Reliance Standard Life Insurance Company is a member of the Tokio Marine Group. Reliance Standard, together with sister company Matrix Absence Management (Matrix), provides a full range of long term disability (LTD) benefits.
ERISA Law and Long-Term Disability Insurance
Federal ERISA long term disability insurance laws heavily favor insurance companies and are not very consumer friendly with individual claimants. The type of coverage afforded by a long term disability policy are governed by the LTD insurance policy. In other words, the most important document in the entire process is the disability insurance contract which defines the type of coverage to be provided and the duties and responsibilities of all parties to the contract (i.e., the claimant and the insurance company).
A long-term disability policy can be very complex. It may be hard for a layperson to understand the terms of the contract and when a claimant is entitled to disability coverage. If you are the claimant and your insurance company is refusing to pay your long term disability benefits, an experienced ERISA lawyer can help you recover the benefits you deserve under your long term disability care policy.
How Reliance Standard Defines the Term Disability
The definition for the term “disability” will be specifically defined in your long term disability policy with Reliance Standard. Thus, you should look at your own policy to determine how that term will be used in your claim. However, it is still useful to see how Reliance Standard has defined disability in the past. A Reliance Standard policy was detailed a recently published court opinion:
As defined by the Policy, to qualify for disability during the initial 24-month period of coverage, an Insured must demonstrate an inability to perform material duties of her regular occupation. To qualify for benefits after 24 months, a claimant must be unable to perform the duties of “any occupation” which is defined as an inability to perform the material duties of any occupation that her education, training or experience reasonably allow. In addition, under the Mental or Nervous Disorders Limitation, benefits are not payable beyond 24 months for any disability that is caused by or contributed to by a Mental Disorder, including anxiety and depression.
The Reliance Standard Disability Claims Review Process
Once you file a claim for long term disability benefits, a Reliance Standard claims representative will evaluate your application. A representative for the insurance company may contact you and solicit information about your activities of daily living, self-reported symptoms, and the facts and circumstances of any Social Security disability claim you may have. Mr. Ortiz recommends that you hire an attorney to represent you in any communications with Reliance Standard and any of its claims representatives.
If you are approved, you will receive benefits. If Reliance Standard sends you an initial denial letter or terminates benefits, then you must go through the internal appeals review process. If you go through the appeal process, Reliance Standard typically uses outside medical reviewers. These third party vendors are supposed to conduct an “independent” medical exam. However, there is little evidence that these medical reviews are based on proper medical criteria. It is common for such outside doctors retained by Reliance Standard to discount or disregard the disabling effects of pain, fatigue and the side effects of medication.
Why You Need a Long Term Disability Insurance Lawyer
Long term disability insurance policies are insurance contracts that are usually very complex and hard to understand. Moreover, LTD policies are often subject to change and written to in favor of the insurance company. ERISA laws that govern group disability plans are also complicated and favor the insurance companies. A seasoned and experienced long term disability attorney can help you navigate the complex ERISA rules and regulations. The Ortiz Law Firm can help you understand your insurance policy, understand how ERISA laws work, help you with the claims and denial process, and fight for your rights in a lawsuit against your insurance company (if necessary).
If your initial application for benefits is denied, the most important thing you can do is prepare a good appeal. [Note: an internal appeal may not be necessary in some claims. That’s why you should consult with an attorney before further communicating with the insurance company.] Disability appeals are not only important to reverse a denial, but they are important to strengthen the Administrative Record prior to filing a lawsuit.
If you want to know specifically how the Ortiz Law Firm can assist you in filing an appeal to a denial, you should contact the Ortiz Law Firm for a no-cost, individualized evaluation.
How can an attorney help me appeal the denial of benefits under an employer-sponsored disability plan?
Most employer-sponsored long-term disability plans are regulated by ERISA, which is a federal law. Under ERISA, an individual who has been denied long term disability benefits has 180 days after receipt of the written denial letter to submit information to support the claim. This evidence is critical. That’s because a Federal Court usually will not accept or consider new evidence submitted during the course of the lawsuit. Instead, the Federal Court is limited to seeing what was in the administrative record at the time the insurance adjuster made his or her decision. Therefore, all relevant evidence and documentation in support of the disability claim should be submitted to the insurer or disability plan administrator for the initial administrative appeal.
If you hire the Ortiz Law Firm to represent you as your attorney on an administrative appeal, we will obtain the complete claim file and evaluate all the medical, factual and vocational evidence considered by the insurance company. However, we usually go farther by seeking medical and vocational opinions to support of your claim. We will help you documenting the evidence that supports a favorable disability determination, based on the insurance policy or group disability plan document.
Contact Information for Reliance Standard
Reliance Standard’s disability group can be contacted at:
Reliance Standard Life Insurance Company
P.O. Box 8330
Philadelphia, PA 19101-351-7500
(267) 256-4262 (Fax)
You may submit an appeal (a request for review of an denial letter) by submitting your request in writing to:
Reliance Standard Life Insurance Company
Quality Review Unit
P.O. Box 8330
Philadelphia, PA 19101-8330