The Policy).
In 2002, the plaintiff became involved in an body surfing accident resulting in him suffering a spinal fracture and dislocation at his T3-4 level. Due to these injuries, the plaintiff became a complete paraplegic. Upon becoming a paraplegic, the plaintiff became totally disabled under the terms of the above mentioned Policy. The plaintiff was also determined to be totally disabled from any occupation by the Social Security Administration.
Claim for Long Term Disability Benefits Against Standard Life Insurance Company
In accordance with the terms of the Policy, the plaintiff filed a claim for long term disability benefits with Standard Life. The plaintiff was also determined by Standard Life to be totally disabled and unable to perform all of the essential functions of his own occupation and hence entitled for long term disability benefits under the terms and conditions of the Policy.
A review of the plaintiff’s long term disability benefits was conducted by Standard Life in February 2005. The review concluded that the plaintiff was unable to perform the material duties of any occupation which he has the education, training and experience to perform.
On November 17th 2010, Standard Life informed the plaintiff that it had conducted another review of the plaintiff’s long term disability benefits and decided to cancel the plaintiff’s long term disability benefits retroactive to December 31st 2006. Standard Life also demanded $124,389.45 from the plaintiff on the ground that this represented overpayments of disability benefits. According to Standard Life;
Based on our review, you are no longer disabled, and no longer eligible for LTD benefits.
The plaintiff alleged in the lawsuit that Standard Life’s decision to terminate the plaintiff’s disability benefits was not based on any medical evaluation, reports or opinions. The plaintiff argued that Standard Life had based its determination to deny the plaintiff’s claim for long term disability benefits on some newspaper articles and internet websites and assuming that the plaintiff was earning money as an officer of his family business, the Nielsen Construction CA.
The plaintiff argued that at all times since 2002, he has been paralyzed from the chest down. The plaintiff stated that his physical condition had gotten worse as the 2002 injuries to his spinal cord also caused a mass on plaintiff’s spine (syrinx) resulting in him feeling constant pain.
“Return to Work Incentive”
Nevertheless, Standard Life argued that even if the plaintiff was disabled, he is subjected to the policy’s “Return To Work Incentive” as he had earned income. The “Return To Work Incentive” calls for the reduction of the plaintiff’s disability benefits in proportion to ½ of the payment that the plaintiff received for the work that he had done.
The plaintiff argued that Standard Life had tried to use the Return to Work Incentive to redefine the term “Disability” and is contradictory in nature to the terms of the policy. Despite the plaintiff’s arguments, Standard Life refused to reverse its position to confirm that the plaintiff is not disabled and is subjected to the “return to work incentive.” Standard Life response instead was to recalculate the overpayment amount to $118,971.93 instead and insist that the plaintiff owed Standard Life this amount in overpayment. At the same time, Standard Life refused to make further payments of long term disability benefits to the plaintiff.
The contradictory nature of Standard Life argument stem from the fact that if Standard Life insisted that the plaintiff is subjected to the “return to work incentive”, this would imply that the plaintiff is disabled. However at the same time, Standard Life had insisted that the plaintiff owed $124,389.45 (later recalculated to $118,971.93) in overpayment of disability benefits. This, on the other hand, would imply that the plaintiff is no longer deemed to be disabled.
Exhaustion Of Administrative Remedies And Relief Sought
Having exhausted all administrative remedies in trying to explain to Standard Life why its determination is erroneous, the plaintiff is forced to seek relief through the Court:
- Payment of past disability benefits due to the plaintiff.
- A declaration that the plaintiff is entitled to immediate reinstatement to the POLICY, with all ancillary and future benefits to which he is entitled by virtue of his disability;
- A declaration finding Standard Life’s “return to work incentive” void under applicable California and Federal law, or inapplicable under the circumstances of this case.
- Payment of all costs and attorneys‘ fees incurred in pursuing the legal action
- Payment of prejudgment and postjudgment interest as allowed under ERISA.
- An award of other and further relief as the Court deems just and proper.
Resources to Help You Win Disability Benefits
Disability Benefit Denial Options
Submit a Strong Standard Appeal Package
We work with you, your doctors, and other experts to submit a very strong Standard appeal.
Sue Standard
We have filed thousands of disability denial lawsuits in federal Courts nationwide against Standard.
Protect Your Benefits
Get Your Standard Disability Application Approved
We help claimants throughout the entire application process.
Prevent a Standard Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.
Negotiate a Standard Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Standard Reviews
(653)
Policy Holder Rating
5
0%
4
0%
3
0%
2
60%
1
40%
Timely Payments
1.9out of 5
Handling Claim
1.8out of 5
Customer Service
2.0out of 5
Dependable
1.9out of 5
Value
2.0out of 5
Showing 8 of 653 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 >
Reply
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 >
Reply
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 >
Reply
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
I was placed on disability by my doctor with a diagnosis of Cognitive Impairment (supported by both a neurologist and a neuropsychologist) which severely affects my abilit... read more >
Standard
Standard has keep me jumping through hoops for years
I have been on LTD with The Standard since September 2011. The have had me jumping through hoops for all these years. Very rude if I call and ask a question. They say they... read more >
Reply
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
(28)
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 >
Helpful Videos
(904)
Showing 12 of 904 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips
Applying for Standard Disability Benefits? Top 5 Claim Denial Reasons
At Dell & Schaefer, we've helped hundreds of clients recover long term disability benefits from Standard Disability.What should you know about getting your Standard Disability long term disability claim approved?Understanding the Language in Your Standard Disability Policy Is EssentialGetting your long term disability claim approved on the front ... Read More >
How to Prevent Standard Insurance Company from Denying Disability Benefits
If you have an individual or group long term disability policy with Standard, you may assume that accessing these disability insurance benefits will be as easy as filling out the claim form and providing a release for your medical records. But regardless of which insurance carrier holds your policy, the disability process is rarely so simple. The below tips and ... Read More >
Can My Insurance Company Terminate My Disability Benefits After 24 Months if My Mental Nervous Disorder Contributes to But is Not The Sole Cause of My Disability?
The "But For Test"In the case of George v. Reliance Standard Life Insurance Company, The district court held that RSL did not abuse its discretion when it determined that a mental disorder contributed to George's Total Disability. On appeal, George argued that there was no evidence in the record to show that, absent his mental nervous conditions, he was able to earn close to the same amount in another occu... Read More >
Dentist and doctors: beware of the Standard Insurance Company Group's long-term disability policy
The Standard Insurance Company sells multiple different long-term disability policies to dentist and other medical professionals. The difference in each policy is usually the definition of disability. In my opinion, the following definition of Own Occupation Disability sold by Standard is called an Own Occupation definition, but it is not a true Own Occupation policy. The following definition of Own Occupation... Read More >
Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?
When it comes to securing your disability insurance benefits, it's vitally important that your disability insurance lawyer thoroughly understands the symptoms and impact of your disabling condition. Doctors can help you create strong medical records, but they're not accustomed to dealing with the rigorous documentation disability insurance companies require. Lea... Read More >
Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak
If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >
Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company
When you're seeking disability insurance benefits, your medical records and treating physician's statement are two of the most important components of your claim. But because the insurance company has a vested interest in denying your disability insurance claim, it often will rely on tactics like ambushing your doctor with a phone call in an attempt to get them ... Read More >
Disability Benefit Denial Reason #3 - Video & Social Media Surveillance
One thing many disability insurance claimants don't know about (or expect) from the claims review process involves video and social media surveillance. Disability insurance carriers often hire people to follow claimants around with a telephoto lens - or even send social media friend requests from fake accounts - to glean whatever information they can about the c... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases
Seven Surgeries and The Standard Still Denies Disability Insurance Benefits
Our client was employed with the State of Oregon as a Technical Support Representative. She sought disability through her employer provider LTD Policy with Standard due to low back, hip, and lower extremity pain. She had two hip, two knee and three back surgeries.After paying her for 1.5 years Standard hired a board-certified neurologist to perform a review ... Read More >
After Two Appeals The Standard Insurance Approves Short & Long Term Disability Benefits for Nurse
Prior to filing for disability, our client was a Registered Nurse employed as a Senior Case Manager for United Healthcare. Our client was a dedicated employee who enjoyed her work until chronic pain, frequent headaches, and resulting cognitive dysfunction forced her to stop working in July of 2018. Fortunately, her employer provided disability insurance coverage under two policies: UnitedHealth Group’s ... Read More >
Standard Approves Disability Benefits to Attorney with Fibromyalgia
Fibromyalgia is a multifaceted illness that can affect every aspect of one’s life. While most people are aware of the debilitating pain and fatigue associated with Fibromyalgia there is a less known symptom of the condition that has as great an impact- memory problems known as “Fibro Fog.” Prior to filing a claim for disability benefits our client was a shareholding partner for a large national law firm ... Read More >
Standard overturns decision to deny disabled Project Manager long-term disability insurance benefits after first Appeal
Terry had worked as a project manager for a large national health group earning over $85,000 annually, until type 2 diabetes left him disabled and suffering from peripheral diabetic neuropathy, severe chronic pain, fatigue and depression.In addition to health insurance and other employee benefits his employer provided long-term disability insurance through Standard Insurance Company, based out of Portland,... Read More >
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 Of... Read More >
Standard Overturns Denial of Benefits to Shareholder of Major Law Firm
When Mr. L contacted us he had recently left a major law firm where he had been working for 27 years. Mr. L, a commercial finance and real estate transaction attorney, was forced to stop working due to debilitating symptoms from several medical conditions. He had been suffering from these conditions for several years but his symptoms had gradually worsened over time and eventually reached the point where he wa... Read More >
Disability Attorney Alex Palamara wins LTD Benefits for Police Officer Denied by Standard
Disability insurance companies are always trying to deny disability claims based upon a pre-existing condition.In this claim our client was a police officer in Washington DC and the Standard insurance company denied his long term disability benefits. In this claim we were able to get the Standard disability denial reversed at the ERISA appeal level.In th... Read More >
Standard Overturns Denial of Disability Insurance Benefits
Prior to contacting our office our client had been on disability with Standard due to Ulcerative Colitis and several other serious gastrointestinal conditions for the prior 36 months as Standard had determined she would not be able to perform the material and substantial duties of her prior occupation as an Office Manager. However, with the change in definition to the much maligned “any occupation” standar... Read More >
Disability Lawsuit Stories
(765)
Reviews from Our Clients
