Reliance Standard Long-Term Disability Denials: How to Appeal
Reliance Standard Insurance Company, also known as “Reliance Matrix,” is one of the largest insurance companies in the United States. It has been in operation since 1907, and it offers employee-sponsored group long-term disability insurance policies. However, Reliance, like other insurers, denies LTD claims often.
Unfortunately, receiving a denial of a long-term disability claim by Reliance Standard is common. When this occurs, claimants need to file an administrative appeal to get the benefits they may be eligible for under their policies. In some cases, the claim may have to go to litigation.
Understanding the reasons behind a Reliance Standard denial of your LTD claim is important if you want to develop a strong appeal. In this article, you will learn:
- Why Reliance Standard denies long-term disability claims
- Tactics insurance companies use to deny LTD claims
- What claimants should do if they receive a denial of their claim
- What happens if an administrative appeal is also denied by your insurer
Why Does Reliance Standard Deny Long-Term Disability Claims?
Reliance Standard denies long-term disability claims when it determines that the claimant did not prove that they meet the definition of disability present in the insurance policy. This definition will either be an “own occupation” or an “any occupation” standard.
Common reasons Reliance Standard denies long-term disability claims include:
- Insufficient objective medical evidence — Insurers prefer objective evidence over subjective evidence. If you have a condition that relies heavily on subjective evidence, then you could receive a denial of your claim.
- Independent Medical Exams — Also known as IMEs, these exams are performed by a doctor paid by Reliance Standard. These doctors have never met you before and typically favor the insurance company and will often say you are not disabled.
- Missing deadlines — All LTD insurance policies include filing deadlines for when the claimant must file their initial claim and appeal. If a claimant misses one of these deadlines, it could be found as a reason to deny a claim.
- Pre-existing condition clauses — If you are filing a claim for a pre-existing condition, then your policy may not cover it.
- Treatment gaps — Insurers often require that claimants receive ongoing treatment for their disabling condition. If there is a gap in treatment, then Reliance can point to this as grounds for denial.
Now, it is important to note that insurance companies like Reliance often resort to certain tactics to deny claims. In short, these companies don’t want to pay claimants if they can avoid it. Therefore, they often employ tactics such as social media monitoring, in-person surveillance, and delaying claims so claimants give up.
Watch CCK Law Partner Leah Small as she discusses Reliance Standard long-term disability denials in this video:
What Should I Do If Reliance Standard Denied My LTD Claim?
Review the denial letter that Reliance Standard sent you and then address the issues it found in your claim by filing an administrative appeal. The administrative appeal is your chance to refute the reasons in this letter.
The administrative appeal is a key point in the claim process. When an insurance company denies an LTD claim, the claimant has the right to appeal this decision. If ERISA governs your claim, then you typically have 180 days to file this appeal.
As CCK Law partner Leah Small notes, “Missing this deadline can permanently forfeit your rights to your LTD benefits, as you must exhaust administrative remedies before going to court.”
During this appeal process, long-term disability claimants should:
- Review the denial letter — Reliance Standard will send claimants a denial letter that outlines the specific reasons for its decision. Claimants should review these reasons. By reviewing this letter, you can build a strong appeal that refutes the reasons within it.
- Gather additional evidence — The appeal stage is often the last time (especially under ERISA) that claimants can submit new evidence. This evidence can include medical records, vocational evaluations, physicians’ statements, witness statements from co-workers, and more. The evidence should respond directly to the gaps mentioned in the denial letter.
- Note filing deadlines — As mentioned earlier, missing a deadline can lead to a denial of a claim, and the same is true of an appeal. Under ERISA, you typically have 180 days to file this appeal. Note any filing deadlines mentioned in your insurance policy to ensure you do not miss them.
- Speak with an attorney — It is possible to handle your appeal on your own. However, speaking with a long-term disability attorney can be beneficial for your claim. An attorney will have experience with Reliance Standard and other insurers and know what they look for in a successful appeal. Moreover, an attorney can keep an insurance company honest so that they don’t try and delay or deny the appeal unfairly.
What If My Administrative Appeal Is Denied?
If Reliance Standard denies your administrative appeal, then you can go to court and litigate for your benefits. However, there are a few caveats with this route.
- If ERISA governs your policy, then litigation can be exceedingly difficult. This difficulty arises from the fact that you typically will not be able to submit new evidence, nor can you have a jury hear your case.
- In states that allow it, the court may give deference to the insurance company. In other words, the court does not need to decide whether the decision to deny your claim was wrong, but whether Reliance had a reasonable explanation for why they decided to deny it. This is a difficult hurdle to overcome.
- Under ERISA, you may also not sue for bad faith practices or damages. Typically, you will only receive your benefits and, potentially, attorney fees, but nothing else.
Lump-sum settlements are common during this stage. Insurance companies like Reliance do not want to head to court if they can help it. So, they offer lump-sum settlements. However, no LTD claimant must accept these settlement offers if they do not want to. It is best to consult with an attorney about your specific situation.
It is important to remember that claimants must exhaust all administrative appeals before filing a lawsuit in federal court.
Frequently Asked Questions
What is the definition of disability in a long-term disability insurance policy?
The definition of disability is the standard you must meet to receive benefits from Reliance Standard. There are generally two: “own occupation” and “any occupation” definitions.
The own occupation standard asks if you can perform the duties of your specific job, and the any occupation standard asks if you can perform the duties of any job whatsoever.
In many policies, the own occupation definitions change to an any occupation definition after a preset period — typically 24 months. When this occurs, Reliance Standard will reevaluate your claim. It is important to note that Reliance Standard can also reevaluate your claim before or after this change occurs.
Does Reliance Standard use surveillance tactics to deny claims?
Yes. Like most insurance companies, Reliance Standard may use surveillance tactics to find a reason to deny your claim. Tactics can include in-person surveillance, monitoring social media profiles, and house visits. They may also delay issuing a decision on your claim in hopes you will forfeit your benefits.
How can I tell if ERISA governs my Reliance Standard LTD Claim?
If you receive your Reliance Standard long-term disability insurance policy through your employer, then ERISA likely governs it. There are a few exceptions: if you work for a government entity or a church, then ERISA may not apply. Moreover, individual policies, i.e., policies you buy yourself, will typically be covered by state law.
Chisholm Chisholm & Kilpatrick May Be Able to Help
Filing a long-term claim with Reliance Standard can be challenging. Insurance policies aren’t always easy to decipher. It’s easy to miss something that could result in a denial of your claim. While it is possible to handle an LTD claim on your own, it is advantageous to contact an attorney with experience.
CCK Law has been helping long-term disability claimants since 1999. While past results do not guarantee future outcomes, we work hard to help you get the benefits you may be eligible for under the terms of your policy.
Some of the ways we help claimants filing for or appealing their disability benefits with Reliance Standard include:
- Handling all communication with Reliance Standard
- Gathering and submitting all evidence
- Reviewing your claim file
- Developing and submitting a comprehensive appeal package
- Litigating in court (when necessary)
If you need help with your claim, you can give us a call at any time at (800) 544-9144 for a free case evaluation. A member of our team will review your claim and see if we can assist.
