Reliance Standard Life Insurance Company, like many other disability insurers, frequently denies or terminates long-term disability (LTD) claims based upon “independent” physician reviews. These reviews play a significant role in the claims process and are often used to justify claim denials. Understanding how Reliance Standard conducts these reviews and how to respond effectively can make all the difference in an appeal.
The Role of Independent Physician Reviews in LTD Claims
Reliance Standard uses “independent” physician reviews to assess whether a claimant’s reported symptoms are consistent with the medical evidence.
[Note: We put the word “independent” in quotes in the first sentence in this article because we do not think the doctors who conduct these reviews are really all that independent. We prefer to call these “compulsory” reviews because the reviewing physicians are not so “independent.”]
These reviews are conducted by physicians who do not personally examine the claimant but instead review medical records to form an opinion about the claimant’s functional capacity. The insurance company then relies on these reports to determine whether a claimant remains eligible for benefits. While Reliance Standard presents these reviews as “neutral and objective,” claimants should approach them with caution.
The reviewing physicians are hired by the insurer and may be inclined to interpret medical evidence in a way that benefits the company rather than the claimant. This can be especially problematic for individuals with conditions that lack clear objective markers, such as chronic pain disorders, fibromyalgia, or mental health impairments.
What to Expect from an Independent Physician Review
During the appeal process, Reliance Standard will often request a physician review to analyze medical records and provide an opinion on the claimant’s ability to work. The physician will typically be asked to answer specific questions, such as:
- What are the claimant’s primary and secondary medical diagnoses?
- Do the medical records support the claimant’s reported functional limitations?
- Are the claimant’s restrictions and limitations consistent with the expected severity of the condition?
- Does the claimant’s prescribed treatment appear appropriate and consistent with medical standards?
- Are there any medication side effects that could affect work performance?
- Do non-medical factors, such as personal or legal issues, appear to be affecting the claimant’s ability to work?
These questions are designed to help Reliance Standard evaluate whether the medical evidence justifies continued benefits, but claimants may find that the review downplays or outright dismisses their limitations.
The Problem with “Independent” Physician Reviews
The term “independent” is misleading. While these reviewing physicians do not work directly for Reliance Standard, they are paid by the insurer to conduct reviews. This financial arrangement raises concerns about potential bias. A reviewer who consistently finds in favor of claimants is unlikely to be selected for future work, creating an incentive to issue reports that are favorable to the insurance company.
In addition, these reviewers never meet or examine claimants in person. Their assessments are based solely on medical records, which may not fully capture the extent of a disability. This can be particularly detrimental to claimants suffering from conditions that vary in severity, such as autoimmune disorders or chronic fatigue syndrome.
At the Ortiz Law Firm, we understand this dynamic and know how to challenge biased or incomplete evaluations. We work with claimants to obtain strong, objective evidence from treating physicians to counter potentially biased findings in the independent review, ultimately strengthening the claimant’s case. By addressing these issues directly in the appeal, we help to ensure that the claimant’s full medical picture is fairly considered.
How to Challenge an Adverse Review
Claimants typically have a limited amount of time to respond to the new evidence, often 21 days. When an independent physician review is unfavorable, claimants should take proactive steps to counteract its effects:
- Engage Treating Physicians: Request a written statement from your treating physician that directly addresses the conclusions of the independent review. Treating physicians can provide context, explain symptoms in more detail, and challenge any misinterpretations.
- Submit Additional Medical Evidence: If the review minimizes the severity of a condition, consider obtaining additional diagnostic tests or evaluations. Updated medical records, functional capacity evaluations, and specialist opinions can strengthen your case.
- Provide a Personal Statement: A detailed statement explaining how your condition affects your daily activities and ability to work can help humanize your claim and provide insight that medical records alone may not convey.
- Point Out Inconsistencies: Carefully review the report for errors or inconsistencies. If the reviewer ignored critical medical evidence or made incorrect assumptions, these issues should be highlighted in your appeal.
Responding to Reliance Standard’s Deadlines
In some cases, Reliance Standard may grant an extension if more time is needed to gather additional documentation. However, failure to respond promptly may result in the insurer finalizing its decision based on the existing record, making it more difficult to overturn the denial later.
While these reviews may feel like an additional hurdle, they are also an opportunity to strengthen your claim. A well-prepared response, supported by medical evidence and relevant personal insight, can make a strong case for the need for long-term disability benefits.
How the Ortiz Law Firm Can Help
Navigating the complexities of a long-term disability appeal, especially when dealing with independent physician reviews, can be overwhelming. At the Ortiz Law Firm, we specialize in helping individuals appeal denied LTD claims to secure the benefits they deserve. Our team has extensive experience with insurance companies, including Reliance Standard, and understands the tactics they use to deny claims.
At the Ortiz Law Firm, we represent claimants in long-term disability appeals nationwide. We understand how Reliance Standard and other insurers use independent physician reviews to deny claims, and we know how to fight back.
If your claim has been denied or terminated due to an independent physician review, we can help you navigate the appeals process and protect your right to benefits. Call us at (888) 321-8131 for a free consultation and let us fight for the disability benefits you deserve.
