Reliance Standard is one of the biggest names in the group long term disability (LTD) insurance world. Even though it’s a major player in the insurance industry, it deals with the same problems as other insurance companies – including high employee turnover and inadequate training. Because of this, Reliance Standard’s disability insurance claim denial decisions may not be as thorough or as well-documented as they should be. There are ways to win these claims, even if you’ve already been denied.
Top Things to Expect in a Disability Denial Lawsuit Against Reliance Standard Insurance Company
Once a lawsuit is filed against Reliance Standard, it can take a while to get the case set for trial – sometimes as long as 12 to 18 months. The claimant will be required to participate in court-ordered mediation before a trial can take place. Mediation is generally a shorter process, resolving a case in four to six months.
If mediation is unsuccessful, the judge will review the claim to determine whether Reliance Standard was “arbitrary and capricious” in their denial of your claim for coverage.
The Biggest Challenge is the Standard of Review and “Discretionary Clause” in Reliance Policy
The standard of review in an ERISA lawsuit like a Reliance Standard case is whether the denial of coverage could be considered “arbitrary and capricious.” In other words, did Reliance have a reasonable basis to deny the claim? A claimant will need to convince the judge that denial was unsupported by facts and law. Reliance Standard’s policies are governed by a “discretionary clause,” which means Reliance has broad discretion to make policy determinations and decisions; this arbitrary and capricious standard can be a tough bar.
The Best Case Scenario for a Claimant is that the Court Will Conduct a De Novo Review
In some cases, a “de novo” review can replace the arbitrary and capricious review. A de novo review means that the reviewing court applies a fresh set of eyes to the entire record in a claimant’s claim, providing the court with far more leeway to make substantive determinations on whether or not the claimant is eligible for a long term disability insurance claim.
The Definition of Disability in a Reliance Policy is Usually A “National Economy” Job Description
Many with a denied disability insurance claim are confused by the fact that their denial didn’t seem to take into account the unique duties of their job. But Reliance Standard uses a “national economy” job description, which is far more general and defines the duties of a job based solely on the job title. While this may not seem fair, as it often has the effect of denying coverage to someone who can no longer perform the majority of their job, this is the standard. As a result, you may need to utilize vocational experts or review records to clarify what job duties are beyond your capacity.
The Law Does Not Require Reliance To Defer to the Findings of a Claimant’s Treating Doctors
There’s no “treating physician” rule in the ERISA world; in other words, Reliance Standard has no obligation to defer to the opinions of your treating doctors. In this “battle of the experts,” it can be tough to prove that a Reliance-hired doctor’s review was unreasonable. But if you hire an experienced disability insurance attorney from Dell & Schaefer to handle any appeals of your coverage denial, you’ll be able to rest assured that we’re building a thorough administrative record on your behalf.