Has Standard Insurance Denied Your Disability Insurance Claim? 

Newfield Law Group Fights Back When Standard Insurance Company Wrongfully Denies or Terminates Disability Claims

Standard Insurance Company is one of the world’s largest insurance companies. Based in Portland Oregon, it sells financial throughout the United States. It was founded in 1906 and has honed its business over a century plus. It markets many products, but its group ERISA disability coverage is where Standard Insurance Company impacts claimants.

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Many hospitals throughout the country use Standard Insurance Company (or The Standard Life Insurance Company – for New York)  for Group LTD (ERISA) long term disability insurance. Many doctors and nurses have this coverage.  Anyone receiving a disability denial letter from Standard Insurance Company will understandably be overwhelmed, shocked and unsure of how to proceed. But when a denial or termination of a claim occurs, it is not the end of the claim – – claimants have the right to appeal a denial or termination.  It is the time to get an advocate, someone to stand with you, and fight for you. 

Standard Insurance Company is no stranger to litigation in ERISA disability claims; the company is well known for wrongfully denying claims, making disabled claimants go through the appeals process and needing to go to litigation. In the case of ERISA claims – group disability policies provided by your employer – this means going to Federal Court.  We have fought these battles with Standard Insurance Company, securing positive results for our clients.

This insurance company counts on the attrition model, that a certain number of claimants accept their wrongful claim denials or terminations and do not fight back. For Standard Insurance Company, it is purely a numbers game, but it is a serious matter for someone who is no longer able to work, and who is relying upon these benefits to preserve their homes and lives. We take these issues personally, and advocate for our clients like they are family members.

Can I Handle a Standard Insurance Company ERISA Appeal on my Own?

Technically, you could try to appeal a long term disability insurance denial on your own, but you would be wise to enlist the help of an experienced long-term disability insurance law firm like Newfield Law Group.  This is the most important time in the claim process.

Here’s why:

Appealing a denied disability claim is spring-loaded with pitfalls, none of which benefit the claimant. The appeal will not succeed unless it is as complete as possible, including medical records, diagnostic tests, an occupational evaluation, medical literature and support, collateral evidence, and other supporting documents.  

Newfield Law Group has represented insurance attorneys and insurance agents who thought they would easily be able to manage their own claim – but even they did not know how a disability insurance claim works, and their appeals were denied. 

Providing materials for an appeal is also preparing for litigation if it becomes necessary. 

When dealing with Standard Insurance Company on a claim denial or termination for a group LTD (ERISA) disability insurance claim, the evidence and other materials submitted in an appeal will typically be the only materials permitted to be admitted into evidence and considered by the Court if the case needs to go to Federal Court.  Preparing a claim and going to Federal Court requires experience and knowledge of how these proceedings work, what documents and other evidence are required to ensure success. The stakes are simply too high to do this without the guidance of an experienced disability insurance attorney with deep experience working with Standard Insurance Company.

Why Would Standard Insurance Company Deny or Terminate My Claim?

My Doctor Says I Still Cannot Work

Standard Insurance Company seeks medical records from your providers, which it may scour to find notes in your doctor’s records that can be used to show you have functionality, and to deny or terminate your claim.  A doctor stating you cannot work, without more evidence to support this conclusion, is not enough to demonstrate a disability. The medical review conducted is seeking objective documentation which can include diagnostic test results supporting an illness or injury – but also requires some documentation of functional deficits.  

If your treating physician is not a specialist, Standard Insurance Company may challenge the significance of your disability insurance claim. Securing support from a specialist in the field of your disability, whether it is an illness or an injury, cannot be underestimated. A person filing a claim with Standard Insurance Company who has an orthopedic condition, for instance, could be denied if their medical records have been submitted by an internist or even a chiropractor, but not an orthopedist or neurologist. There are objective tests which can help to document and the level of care will be evaluated. Relying upon a primary care doctor and an x-ray will not be enough.

Vocational evaluations are important to Standard Insurance Company when evaluating a claim. However, particularly with group policies with hospitals, Standard Insurance Company has an onerous policy interpretation which may be harmful to doctors and nurses. These policies have a “broad scope of license” provision, which Standard Insurance Company has repeatedly interpreted against claimants. Standard Insurance Company will view a surgeon through a broad lens, and potentially deny or terminate a claim if that doctor can perform ANY type of medical doctor work, even if that work is administrative. This would seem to violate any meaningful analysis of one’s “own occupation” but we have repeatedly seen Standard Insurance Company seek to invoke this analysis. 

Where Standard Insurance Company disability insurance claims are denied or terminated, disability attorney Jason Newfield advocates to secure their benefits.  

Why is Standard Claiming I Have a Pre-Existing Condition?

Most group ERISA policies have a pre-existing limitation clause, which comes into effect if or when a claimant files a claim within the first year of having coverage.  The policy often has a “look-back” period where any medical treatment that occurred for conditions will serve to limit coverage for a claim that has occurred. 

Claimants who suffered an illness, for which they might have recovered, but saw a doctor during a look-back period, might become ensnared in this situation, despite the condition having resolved (only to return later).  Disability insurance companies have the ability to broadly interpret this policy language and it often captures a wide swath of conditions frustrating a claimant’s ability to pursue benefits. In New York, the law is more favorable, and only permits an insurance company, like Standard Insurance Company, to delay a pre-existing claim, but not deny the claim for coverage outright. 

Why Does Standard Send Investigators to Conduct Field Visits?

Field visits of a disability claimant by an investigator may be one of the most intrusive and, in our opinion, morally wrong actions taken by a disability insurance company like Standard although Standard is far from the only insurance company using field visits.

What is a Field Visit?

For the disability insurance company, a field visit is when an investigator, hired by the insurance company, or a disability insurance company employee, travels to a claimant’s home to get a look at the claimant, their surroundings and in our mind, gathers information that can be used to deny, delay, or terminate a claim.  Sizing up the claimant is how it is summed up – and admitted by these investigators, some of whom are former law enforcement.  

Not every policy requires this activity.  Each disability insurance policy is different, so carefully review your policy to determine if Standard Insurance Company can require this. Newfield Law Group advises our clients to do the following if a field visit is required by their policy:

Do not permit a random visit, and do not answer the door if someone arrives without having made prior arrangements. There are far too many scams and violent criminals who attempt to gain entry to permit anyone to enter your home without an appointment. Call your disability insurance attorney if someone arrives at your door and says they are with your disability insurance company.  Tell them you will not meet – if you even agree to meet – without an appointment.

If an appointment with a Standard Insurance Company representative is made, never admit them into your home without a witness being present. It may be a family member or a trusted friend, but you need someone to advocate for you and to take detailed notes about the appointment.  Do not let the narrative be one sided – and protect yourself.

No matter how friendly the investigator may be, they are not there for a social call. This is Standard Insurance Company seeking information to use against you and using this visit to your  home to challenge your claimed inability to work. 

If possible, have your friend/family member video the meeting. If the investigator protests, tell them it’s for your protection and theirs. You want a record of what takes place during this meeting.  At a minimum, audio record the discussion.  

Surveillance of Disability Claimants and the Perils of Social Media

Surveillance is a tool that is utilized by all insurance companies on disability insurance claims.    It may be that Standard Insurance Company is using one of their investigators or claims adjusters to gather information about your comings and goings. We advise our clients to document their trips out of their homes, even though all you do is go to doctor’s appointments.

Standard Insurance Company will attempt to characterize your appointments and errands as evidence that you are able to work. Maintaining a list of your appointments and activities will be helpful if you have to rebut your claim.  Being mindful of your surroundings is always advised.  

People on claim or who have filed a disability claim with Standard Insurance Company should also reduce or eliminate their presence on social media and tell friends not to include you in photos or tag you in posts. Insurance companies learned long ago how to monitor claimants’ activities when they are active on social media.   They have refined these skills and use this cheap resource abundantly.  Regardless of what platform you are on and how you’ve set your privacy settings, the insurance company will find your posts and use them against your claim.

What’s My Next Step with Standard Insurance Company Long Term Disability Insurance Claim?

Your best strategy  at all stages of the claim process is to be proactive about your claim. We tell claimants they should let us help you prevent the spill before it needs to be cleaned up. Let us spot the issues, so we do not have to fix the problems.

Jason Newfield has decades of experience representing Standard Insurance Company disability policy owners who have wrongfully had their claims denied or terminated, and at all stages of the disability insurance process. If you need help with a Standard Insurance Company group LTD (ERISA) claim, please call us for a free consultation. 

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