The Standard specializes in American insurance products for millions of customers, including group and individual long term disability insurance policies. The Standard includes both Standard Insurance Company (based in Portland, Oregon) and the Standard Life Insurance Company of New York.
If you have disability insurance through The Standard, you should receive benefits if you experience a covered illness or injury. Disability insurance replaces a percentage of your income if you cannot work due to a medical condition. However, many claimants receive The Standard disability denial letters instead of monthly disability payments.
Top Reasons for The Standard Long Term Disability Denials
The Standard Insurance Company does not always pay benefits as it should. You can see numerous complaints about The Standard’s disability claim handling on the Consumer Affairs website. The Standard has a one-star satisfaction rating out of five stars (as of August 14, 2021).
The Standard denies long-term disability claims in one of two ways:
- The Standard denies your claim from the start.
- The Standard terminates your claim and cuts off your benefits.
There are five primary reasons why The Standard may deny or terminate your claim:
Physician Consultant Review / Independent Medical Examination
Reason number one is that they sent you or your file to an independent doctor for review. The Standard tends to use paper and in person medical evaluations to pick apart cases involving a wide variety of medical conditions. They may also say that your condition does not cause sufficient limitations to prevent you from working.
Your denial letter may state something like:
“It is determined based on your medical records and the physician consultant review that you do not meet the Group Policy Definition of Disability.”
Vocational Expert Review
The second reason why The Standard may deny your claim is because they had your file reviewed by a vocational expert as part of a vocational assessment. A vocational expert reviews your medical evidence and work history to determine if you can work despite your limitations.
Insufficient Medical Evidence
The third reason why the insurance company may have denied your claim is insufficient medical evidence to support your case. This means the insurer does not think your medical problems are severe enough to keep you from working.
However, the insurance company may not have all your medical records. And even if you have evidence from your own doctors, you could still face a claim denial. Your doctors may mistakenly fill out your forms in a way that leads to a wrongfully denied claim.
Video and Social Media Surveillance
The fourth reason why the insurance company may have denied your claim is because they have conducted surveillance on you. Surveillance by the insurer may come in one of two ways. First, they may have conducted video surveillance by a private investigator. Another method of surveillance in today’s day and age is by tracking you on social media.
In many of our cases, the insurance company does not grant claimants the benefit of the doubt. They may say that your activities on video are inconsistent with your claim. Despite all the evidence, the insurer will doubt your claim’s credibility.
You Do Not Meet the Definition of Disability
The fifth reason is that you do not meet the definition of disability. You must meet the definition of disability as defined by your policy to be eligible for benefits.
A cessation in benefits typically occurs after approximately two years of receiving benefits. This is because many disability insurance policies have a definition of disability that changes. The definition changes from an “own occupation” standard to an “any occupation” standard.
Your denial letter may state something like:
“It is determined based on your medical records that you do not meet the Group Policy Definition of Disability.”
Exclusions and Limited Pay Periods
Review your policy carefully before filing a claim. The fine print on your plan document can affect whether you qualify to receive disability insurance benefits. Some disabilities are limited or excluded from coverage altogether.
Pre-Existing Condition Exclusions
There are typically exclusions for pre-existing conditions. Here is an example from a Standard disability insurance policy:
“Preexisting Condition means a mental or physical condition whether or not diagnosed or misdiagnosed:
- For which you have done or for which a reasonably prudent person would have done any of the following:
- Consulted a physician or other licensed medical professional;
- Received medical treatment, services or advice;
iii. Undergone diagnostic procedures, including self-administered procedures;
- Taken prescribed drugs or medications;
- Which, as a result of any medical examination, including routine examination, was discovered or suspected;
at any time during the 90-day period just before your insurance becomes effective.
You are not covered for a Disability caused or contributed to by a Preexisting Condition or medical or surgical treatment of a Preexisting Condition unless, on the date you become Disabled, you:
- Have been continuously insured under the Group Policy for 12 months; and
- Have been Actively At Work for at least one full day after the end of that 12 months.”
Mental Disorders and Substance Abuse
Exclusions for mental disorders or conditions related to substance abuse are also common. Here is an example from a Standard disability insurance policy:
“Payment of LTD Benefits is limited to 24 months during your entire lifetime for a Disability caused or contributed to by any one or more of the following, or medical or surgical treatment of one or more of the following:
- Mental Disorders; or
- Substance Abuse.
Mental Disorder means any mental, emotional, behavioral, psychological, personality, cognitive, mood or stress-related abnormality, disorder, disturbance, dysfunction or syndrome, regardless of cause (including any biological or biochemical disorder or imbalance of the brain) or the presence of physical symptoms.
If you are confined in a Hospital solely because of a Mental Disorder at the end of the 24 months, this limitation will not apply while you are continuously confined.
Substance Abuse means use of alcohol, alcoholism, use of any drug, including hallucinogens, or drug addiction.
- If you are Disabled as a result of a Mental Disorder or any Physical Disease or Injury for which payment of LTD Benefits is subject to a limited pay period, and at the same time are Disabled as a result of a Physical Disease, Injury, or Pregnancy that is not subject to such limitation, LTD Benefits will be payable first for conditions that are subject to the limitation.
- No LTD Benefits will be payable after the end of the limited pay period, unless on that date you continue to be Disabled as a result of a Physical Disease, Injury, or Pregnancy for which payment of LTD Benefits is not limited.”
How Do I Appeal a Long Term Disability Claim Denial from the Standard?
The Standard frequently denies long term disability claims. Fortunately, the insurance company’s denial of your claim is not the end of the road.
Focus on developing the weaker sections of your claim. You need to obtain strong evidence to dispute the denial and support your claim. Having a disability insurance expert guide you through the appeal process may also improve your chances of approval.
The Standard’s Appeal Review Process
If the Standard denies your claim you have the right to file an appeal. A claim representative may ask you for more information. They may have questions about your symptoms, limitations, and daily activities. The insurer may also request information related to any personal injury or Social Security Disability claims.
ERISA Long Term Disability Insurance Claims
The Employee Retirement Income Securities Act (ERISA) is a federal law that governs most group disability insurance policies. Unfortunately, ERISA disability law heavily favors disability insurance companies such as The Standard. There are strict procedures that a claimant must follow during the claims process.
Filing an administrative appeal in accordance with the ERISA Act is absolutely necessary after an ERISA claim denial. Failure to appeal within the allowed time frame could mean the end of your case. You must exhaust your appeal rights before filing a lawsuit.
Under ERISA law, federal courts cannot take up new evidence or updated medical records submitted during case proceedings. Federal courts can only review documents that are already in the claim file. You must submit all the relevant evidence during the administrative appeal process.
Non-ERISA Long Term Disability Insurance Claims
If you have an individual insurance policy with the Standard you may not have to file an administrative appeal. This is because ERISA does not govern individual disability insurance policies. However, that does not mean that it would be beneficial for you to skip the appeal process. You should speak with a Standard disability lawyer to discuss the pros and cons of appealing your denial.
Work With an Experienced Standard Disability Lawyer to Recover Your Benefits
The effort and attention to detail needed to win an administrative appeal is much more in-depth than most claimants realize. The first thing you should do after a claim denial is contact an attorney for a free case evaluation.
Nick Ortiz is an experienced disability lawyer who has handled hundreds of claims against The Standard and other disability insurance carriers. He will review your unique situation and explain how we can help you recover the long term disability benefits you deserve.
Call to Request a Free Legal Consultation Today
You only have a limited time to fight back, so you should contact a disability attorney as soon as possible. Contact the Ortiz Law Firm at (888) 321-8131 for a free consultation with an attorney.