Reliance Standard has often been in the news recently for all the wrong reasons. The company is currently defending against a lawsuit someone filed after suffering from long-haul COVID and cannot work. Predictably, Reliance Standard denied their disability claim, stating that the claimant was not disabled based on the policy’s definition of “disabled.”
Tactics like these are what Reliance Standard has become known for over the years. The company looks for any way possible to deny a claim. Reliance Standard will deny your claim and force you into litigation if there is any type of close call. The company will often take a hard line if a novel issue like COVID-19 arises because anything that can cause it to pay more policy benefits hurts its bottom line.
When you need to go up against Reliance Standard for a disability claim, you want a disability claims lawyer from J. Price McNamara ERISA Insurance Claim Attorney standing beside you. We allow our clients to adjust to their lives with disabilities while we fight for the benefits or settlements they deserve.
Table of Contents
- Reliance Standard is Often Inflexible in Practice and Court
- Why Long-Term Disability Claims Are Hard?
- Common Reasons for Long-Term Benefit Claims Denial
- You Have the Right to Appeal a Denial of Benefits or Termination
- Reasons Why Claimants Win Appeals
- Call a Reliance Standard Long-Term Disability Benefits Attorney
Reliance Standard is Often Inflexible in Practice and Court
One case that went to the Fifth Circuit Court of Appeals involved a claimant whose disability progressively reduced the amount that he worked. By the time he applied for disability benefits, his work schedule was 30 hours per week. He kept trying to work until he could not work anymore.
His claim received a denial because Reliance Standard claimed that he was not a full-time employee and, therefore, not eligible for benefits. Reliance Standard fought this claim up to the Court of Appeals in a case that dragged on for years.
In another case, a claimant filed state law claims against Reliance Standard for emotional distress because they felt ridiculed by a claims administrator. You can get the sense that Reliance Standard is a difficult company with which to do business.
Unfortunately, when dealing with an ERISA long-term disability claim, you do not get to choose the company. Your employer chooses the company that provides the insurance, and you are stuck dealing with whomever they have selected. It leads to situations where the insurance company will unfairly deny your claim.
Reliance Standard is receiving a large payment from your employer to provide coverage, and they want to keep as much of the money for themselves as possible.
Why Long-Term Disability Claims Are Hard?
All this means that qualifying for long-term disability benefits may be far more challenging than you think.
If auto insurance claims are hard, ERISA claims are far more difficult for many reasons:
- Long-term disability claims can be worth over $1 million because they can theoretically pay you benefits for the rest of your career. Reliance Standard currently pays 60 percent of the employee’s pre-disability salary up to $7,500 per month. If the employee was a high earner with a long time left in their career, the benefits will add up quickly.
- ERISA itself gives insurance companies far more power than they have in standard claims
- While you can appeal the denial of a claim, it is next to impossible to sue an insurance company for damages for unreasonably denying your claim.
Lawsuit after lawsuit against Reliance Standard shows a company that puts profits over people at every turn. Claimants suffering from serious and significant health issues must fight legal battles that can last for years when they need the money that long-term disability insurance should provide.
Reliance Standard themselves tells companies that “your employees rely on their paychecks for the necessities of life.” At the same time, they do not hesitate to unreasonably deny claims because what they do in practice is different from how they market themselves.
Common Reasons for Long-Term Benefit Claims Denial
Here are some of the reasons that Reliance Standard gives when they deny claims:
- The employee’s condition did not fall within the plan’s definition of disability. Insurance companies get to set the rules because their plan documents define the word “disabled.” For an initial claim, being disabled usually means that you cannot work at your job. After some time, the definition can change to being unable to do any work.
- You suffered from a pre-existing condition – long-term disability claims only cover “new” injuries or illnesses. If you had a condition beforehand, the insurance company might not provide benefits.
- The insurance company thinks that your lifestyle is inconsistent with your claim – if you think that insurance companies are not beneath hiring an investigator to follow you, think again. They may also review your social media posts and interview you. If they find any detail that they can use against you, they will not hesitate.
- The insurance company’s doctor thinks that you can work – you might think that your treating doctor’s opinion receives a great deal of weight because they are the ones who have seen you in person. Insurance companies often listen to their hired physicians or an “objective” doctor who receives payment from the insurance company. These doctors take an unrealistic view of your life, expecting you to work through significant pain and debilitating conditions.
- You have not sufficiently documented your claim – insurance companies will not give you the benefit of the doubt in any way. It is up to you to provide extensive documentation of your disability that leaves no doubt. The insurance company may still deny your claim if it is a close call because there is almost no downside for them.
In addition to denying initial claims, Reliance Standard has also terminated benefits for which people have already qualified. They often change the rules of the game in the middle.
The insurance company may request that you submit for an independent medical examination (IME) to verify your continued eligibility for benefits. This is time to hire an attorney because an IME usually precedes a denial or cutoff of benefits. Reliance Standard tightens up the requirements because they look to cull people from their benefit rolls.
You Have the Right to Appeal a Denial of Benefits or Termination
Because of the difficulties involved, you should consider hiring an attorney to help you with your initial application for ERISA long-term disability benefits. If your claim received a denial, it is time to hire an attorney.
You do not have to accept the insurance company’s decision to deny your claim and move on with your life. Like any denied insurance claim, you have the right to fight the denial. However, the process is somewhat more difficult and favorable to the insurance company with ERISA benefits. Even though ERISA should protect employees, the law has created a system that favors insurance companies.
Still, insurance companies cannot get away with an incorrect decision that refuses you the benefits you have qualified for under your plan. You may just need to fight for longer than you might with other types of insurance claims. As you saw above, long-term disability claims can drag on for years, although the insurance company must pay you back benefits and interest if you win your appeal.
The Steps of the ERISA Appeals Process
There are three levels of appeal in an ERISA case. You must follow the order. In other words, you must begin at step one and proceed to other steps if your appeal fails.
You cannot go to federal court until you have heard the last word from the insurance company.
- The first step is to appeal to the insurance company themselves, which will decide whether the adjuster was wrong to deny you benefits.
- If the insurance company denies your appeal (most likely, they will), you can take your case to a federal court where a judge will review the record and either determine whether you deserve benefits or whether the insurance company made an arbitrary decision to deny your claim.
- If you do not win in federal district court, you can take your case to the Federal Court of Appeals, where a panel will review the lower court’s decision
The insurance company must decide your initial claim within 45 days. They may seek an extension of that deadline. Once the insurance company denies your claim, you need to move quickly. Not only do you have tight timelines under ERISA to appeal, but you also need the money. ERISA cases can take longer, especially given courts’ backlogs, so you need to begin promptly. Still, take your time to hire an experienced long-term disability lawyer who will get the appeal right.
Many people wonder why they cannot simply begin with a federal court because they question whether they will get a fair shake from the same self-interested insurance company that denied their claim in the first place. Of course, this is a valid concern, but an insurance company appeal is what the law requires, even if it seems like a fruitless exercise.
A Federal Court Will Give You the Objective Review That an Insurance Company Will Not
You must go through every formality with the insurance company, building as strong a record as you can for their consideration. Even if Reliance Standard does not take an objective look at the record, a federal judge will. The most important thing to know is that the federal court will review the same record as the insurance company.
While you may explain your point of view (in writing through your lawyer and not through your testimony in court), you cannot add to the Administrative Record in an ERISA case.
Therefore, you must put in the time and work at the insurance company appeals stage. Otherwise, a federal judge will have no basis to decide that the insurance company made a mistake. You want an experienced Reliance Standard disability attorney handling this process for you.
Reasons Why Claimants Win Appeals
Claimants can win an appeal in federal court if:
- The insurance company read into the definition of “disability” in a way your plan or policy language does not support.
- The denial focused exclusively on the opinion of a doctor who has never seen you and completely ignored your doctor’s opinion.
- The insurance company has cherry-picked one or two details that support their side but ignores the totality of the record.
- The record supports your contention that you are disabled and cannot work.
However, you need an experienced ERISA appeals attorney to present your case and make these arguments to reach this point. Reliance Standard has its lawyers and plan of attack for federal ERISA appeals, and you need your plan of attack – your attorney – to beat them.
You must look at an ERISA appeal as taking on the insurance company because, if they have their way, you will get nothing. It can be next to impossible to beat Reliance Standard in federal court on your own, not knowing how an ERISA appeal works
When you are filing an ERISA appeal, your lawyer will work for you on a contingency basis. If you are successful, they will receive a portion of the amount recovered. You do not need to pay the attorney upfront. People who are injured and cannot work simply cannot afford to pay an attorney hundreds of dollars an hour for years while they fight their case. We make it easy for you to get the legal help you need.
Call a Reliance Standard Long-Term Disability Benefits Attorney
- Price McNamara ERISA Insurance Claim Attorney has helped countless clients who are in your exact shoes. Our law firm works with clients to file initial long-term disability claims with Reliance Standard and appeal claim denials.
We are ready to go every round with the insurance company necessary to get you long-term disability benefits. We do not hesitate to take the fight to large companies like Reliance Standard.
For your free initial consultation, you can reach out to us online or call us today at (504) 420-6962. You do not have to let the insurance company get away with an unfair and arbitrary decision.
Testimonials
This has been a very difficult time for myself and my family. Mr. Mcnamara did his best to be as empathetic and compassionate as possible. He is very knowledgeable and a man of great integrity.
Nicole
Following graduation from Loyola Law School in New Orleans in 1990, Price McNamara served as a Federal Judicial Law Clerk to the Honorable John M Shaw, Chief Judge, United States District Court Western District of Louisiana.
Mr. McNamara founded J. Price McNamara ERISA Insurance Claim Attorney, and began putting his past experience to work for the injured and disabled clients he now represents against the insurance companies in personal injury and long term disability and other insurance disputes in both federal and state courts
