Although it may not have the name recognition of Cigna, Northwestern Mutual, or MetLife, each year Standard Insurance Company issues and administers thousands of individual and group disability policies throughout the U.S. But Standard policyholders may find actually qualifying for benefits to be a bit of an uphill battle. Below, Dell & Schaefer’s attorneys Gregory Dell and Stephen Jessup will explain how to prevent Standard from denying your claim for individual or group long term disability benefits.
GREGORY DELL: Hi, I’m attorney Gregory Dell. I’m joined today by attorney Stephen Jessup. And today we’re going to talk about how to prevent your Standard long-term disability insurance benefits from being denied.
And Stephen, this basically deals with the claim handling service that we offer for our clients in which we provide them with tips, how to prevent their benefits from being denied and steps that they should take in order to put them in the best position so that in the long-run, they can avoid problems with the standard. So when someone calls you with Standard, generally, what is your take in the manner in which Standard handles their long-term disability claims?
STEPHEN JESSUP: Standard is a major company, but it’s not one of the companies we probably get the most calls on, not like a Cigna or a Prudential. One of the interesting things about Standard is the fact that they also have individual policies that you can purchase on your own or the group ones. I find that most time, people are calling us on the employer-provided group policies.
But the fact that they do have claims handling on the individual side, they kind of impart that a bit into their group handling. So they’re much more thorough, and probably up-to-date knowing what’s going on with the file, whereas some other insurance companies, it may seem like the person, the claims manager has no idea who the doctors are, when the treatment is, those types of things.
Standard is very thorough. So you can expect that any reviews they are doing, they are not just doing really small minimal reviews to deny claims. They’re really building up a body of evidence if it’s going to support a denial of benefits.
So when I hear Standard, the first thing I think to myself, generally speaking, would be, you’d better hope you have all your ducks in a row, all the information organized, and being presented to them in a correct way.
GREGORY DELL: OK. So you know that our law firm offers a unique service in which we manage claims for people, where we deal with all the communications from the carrier. They never speak to the disability insurance company. And then we deal with the medical records. Basically, we’re always there for the claimant to kind of be like their insurance on top of insurance, to help them protect the benefits.
But in this video, I want to give some tips as to important steps that claimants should be taking in order to avoid a Standard denial. So what do you think is the first, most important thing that a claimant should be doing who’s on claim and wants to make sure they’re doing everything they can to keep their benefits from being denied?
Your Medical Records Should Include Strong, Detailed Documentation of Your Symptoms, Restrictions, and Limitations
STEPHEN JESSUP: I mean, first, the biggest overarching theme is always going to be your medical records and your treatment. So treatment, actually treating with doctors– a lot of times you’ll find people, they’ll contact us and like, well, my doctor says there’s not much they can do for me, so I don’t really go in.
Well, the problem is an insurance company is just going to determine what your level of impairment is, a lot of times, based on your medical records. So getting the treatment, communicating with your doctor what the problems are, and making sure the doctor’s actually noting it in the records.
It happens all the time where a person says, well, I told my doctor X, Y, and Z. But then when we reviewed the medical records, none of that’s there. So treatment. Communicating with your doctor.
And also, letting the doctor know– if you’re on claim, a, the doctor is going to have to fill out forms. But then the doctor may get a call from an insurance company too. And if that happens, making sure kind of coordinating with it.
This is if your handling on your own. These are the things you need to really be focusing on. So your medical treatment and what those records are saying.
GREGORY DELL: And then you talked about the records, so I want to take it a step forward. What types of things are very important to be in the medical records?
STEPHEN JESSUP: The biggest thing, really– and this is where I feel is missing. And when you see a denial letter, the reason why is a lack of restrictions and limitations. So the doctor– you have a back problem, say for instance.
You say, well, you know, there’s issues with the lower back, L4, L5, and they just kind of go there. They don’t talk about what the recommended restrictions are with lifting and sitting, carrying, pushing. And the insurance company is really looking for that type of stuff.
Also, if you could get an updated objective medical evidence that can support the levels of impairment, things like that. So I think that’s really the big thing that I find is missing, because a lot of these medical records we see, you have your portions where the doctors just kind of plug in various different things. Then they have a spot to write. A lot of times, those don’t necessarily gel. They’re inconsistent. And an insurance company will tend to focus on the part that helps them while ignoring the parts that will help you.
Keep a Pain or Symptom Journal and Share it With Your Doctors
GREGORY DELL: Right. And the other thing I wanted to add to what you said is that it’s really important to get the claimant’s symptoms into the medical records, and even going as far as maybe keeping a daily pain journal or activity journal or symptom journal– because some people may not be in pain, but they may have a limited range of motion or something like that. Or if it’s headaches or migraines, how many times you’re having it per day– whatever the different medical conditions are.
And then if you’re seeing your doctor– which, we’ll get into how often someone should see a doctor. But whenever you do go to a doctor, bringing that journal to the doctor, sharing it with the doctor, and letting the doctor say, claimant brought to me today a pain journal, a symptom log. I’ve documented the following key things. Or they’ve provided me with a copy, which I’ve attached to my medical records. And that can be very helpful, because this way it’s not missing anything.
You know how the carriers always say, well, we saw that you went in there, but we didn’t see that you’re having any symptoms. So the records aren’t supporting what you’re telling us on claim forms. So that’s another tip that’s really helpful.
The other thing I want to move into is the claim forms. And where do you see that claimants get into problems in the manner in which they fill out the claim forms?
STEPHEN JESSUP: With the claimant– we’ll get there. But I think the bigger thing is how the doctors fill it out, because I think those forms are a lot more tricky, or set up for failure.
Standard’s Attending Physician Statement May Not Leave Enough Space to Properly Document Your Restrictions
GREGORY DELL: So you’re talking about the attending physician’s form.
STEPHEN JESSUP: The attending physician’s statement. Because a lot of times, it’s a one-size-fits-all. Unless you have a behavioral health problem, that may have its own form. Every other physical condition – whether you have a bad back, you have a heart problem– whatever the case may be, they’re going to give them the same form.
And a lot of times on these forms they want to know, basically, can the person do sedentary work? Light, medium, things like that. And a lot of times, that may not be relevant. That may not be the cause. If you have gastrointestinal problems– I was speaking with a client recently, and that was the case. She was like, my doctor got this form and he’s like, I can’t fill this out. This has to do with orthopedic problems. So they set it up for doctors to feel almost stymied with the ability to really elaborate on it. So I think that’s where it is.
With claimants on it, though, part of the issue– and a lot of times when they’re asking about what you do, your activities of daily living, and how far you can drive and things like that, they seem innocuous. But what they’re really doing is trying to build up information. If they put you under video surveillance later and you say, oh, I can’t drive more than five miles, but they get you going 25, 30, it’s attacking your credibility.
So sometimes people will try to almost sell their disability a bit too much about, the restrictions are so severe. But a lot of that stuff is really being set up for potential attacks on credibility later. As a lawyer, we always hate seeing the word “never,” because if they find you doing something you said you could never do, it’s going to be a problem.
Because most conditions are going have such a subjective component, especially your pain– so if the insurance company, if Standard is not trusting you to provide them truthful answers on simple things, why should they then believe your subjective complaints regarding your pain or whatnot?
GREGORY DELL: I want to bounce back a second, because you brought up the attending physician statement. And I was talking about how we help clients when we’re in the claim. How do you work with your clients to make sure the attending physician statement is providing the information that you think needs to be in there?
STEPHEN JESSUP: I think one of the big things– I call it “see attached.” A lot of times when these things– and especially if it’s a situation where it’s not an orthopedic problem, see attached, and then an addendum to that. Because you can create an addendum to explain what the medical problem is and what the restrictions and limitations from that are preventing from work.
And even on orthopedic problems– if it is a pain-based condition, they don’t often give a lot of chance for a doctor to put, someone has below sedentary level work. So to be able to write into that and explain that to the doctor, have a phone call with the doctor and explain. And also very important– doctors generally are trying to help their patients.
They see the form, and they see sedentary. Can lift up to 10 pounds. And they go, well, yeah. It’s also reminding the doctor that this disability is not activities of daily living. It’s towards if it’s the person’s own occupation or any gainful occupation. So it’s this idea of working 40 hours a week with reasonable continuity.
GREGORY DELL: Right. So I know many times, whether I have to set a phone conference with a doctor and then explain to them– and it can be a five- to 15-minute type call, go through the form. Explain, like you were saying, this is not about activities of daily living. This is about the ability to do, whether it’s an own occupation or any occupation– and like we always say, eight hours a day 40 days a week, doctor needs to understand that. This is basically being a reliable employee who can work with reasonable continuity.
And so much to the point to say, doctor, if you had a position in your office, would you hire this person and expect him to be there eight hours a day, five days a week, and doing everything that needs to be done without taking breaks, without having to lay down, without whatever it may be? But having to be reliable is kind of the standard of what it comes out to– not, can the person go to dinner, cook, take the garbage out, walk the dog? That’s not what this is about.
STEPHEN JESSUP: Or be a warm body in an office. It’s actually work.
GREGORY DELL: So doctor has to understand that. And then we work with the doctor, or we help also educating the claimant and being like an intermediary, because it’s easier for a claimant to go into a– because the claimants are always uncomfortable. Doctors don’t like insurance companies at all, and they don’t want to be bothered with additional paperwork. Honestly, they’re not getting paid enough to do it, because the insurance companies are already giving them like $20 every time a patient comes in.
So our clients like the ability to be able to go to the doctor and say, I have a lawyer who’s helping me. He suggested the following things for the claim form. And the doctors, 99 out of 100 times, they love that.
If they agree with everything that you’re telling them as a claimant, then they’re like, that’s wonderful. That’s very helpful. I’m going to document. I’m happy to help. And if your lawyer has any other questions, tell them to let me know. So I think that’s a big plus that the claimants really like.
Be Honest About Your Activities and Don’t Exaggerate
Going back to the claim form, you were talking about an addendum as well. And I think that’s super important. And I wanted to reiterate why it’s so important to just disclose everything you’re doing, and how that relates to the tactics of video surveillance, because I think that the more open you are about what you’re doing, then the carrier is not going to be like, oh, you misrepresented. They may not like what you’re doing.
But if you go out and do something for an hour or two hours a week in a totality, it’s better you tell them than they catch you on video and say, you said you couldn’t drive for an hour. You said you couldn’t go outside for a walk for an hour. And then you go ahead and do it, and you have a problem.
You’re better off just telling them, because all the things that you are worried about as a claimant are usually not going to be an issue. It’s when you don’t tell them that they go, OK. If they get you in one lie, is that all it takes?
STEPHEN JESSUP: That can be really all it takes. Standard will dig in. That’ll set the tone as the way they’re going to review, especially any subjective nature of your condition. So you do. You want to steal the thunder. You don’t want to give them any extra aha moments, because you’ve already provided them with that.
Like you said, they may not like it. But it’s better, because if you were in a position of responding and on the defensive, it’s very difficult when you’re on the defensive against a massive insurance company.
GREGORY DELL: And the thing about Standard, which you know, is they often have their own in-house doctors. Nurses, for sure. And one of the other things we know, their claim reps– and this is good and bad– are very experienced. I’ve had claim reps there that are attorneys, on not just one occasion, but multiple occasions. And you know when we get denial letters from them–
STEPHEN JESSUP: Yeah, they’re very detailed.
GREGORY DELL: Yeah. It’s not the two-page nonsense. So for right or wrong, whether we agree with the denial or not– which, often we may not, but sometimes it is correct. The person’s just not disabled, for a variety of reasons. They are detailed in their review of the claim and are going to reach out to all of their resources, whether it’s medical, vocational.
Be Cautious With Your Social Media Posts
They’re not afraid to use video surveillance. And they’re certainly going to look, which is the last thing, in the social media. What’s your tip about how to manage social media if you’re a person who’s on claim?
STEPHEN JESSUP: I mean, privacy settings, first and foremost. I’m amazed at how often, now when we get the claim file and they have screenshots after screenshot in the claim file of this social media stuff, pictures– whether they be on vacation, out doing whatever the case may be. And they will use that to draw a better picture of what it’s really like for you on a day-to-day basis.
And do I agree with it all the time? No. Someone goes on a vacation. They have an opportunity to go. Of course you’re going to want to take those things. But just know that someone’s going to be looking at that as a way to find a way to deny a case. So social media can be very, very problematic.
I think it’s even getting to a level of video surveillance in a lot of ways, especially right now when we’re filming this, COVID is happening. So video surveillance wasn’t happening as much. It was a lot harder to blend in when people aren’t leaving their homes. So insurance companies started really doing an uptick of reviewing people’s online presence.
And not just your Facebook or YouTube or any of that stuff, but other things you may be doing– your Yelp reviews. How often are you going out? They track a lot of information. So any time you put something out there, just know it can be used against you.
GREGORY DELL: So those were some helpful tips. I want people to know that we always offer a free initial consultation. So if you have a claim with Standard disability insurance company, should feel free to call Stephen or call myself, and we’ll review your policy and we’ll right away let you know how we think we can assist you.
We also encourage you to spend some time and look around our website. You can find that you can search specifically, look for a lot of stuff on Standard, such as cases that we’ve handled, lawsuits that we’ve written summaries about. You can also search by your occupation. You can search by your medical condition.
And the idea there is to find a lot of helpful claim tips, which are going to help put you in the best position to keep your benefits from being denied. Our clients are located all over the country, so we’re available to assist you no matter where you live. And we look forward to speaking with you in the future should you need us. Thank you.
Whether you have an individual or ERISA long term disability policy through Standard, jumping through its required administrative hoops – gathering medical records, making specialist appointments, and completing your claim form and any required addendums – can be a challenge. Even after your claim is approved, you’ll still need to remain conscious of what you post on social media or actions you perform in public. Fortunately, you don’t need to go through this process alone. The experienced attorneys at Dell & Schaefer can assist you at all stages of the long term disability insurance claim process, from helping you fill out your claim form to appealing the denial of benefits to ensuring you continue to receive disability benefits after you’ve been approved. If you’re ready to get started, give us a call today to schedule your FREE consultation with a member of our legal team.