The disability insurance attorneys at Dell & Schaefer have seen a lot of disability insurance claim denial letters from Reliance Standard. Reliance Standard stands behind its disability insurance claim denials, and it’s not afraid to litigate them in court. But don’t be discouraged – because Reliance Standard is such a large insurance company and has such high employee turnover rates, their claims denials often aren’t as detailed or thorough as those seen from smaller companies. It’s possible to appeal a claim denial and win, although it may take a year or longer to cross the finish line.

GREGORY DELL: Hi, I am Attorney Gregory Dell, here with Attorney Rachel Alters. And we are going to discuss lawsuits against Reliance Standard Insurance Company, and specifically, long-term disability insurance lawsuits.

Top things to expect in a disability denial lawsuit against Reliance Standard insurance company

Now, Rachel, Reliance Standard – when you hear some, people call you from all over the country with claims against all different types of companies, what is your first initial impression when they say, oh, I’ve been denied by Reliance Standard.

RACHEL ALTERS: Of course, you have because they don’t want to pay you.

GREGORY DELL: OK.

RACHEL ALTERS: That’s my first reaction.

GREGORY DELL: I mean, do you say that with everybody, or is it more prone towards–

RACHEL ALTERS: No, Reliance is one of those companies that, you know, they’re very hesitant to pay. They deny a lot of claims, and when you litigate against them, they’re kind of difficult and they also don’t like to pay large settlements. That’s just the nature of their business model.

GREGORY DELL: OK, so kind of like they feel very– so your opinion is they feel very strongly. And that’s been my experience about their denials. Kind of like, it would be an insult to their claims people if they were to disagree with them and review the claim. And they want to fight tooth-and-nail. And probably, a lot of that has to do with the National Council that they hire who they tend to lean on to lead them all over the country. Just like we’re a national law firm, they often have National Defense Counsel and then use local resources, as needed, to litigate their cases.

RACHEL ALTERS: Sure.

GREGORY DELL: But I don’t want someone to be discouraged, in terms of watching this video, because Reliance is still fairly large in the group disability insurance world. And because of that, they can have turnover with their employees, they can have a lot of claims that they’re dealing with, and their denials may not be the most thorough or detailed denials like we see from the smaller companies. So that’s the real positive and benefit that you get if you have a Reliance center. There are ways to win these claims, especially at the appeals and then obviously, at litigation.

RACHEL ALTERS: Sure.

GREGORY DELL: What are the expectations that a person should have for the litigation process, once you file a lawsuit against Reliance Standard?

RACHEL ALTERS: Once a lawsuit is filed, you know, it does take a while to get the case set for trial. Sometimes often a year before a judge sets it out for trial. Other than that, the claimant is going to be required to mediate the case, because it’s court-ordered. So before we go into a trial, and the trial is usually a one-day bench trial where there’s no witnesses and there’s no testimony, it’s just a judge reviewing the claim and the claim file and trying to determine whether Reliance Standard was arbitrary and capricious in the denial of the claim.

So it’s not a typical trial like one would think, where the claimant gets to go and testify. It’s nothing like that, unfortunately. But it does take a while. The mediation is court-ordered. If the case settles in mediation, obviously you don’t go to trial. Other than that, you do try the case. But it can take up to a year or more to get to the end of the line. It’s not a quick process.

GREGORY DELL: OK, so that was a good summary of that, they know that time frame, which is usually 12 to 18 months to get a resolution, although if you go to a mediation you could have a resolution as soon as four to six months, potentially.

RACHEL ALTERS: Sure.

GREGORY DELL: Again, it depends where in the country we filed the lawsuit. And we file these all over the country.

RACHEL ALTERS: Absolutely.

The biggest challenge is the standard of review and “discretionary clause” in Reliance policy

GREGORY DELL: But I want to specifically talk about the biggest challenges in a Reliance Standard lawsuit. And let’s start with the standard of review and explain to people what the common standard of review is in a Reliance Standard policy and why it is that way. Because the people watching this don’t know. They think, I got denied, I’m getting my day in court. And you really don’t get the typical jury day in court.

RACHEL ALTERS: No.

GREGORY DELL: So go through the basics of the Standard review and what to expect with that.

RACHEL ALTERS: Sure. Well, when you have a group policy that’s given to you or provided to you by your employer, it’s governed by ERISA. ERISA is the Employee Retirement Income Security Act, which was written in 1974, and it basically was written to encourage insurance carriers to, you know, to give these policies and encourage employers to provide this type of disability insurance to their employees, which is a good thing. But the bad thing is, it takes a lot of rights away from claimants, once they believe that their claim has been wrongfully denied.

So when you have filed one of these claims, you do not get a jury trial. A trial is usually a one-day bench trial, which is literally just a judge reviewing the claimant’s administrative record to determine whether or not Reliance Standard was arbitrary or capricious in the denial of the claim. What that means in layman’s terms is that was there a reasonable basis to deny the claim? And if there was, then Reliance Standard wins and the claimant walks away with nothing. Unfortunately, you know, people will call me and they’ll say, well, I want a jury trial. I want to sue them for bad faith. I want to sue them for punitive damage. I want emotional pain and suffering, because they put me through the wringer. I lost my home. And these are all real life things that happen to people. Unfortunately, none of these remedies are available.

So when you go to trial in federal court, in an ERISA case, you’re allowed to obtain, if you win, on a good day, past damages, which would be the past benefits that they owe you to date. And then you can possibly get an attorney’s fee award. It’s at the discretion of the judge. But if they award that, those are the damages and the remedies you can get. And then they can remand your case back to Reliance Standard for another review to determine if you’re still disabled going on into the future, which is all a possibility.

But you have to get past that arbitrary capricious standard of review, which is very hard, because you have to prove that there was not one reasonable basis to deny the claim. And judges often find that just having a peer review physician who is a doctor that’s on staff with an insurance carrier review your records and find that you’re not disabled is a reasonable basis to deny the claim. So you know, we have a battle, usually, ahead of us.

The best case scenario for a claimant is that the court will conduct a de-novo review

GREGORY DELL: So when you talk about that arbitrary and capricious standard, capricious standard, of course, that comes from the discretionary clause, which is a provision within your policy that’s in almost all of the Reliance Standard policies, which says Reliance Standard has been assigned or has the right to administer and make determinations on the policy. And that’s called a discretionary clause. Now, there are a handful of states– your home state of Michigan– which have outlawed discretionary causes. And if policies were reissued after the date in which discretionary clauses were made illegal by that state, because many state governments have found these discretionary clauses to be so unfair, that there are certain states that have outlawed them. And then you would end up with a de novo review.

RACHEL ALTERS: Right.

GREGORY DELL: Which, talk about the difference between if it’s a de novo standard versus the arbitrary and capricious standard.

RACHEL ALTERS: OK. If a court does rule that they will do a de novo review on your claim, it is a much better standard of review for the claimant, because it allows the judge to look at the claimant’s entire claim file, medical records, everything that was submitted to the insurance carrier, with a fresh set of eyes, and for the judge to determine his or herself whether or not the claimant is disabled.

GREGORY DELL: Right.

RACHEL ALTERS: And a lot of times, you’ll see an in court opinions where the judge will say, I believe that this claimant was disabled. We believe the claimant can’t work at this time, due to the claimants disability, injuries, whatever they have. But unfortunately, we are stuck with the arbitrary and capricious standard of review when we have to say that there was a reasonable basis for them to deny the claim. So the claimant ends up losing, even though the judge knows and the judge believes that the claimant is disabled.

So with the de novo standard of review, you do have that judge looking with a fresh set of eyes, determining whether or not you are actually disabled and looking at all the evidence.

GREGORY DELL: Right. The judge makes determination.

RACHEL ALTERS: The judge makes the determination and you know, it’s a much better standard.

GREGORY DELL: OK, I want to talk about, in litigation, people to understand number one that if your claim has been denied already and then we’re filing the lawsuit for you, that there is no new information that we can bring in, that the administrative record is closed, and we’re married to what’s there already.

RACHEL ALTERS: Right.

GREGORY DELL: So extreme, that I often say, if you were hit by a bus the day after Reliance Standard finalized their decision, the court can’t consider that information. So unfortunately, you may get approved for Social Security disability after the administrative record has been closed. You may find a new finding or a new MRI or some good piece of evidence, but the court can’t consider that information after the fact. So that’s a little piece of information that you should be aware of.

The other thing I want to talk to you about, I want you to speak about, that we commonly see with Reliance Standard is people say, I can’t do my job, but they didn’t look at my job the way I’m doing it. How can they get away with that? And what’s the court going to do? So how can Reliance Standard argue that we don’t really have to look at the duties of your job?

The definition of disability in a Reliance policy is usually a “national economy” job description

RACHEL ALTERS: Well, most of these– almost all of Reliance Standard’s group policies, they have a definition of disability where they say, if you can’t do the material substantial duties of your own occupation, then we will consider you disabled. But you can’t just stop there. You have to look at how they define own occupation in the policy. The way they define our occupation in these policies is, your own occupation is as it’s defined in the national economy.

You know, under ONET, or the Department of Occupational titles, they will look up your job title and see the list of duties that are listed in the national economy. And that’s how they base your job. And a lot of my clients will say, well that’s not what my job duties are. My job involves a lot more. My job involves travel. My job involves lifting heavy objects. My job involves you know, sales meetings, and none of this. And how is that fair? Well, it’s not fair, but unfortunately, that’s the standard and a judge will go by whatever your job description in the national economy is.

We can do– we can hire vocational experts to go and do some research on that and review medical records and look up what those definitions are and expand on then write reports that can be very beneficial when it comes to a trial and a judge can consider that. But they won’t look at your specific job duties if the policy doesn’t allow it.

GREGORY DELL: OK. In terms of medical, a lot of times, the claimants say look, I had three treating doctors, they didn’t even examine me. They had one doctor review the medical records and render a decision. And how could we possibly lose at trial? How can they rely on their one doctor versus my three doctors, and will the courts allow that and find that that’s a reasonable review?

RACHEL ALTERS: Right. Unfortunately, yes. That does happen often. The courts will allow one doctor who reviews medical records, a peer review physician, to review a claimant’s records and completely disagree with the treating doctor’s advice, recommendations, treatment, all of it– stating that they don’t believe that this claimant is disabled, even though three or four of their treating doctors have said yes, absolutely, they cannot work. And a judge will look at this peer review– not always, it depends on if that person is qualified, you know, depending what, you know, if they’re having a nurse review an oncologist’s opinions, oftentimes a judge won’t think that that’s enough. But if it’s somebody in this in the correct specialty, oftentimes the judge will say, yes, a peer review, paper review, of somebody’s medical records and opinions is enough to deny the claim.

The law does not require Reliance to defer to the findings of a claimant’s treating doctors

GREGORY DELL: So that the positive side of this is that– well, first of all, there’s no treating physician rule. There used to be a rule in Social Security– we don’t do social security at work, but I think where the court has to defer to the treating physicians.

RACHEL ALTERS: Right.

GREGORY DELL: In the ERISA world, which is what your claim’s governed by with Reliance, it’s crystal clear that there is no treating physician rule. There’s no obligation to defer to your treating doctors. That means that when we get involved with the case, we have to really dive into the extent and the quality of the review that’s been done by the doctors hired by Reliance. Did they hire the appropriate medical specialists, is a key factor. And then when they did hire the doctor, is it just a generic report? Did the doctor really dive into and consider all of the medical information that’s been submitted?

Often, the good news is they don’t. And hopefully, if your lawyer, which we believe we obviously have the skill to do, presents that in such a manner and then backs it up with other cases throughout the country where similar fact patterns– because you’re probably not the first person with your medical condition that’s being litigated because almost every medical condition has been litigated– we’re able to make an argument say that doctor’s review was not reasonable. That no reasonable person could agree with that doctor’s review, and they should have either examined the claimant, or they should’ve used another type of doctor to better and reasonably evaluate the claim versus what we did.

So we are at somewhat of a disadvantage if you do do your own appeal, versus us doing the appeal. Obviously, when we do the appeal it’s significantly different, because we’re building that administrative record and we can put every single thing in there that we want. And we have a video about tips for doing a Reliance Standard appeal, which I recommend you take a look at. But when it comes time to litigate, Rachel and I have handled tons of cases against Reliance Standard. We encourage you to call us for a free initial consultation. And the way that works is that we ask you to send us a copy of your denial letter and your policy. You can fill out the free consult form on our website, or you can just call us and we’ll give you that information.

We’re able to represent you anywhere in the country. Now, Rachel, people always ask very quickly, and they want to know, is how do you charge, I don’t really have the money to pay you? I know this can be hundreds of hours to litigate.

RACHEL ALTERS: Sure.

GREGORY DELL: We don’t charge any fees or costs unless we make a recovery. If we do recover benefits for you it’s a percentage of your past and your future benefits. The fees are always negotiable because of the fact that the benefits amounts differ for every single client. The risk factors are different for every client. So it’s definitely something we want to discuss with you, and make sure that you’re comfortable, and that we’re comfortable, as well, based upon the amount of time that we think we’re going to have to put into your claims.

So we look forward to the opportunity of speaking with you and we are appreciative of you considering our law firm. Thank you.

Disability insurance claim denials are covered by some unique laws, regulations, and standards of review. By partnering with the disability attorneys at Dell & Schaefer, you’ll have the benefit of a law firm with expertise in dealing with Reliance Standard’s claim denials and litigation strategies. Give us a call or visit our website for a free initial consultation—all we need is a copy of the denial letter and a copy of your policy to get started. We don’t charge any fees or costs unless we recover damages, and these fees are negotiable based on the unique facts of your case. We look forward to the opportunity to speak with you about your claim.