• Applying for Standard Disability Benefits? Top 5 Claim Denial Reasons
  • Denied LTD Benefits by The Standard? Lawyer Tips to Win an ERISA Appeal
  • The Standard Insurance Company Long Term Disability Benefit Claims, Denials, Appeal and Lawsuit Help
  • The Standard: What To Expect With A Long Term Disability Benefit Claim
  • Who Makes The Final Decison To Approve Or Deny Disability Insurance Benefits? (Ep. 17)
  • A Senator's View of ERISA Disability Insurance Claims (Ep. 20)
  • The Standard Insurance Company - Disability Buyout or Lump Sum Offer?

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 insured under a Group Long Term Disability Insurance Policy (Plan). He obtained his policy through the Association for Independent and Franchise Professionals. The Plan was administered by the Standard Insurance Company.

The Plan provided short-term disability (STD) benefits and long-term disability (LTD) benefits for those who were totally or partially disabled from performing the material duties of their own occupation due to a physical disease injury, pregnancy, or mental disorder.

The material duties were defined as “the essential tasks, functions and operations, and the skills, abilities, knowledge, training and experience, generally required by employers from those engaged in a particular occupation that cannot be reasonably modified.”

On August 15, 2016, Plaintiff filed a claim for disability benefits noting he suffered from back, leg, and spine pain in addition to headaches resulting from a hypoxic event. He also had ulcerative colitis. He submitted medical records from five treating physicians. Only one treating doctor submitted an Attending Physician’s Statement in which she opined that Plaintiff’s “ability to function had declined significantly due to uncontrolled pain.” The doctor also reported that Plaintiff could not concentrate and could not sit for more than 15 minutes.

On October 13, 2016, Standard informed Plaintiff it needed more information in order to determine his eligibility for LTD benefits. On December 12, 2016, and again on February 7, 2017, Plaintiff wrote letters to Standard emphasizing he was applying for LTD benefits based on his total disability, not just partial disability. Plaintiff also claimed he became disabled in March 2016.

Standard Evaluated the Medical Reports of Five Treating Physicians:

· Dr. Severyn, a pain management specialist, diagnosed Plaintiff with spinal stenosis of the lumbar region and indicated he suffered from post laminectomy syndrome.

· Dr. Viljoen, a neurosurgeon, discussed with Plaintiff the option of surgery which Plaintiff would think about and consider.

· Dr. Kurpita saw Plaintiff many times through 2015 and 2016 and is the physician who provided the Attending Physician’s Statement. Dr. Kurpita noted that Plaintiff reported severe headaches and prescribed medication. The doctor also noted the medication did not cause side effects and did not interfere with Plaintiff’s ability to perform activities of daily living.

· Doctor Lin, a neurologist, treated Plaintiff for his headaches. The doctor thought the headaches were due to hypoxia suffered by Plaintiff during a recent MRI. The doctor saw Plaintiff several times, and Plaintiff reported that his symptoms stayed the same and did not change from visit to visit.

· Dr. Scholl, gastroenterologist and hepatologist, treated patient for abdominal pain. On May 24, 2016, the doctor noted that Plaintiff was feeling better overall, but his abdominal symptoms worsened his back pain.

Standard Called in Reviewing Physicians to Evaluate the Medical Evidence

Dr. Carlson, a vocational consultant and board-certified physical medicine and rehabilitation specialist, reviewed the medical file. She concluded that Plaintiff did suffer from pain due to his spinal fusions and diagnosis of spondylolisthesis, but that she did not believe he would have been precluded “from sedentary level work in the calendar year 2016.”

Dr. Carlson also reviewed Plaintiff’s Facebook account and found he had posts about “doing significant construction work around his house, as well as participating in hobbies and recreational activities such as fishing.” The doctor continued, “In my opinion, if an individual is precluded from doing sedentary level work, I would not anticipate that he would be able to do these other activities.”

Dr. Carlson also noted that Dr. Kurpita had not put any restrictions on Plaintiff. He could still drive a car and there was no impairment from any cognitive activities.

Based the medical evidence, on February 23, 2017, Standard denied Plaintiff’s claim for LTD benefits. Standard acknowledged that Plaintiff had documented chronic back pain and shoulder pain, but the records did not support a finding of disability. There were no restrictions on his ability to perform his sedentary job.

Plaintiff’s Administrative Appeal

On May 26, 2017, Plaintiff submitted medical records concerning should surgery in December 2016, letters from treating physicians and a functional capacity evaluation. He argued that his constant pain was severe enough to qualify him for total disability.

Plaintiff also argued that his Facebook posts merely showed he was trying to lead a healthy life. Besides, he said the gardening was light work that required no thinking and the construction project was done with the help of his wife and adult son.

Standard reviewed the medical records submitted and letters from treating physicians. Comments were that his headaches “are worsened by staring at computer screen,” or that his headaches “affect his ability to concentrate, make important decision, and create financial plans.”

Plaintiff also submitted a Functional Capacity Evaluation (FCE). The physical therapist who conducted the exam concluded that the plaintiff was “limited in function consistent with lumbar radiculopathy.”

One of Standard’s reviewing physicians found that the medical records well-documented Plaintiff’s suffering from chronic low back pain, but that the pain should not limit his ability to perform the duties of his job. Another one found that although Plaintiff was precluded from working for the twelve weeks following his December 2016 spinal surgery, he could have otherwise performed his job duties. His claim for LTD benefits was denied.

Standard’s Denial of LTD Benefits Was Based on Substantial Evidence and Not Arbitrary and Capricious

On October 24, 2017, Standard denied Plaintiff’s appeal, so he filed this ERISA lawsuit. The Court carefully examined the administrative record and considered Plaintiff’s arguments and concluded that Standard’s decision denying LTD benefits was not arbitrary and capricious. The Court stated its reasons for each issue it resolved:

· Standard’s reliance on opinions of independent reviewing physicians was not arbitrary and capricious when Standard adequately explained its reasons for its decisions and also relied on objective evidence in making its decision.

· Standard did not act arbitrarily and capriciously by ignoring intellectual aspects of Plaintiff’s occupation when Plaintiff never argued that he was cognitively impaired. Plus, the independent reviewing physicians did consider those aspects of the medical records.

· Standard’s reliance on social media was not arbitrary and capricious.

· Standard did not act arbitrarily and capriciously when weighing the FCE because it gave a reasonable explanation for its decision.

· Standard did not “cherry-pick” the medical tests to rely on and explained why it made the choices it did.

The Court concluded that, “In sum, the Defendant did not act arbitrarily and capriciously when it denied Plaintiff disability benefits.”

If you have questions about your own disability claim, contact one of our attorneys at Dell & Schaefer for a free consultation.

Leave a comment or ask us a question

Questions About Hiring Us

Do you help Standard claimants nationwide?

We represent Standard clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Standard disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Standard. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Standard.

How do you help Standard claimants?

Our lawyers help individuals that have either purchased a Standard long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Standard:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

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 telephone, e-mail, fax, GoToMeeting.com 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 800-682-8331 or by email. Lawyer 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.

Dell & Schaefer Client Reviews   *****

Michael M.

We need more lawyers like Rachel Alters with an understanding heart and mind. May God bless you and your staff. I enjoyed working with Rachel and thank you so very much. I’m am very happy that I chose Dell & Schaefer as my law firm to handle and monitor my claim with Hartford.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us