Court Upholds Standard's Termination of Long-Term Disability Benefits

In Lopez v. Standard Insurance Company, the U.S. Court of Appeals for the Eleventh Circuit upheld Standard’s termination of long-term disability benefits to Plaintiff who, according to Standard, was not disabled from performing “any occupation.”

Plaintiff went to work as a sheetrock applicator for Palm Harbor Homes, Inc. in May 2003. In late September 2005, he had to leave work due to groin pain and cramping. He returned to work for one day in November 2005 and then was terminated.

Almost a year later, on October 13, 2006, he filed a claim for long term disability benefits with Standard, claiming he was injured June 1, 2005, while working for Palm Harbor Homes, Inc. After several denials and appeal“>appeals, Standard finally awarded him long-term disability benefits, finding him disabled from performing the duties of his own occupation.

After two years, the definition of disability changed, requiring Plaintiff to be disabled from working in any gainful employment for which he was qualified. After several professionals reviewed his medical records, and a report from a vocational consultant, Standard determined that he could work in a sedentary position and terminated his disability benefits.

Plaintiff disagreed. After exhausting his administrative appeals, he filed an ERISA lawsuit in a Florida Federal Court, which agreed with Standard. Plaintiff appealed.

Policy Language Defining “Any Occupation”

According to Standard’s disability insurance policy, after two years of receiving benefits due to being unable to perform the duties of his own occupation, the policy required proof that Plaintiff was unable to perform the duties of “any occupation or employment…in which you can be expected to earn at least 60% of your Indexed predisability earnings…”.

The vocational consultant used the 2013 wage data from the Bureau of Labor Statistics (BLS) that determined Plaintiff would actually make more per hour in the consultant’s suggested sedentary occupations than he made while working as a sheetrock applicator.

Plaintiff objected, and in his ERISA lawsuit, he claimed that it was an error for Standard to use 2013 wage data when the analysis should have been based on his eligibility for benefits under the “any occupation” standard beginning in 2007, not 2013.

Standard provided the court with relevant data from 2007, showing the same result as its analysis based on 2013 data. Plaintiff then claimed it was wrong for the district court to use information that was not part of the administrative record and submitted for the first time in court. The court ruled any error was harmless and Plaintiff had not sustained his burden of proof, so Plaintiff appealed.

Appellate Court Agreed with Standard and the District Court

The one issue raised by Plaintiff on appeal was that the district court should not have considered evidence concerning the 2007 analysis since it was not part of the administrative record when the plan administrator “made its final decision to deny disability benefits.”

The appellate Court noted that “the analysis turned out the same no matter which data was used” and concluded that it agreed with Standard that Plaintiff “did not meet his burden of showing that he was disabled from performing any occupation because he could perform sedentary work.”

This case was not handled by our office, but we think it can be helpful to those who need to prove they are unable to perform the duties of any occupation. If you have a question about this or any other aspect of your disability claim, contact our disability attorneys at Dell & Schaefer for a free consultation.


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Standard insurance just dropped me with no communication with me.

Reviewed by D Larson on October 4th 2023   Verified Policyholder | June 2019 date of disability
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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Sent on October 4th 2023 by Attorney Gregory Dell

I am sorry to hear about your experience. Do you currently have a denial letter from them that you can email to me?

Standard

Standard is one of, if not the worse, company in the industry now

Reviewed by Anonymous Erisa Victim on December 5th 2019   Verified Policyholder
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'

Reviewed by S.B. on August 22nd 2019   Verified Policyholder
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

Reviewed by Marissa on June 11th 2019   Verified Policyholder
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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Sent on June 11th 2019 by Attorney Gregory Dell

Marissa, I am sorry to hear of your diagnosis and the troubles Standard is giving you. Please contact our office at once for a free consultation. We would love to speak... read more >

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

Reviewed by Gena on December 10th 2017   Verified Policyholder
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

Reviewed by Linda on September 13th 2017   Verified Policyholder
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 >
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Standard has keep me jumping through hoops for years

Reviewed by Donna on July 26th 2017   Verified Policyholder
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 >
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Sent on July 26th 2017 by Attorney Stephen Jessup

Donna, please contact our office with a copy of the denial letter so we can discuss in detail how we may be able to assist you in appealing the denial.

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Mental health LTD should be covered under the Mental Health Parity Act

Reviewed by Kim V. on February 10th 2017   Verified Policyholder
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