California Federal Judge Orders Standard Insurance Company to Pay Disability Benefits to Teacher with Lyme Disease

In Tisha Entz v. Standard Insurance Company, Plaintiff Entz was a classroom teacher in Victorville, California from 1997 until she became too ill to work following the end of the 2014-2015 school year on June 10, 2015. She applied for her disability insurance benefit provided by her employer. She alleged in her claim for disability insurance benefits that her first day off work should be August 14, 2015, the day teachers were required to return to work, which made this her first day of missed work.

Plaintiff had an extensive medical history including heart surgery in 1997, donation of a kidney to her father that same year, spinal discectomy in 2007, and various biopsies over the years. Her main complaints, leading to the claim for disability, began in late 2013. She began feeling ill and weak. She reported to her doctors, “fatigue, headaches, muscle cramping, night sweats, palpitations, and rash.” She told her doctor she had done some research and thought she had Lyme disease.

Between late 2013 and the time she filed a claim for disability insurance benefits in September 2015, she saw her primary care physician and many specialists. At one point, she was being treated by nine different doctors. An orthopedist said she could not work due to pain in her spine.

Her primary care doctor, Dr. Harris, sent Standard a statement on September 9, 2015, saying Plaintiff had a primary diagnosis of Lyme disease with a secondary diagnosis of Bartonella. Dr. Harris also listed diagnoses of Babesia, arthritis, headaches, abdominal pain, diarrhea, nausea, and other gastrointestinal issues.

Dr. Harris stated, Plaintiff’s “physical, mental, and cognitive limitations and work activity limitations” were “due to muscle and joint pain, headaches, gastrointestinal issues” and opined “she is unable to function at work. Needs to remain out.”

On October 16, 2015, a Standard representative interviewed Plaintiff. The representative asked Plaintiff to send Standard her medical records from all physicians who had treated her including test results. Standard ordered medical records, but asked only for those from Jun 1, 2014 to October 26, 2015.

A vocational analysis conducted by a Standard employee found Plaintiff could do “a light duty occupation.” Standard commissioned a paper review by a doctor who noted that while Plaintiff had “multiple somatic complaints” there was “no diagnoses that establish any clear etiology” and no disease process that should limit her work other than an “arthritic knee.”

On January 12, 2016, Standard sent Plaintiff a letter informing her it had denied her claim. The letter informed her she could appeal the denial, but it did not tell her that there were any contractual limitations. She filed an appeal including 150 pages of documents. She added a lengthy letter.

Standard had an outside physician vendor review Plaintiff’s medical records, asking him to evaluate the diagnosis and treatment of Lyme disease and to evaluate whether Plaintiff’s symptoms were supported by the medical evidence. On October 11, 2016, Standard again denied Plaintiff’s claim and said she had not supported her claim with medical evidence and that “chronic Lyme disease is not an evidence based Sickness/illness” and Standard did not accept that as a valid diagnosis.

Plaintiff then filed this ERISA lawsuit in the United States District Court for the Central District of California. The Court agreed with Plaintiff and ordered Standard to pay her total disability benefits for 24 months as required by her policy.

The Lawsuit was Timely Filed

Standard asked the Court to dismiss the case as untimely. According to the policy language, a lawsuit was required to be filed within three-years of the time “proof of loss is required to be furnished.” Standard argued that Plaintiff missed the deadline.

The Court pointed out that this was a case of apparently an ongoing disability, which changed the proof of loss date to 90 days after the end of the period for which the provider is allegedly liable. Applying that law, the three-year limitations period would expire on November 12, 2020. Since Plaintiff filed her lawsuit in March of 2019, her suit was not time-barred.

In addition, the Court found that Standard did not inform her of the application of the limitation period which was a breach of its fiduciary duty. This breach would not trigger the running of the limitations period. So, under this standard alone, the lawsuit would be considered timely.

Plaintiff Met Her Burden of Proving By a Preponderance of the Evidence That She was Totally Disabled

The Court noted that Standard’s review of Plaintiff’s claim, both initially and on appeal, “focused narrowly on discrediting Dr. Harris [Plaintiff’s primary care physician] as a quack, and casting doubt on Plaintiff’s reports that she had Lyme disease.” Standard’s doctor admitted Plaintiff had a number of “somatic complaints” but opined that “no objective identifiable disease process” limited her work. He “did not credibly opine on whether she could ‘with reasonable continuity’ perform the ‘Substantial and Material Acts’ necessary to being an elementary school teacher.’”

The Court gave “greater weight to the opinions of Plaintiff’s multiple treating physicians, each of whom witnessed and assessed her condition over a significant period of time.” The Court also commented that “Disability should have been measured by Plaintiffs functional capacity, given her symptoms, compared to her duties as a teacher…. Plaintiff’s primary treating physicians opined more often and more directly on her inability to work in any capacity. They relied on both their objective observations of Plaintiff’s comfort level as well as her own subjective reports.”

Ultimately, the Court concluded that, “Plaintiff has adequately established she was “totally disabled” under the terms of the Plan for the 24-month period. Accordingly, the Court REVERSES Standard’s decision to deny Plaintiff’s LTD benefits for the 24-month period and AWARDS Plaintiff $51,511.73 in disability benefits owed.”

This case was not handled by our office, but we believe it can be instructive to those struggling to obtain disability benefits from an insurance company that is searching for ways to issue a disability insurance claim denial. For more information about this case, or for assistance with your own claim, even if you have received a denied disability claim from your insurance company, and no matter where you live across the nation, contact us at Dell & Schaefer for a free consultation.


Did you find this helpful?
Unhelpful (0)

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.

Learn more

Sue Standard

We have filed thousands of disability denial lawsuits in federal Courts nationwide against Standard.

Learn more

Protect Your Benefits
Get Your Standard Disability Application Approved
We help claimants throughout the entire application process.

Learn more

Prevent a Standard Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.

Learn more

Negotiate a Standard Lump-Sum Settlement

Our goal is to negotiate the highest possible buyout of your long-term disability policy.

Learn more

Standard Reviews
(642)

Policy Holder Rating

1.6 out of 5
Read 25 reviews
0%would recommend
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 642 Reviews
Standard

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 >
Reply
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 >
Reply
Sent on August 22nd 2019 by Attorney Jay Symonds

S.B., this sounds extremely unusual and unreasonable, I suggest you contact our office and speak with one of the attorneys to address the specific questions you have re... read more >

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 >
Reply
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 >
Standard

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 >
Reply
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.

Standard

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

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

Answered on September 21st 2023 by Attorney Gregory Dell
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.

Answered on May 31st 2023 by Attorney Gregory Dell
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?

Answered on December 8th 2020 by Attorney Alex Palamara
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?

Answered on September 11th 2020 by Attorney Alex Palamara
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?

Answered on July 10th 2020 by Attorney Steven Dell
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: How can Standard deny my claim and expect me to work when I am disabled?

Answered on March 30th 2018 by Attorney Rachel Alters
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?

Answered on December 1st 2017 by Attorney Stephen Jessup
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
(888)
Showing 12 of 888 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 benefit... 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 ... 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 di... 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 differen... Read More >

Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?

When it comes to securing your long term disability benefits, it's vitally important that you... 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 concern... Read More >

Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company

When you're seeking disability benefits under a long term disability policy, your medical rec... Read More >

Disability Benefit Denial Reason #3 - Video & Social Media Surveillance

One thing many long term disability claimants don't know about (or expect) from the claims re... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases

Seven Surgeries and The Standard Still Denies Long Term Disability Benefits

Our client was employed with the State of Oregon as a Technical Support Representative. She ... 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 de... 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 ... 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... 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 est... 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-e... 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 gastrointes... Read More >
Disability Lawsuit Stories
(765)
Showing 8 of 765 Lawsuit Stories

Can Standard Insurance Company’s Failure to Raise an Issue be Considered a Waiver?

The case of Jose Chavez v. Standard Insurance Company has quite a history with the United States District Court for the Northern Dis... Read More >

California Federal Judge Orders Standard Insurance Company to Pay Disability Benefits to Teacher with Lyme Disease

In Tisha Entz v. Standard Insurance Company, Plaintiff Entz was a classroom teacher in Victorville, California from 1997 until she became... Read More >

The Standard's Denial of LTD Benefits for Financial Planner Upheld by Ohio Court

The Plaintiff in Daniel M. Wehner v. Standard Insurance Company (Standard) was an independent financial planner who was in... Read More >

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 disabi... Read More >

First Circuit Finds for Plaintiff and Awards Retroactive Mental Health Benefits

In Jane Doe v. Standard Insurance Company, plaintiff Doe spent more than 25 years as an environmental attorney for a Maine law firm prior to b... Read More >

Standard Insurance Wins Appellate Remand for Claimant's Own Occupation Disability Determination

Cheney v. Standard Insurance Company and Long Term Disability Insurance (Standard) is a case in which the U.S. Court of Appeals for the Sevent... Read More >

Claimant is Ordered to Pay Attorney Fees to Standard for Failing to Exhaust Her Administrative Remedies

In Spath v. Standard Insurance Company, the plaintiff was injured at work and was initially granted disability benefits. Upon a review of the ... Read More >

Oregon Court Orders Standard to Pay Plaintiff Prejudgment Interest

The current case of Robertson v. Standard Life Insurance Company concerns the proper calculation of prejudgment interest based on the court's ... Read More >

Reviews from Our Clients

Request a Free Consultation

Our Lawyers Respond Same Day

5 Ways We Help Get Your Benefits Paid

Get Your Disability Application Approved

Our goal is to get your application for disability income benefits approved. Applying for disability benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their "hired gun" doctor.

Through our experience of having helped thousands of disability insurance claimants, our lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.

Submit A Strong Appeal Package

If your disability insurance benefits have been wrongfully denied, then our lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.

Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of "disability". We encourage you to contact any of our lawyers for a free immediate review of your disability denial.

Sue Your Disability Company

98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability lawyers have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the "little guy" against the multi-billion dollar insurance company giants.

We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.

Prevent A Disability Benefit Denial

Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.

Our law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.

Negotiate a Lump-Sum Settlement

Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.

Questions About Hiring Us

Who are Dell Disability Lawyers?

We are disability insurance lawyers that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.

In more than 98% of our cases, our lawyers have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement. Our lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.

We welcome you to contact any of our attorneys for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 700 videos and regularly provide tips to help protect your disability benefits.

Who do you help?

Our lawyers help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.

Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.

A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.

Do you work in my state?

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.

What are your fees?

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.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, GoToMeeting 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.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.