Reliance Standard Disability Claim Denials

Last Updated: October 3, 2024 | Reviewed and Edited by: Ortiz Law Firm

Founded in 1906, Reliance Standard Life Insurance Company is a member of the Tokio Marine Group, a multinational insurance holding company. Reliance Standard is a leading provider of employee benefits solutions, including a full range of short and long-term disability benefits. Unfortunately for claimants, Reliance Standard Disability claim denials are much more common than approvals.

If Reliance Standard has denied your disability claim, we can review your disability denial letter from Reliance and advise you on how to move forward. We can help with the administrative appeal process with Reliance Standard Life Insurance Company. We can also file a lawsuit against Reliance Standard.

At the Ortiz Law Firm, we have extensive experience handling claims with Reliance Standard, having represented clients in hundreds of cases involving this insurer. We are deeply familiar with the tactics Reliance Standard uses to deny or delay paying benefits. This gives us a significant advantage in anticipating and countering their strategies.

Attorney Nick Ortiz is not only well-versed in the legal framework surrounding long-term disability claims, but he also has a unique insight into how Reliance Standard operates. Over the years, he has built professional relationships with many of the defense attorneys that Reliance Standard frequently hires.

In fact, Nick speaks with these attorneys multiple times each week, and he even has their cell phone numbers—meaning he can reach out to them directly at any time to discuss cases and facilitate negotiations. This level of familiarity and access can make all the difference when fighting for the benefits you deserve.

Our firm’s deep understanding of Reliance Standard’s internal processes and defense tactics allows us to deliver focused, effective representation that is tailored to your specific case. You can trust the Ortiz Law Firm to stand up to Reliance and fight aggressively for your rights.

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Reliance Standard Disability Claims Review Process

Once you file a claim for Reliance Standard disability insurance benefits, whether it be for long-term disability or short-term disability benefits, a Reliance Standard disability claim representative will evaluate your application. A disability claim representative for Reliance Standard Life Insurance Company may contact you and solicit information about your activities of daily living, self-reported symptoms, and the facts and circumstances of any other disability claims with different insurance companies or Social Security Disability Insurance claims you may have filed.

Contact Information for New Claims

You can use the contact information below to submit your Reliance Standard disability claim to the insurance company:

Reliance Standard Life Insurance Company
PO Box 8330
Philadelphia, PA 19101-351-7500

Contact Information for Appeals

Suppose Reliance Standard has denied your disability claim. In that case, you can appeal by submitting your request in writing to the following address:

Reliance Standard Life Insurance Company
Quality Review Unit
PO Box 8330
Philadelphia, PA 19101-8330

NOTE: If your denial letter provides a different address, you should always submit your request to the address provided by the insurer.

Reasons Why Reliance Standard Denies Disability Insurance Claims

It is not unusual for Reliance Standard to unfairly deny long-term disability claims. Reliance Standard has earned a reputation for denying claims by any means necessary.

You (Purportedly) Do Not Meet the Definition of Disabled

Recently, Reliance Standard has garnered media attention for its stance in a current lawsuit. The case involves an individual who, after enduring prolonged COVID-19 symptoms, found themselves unable to work and subsequently had their disability claim rejected. The company dismissed the claim, asserting that the individual did not meet their policy’s criteria for being “disabled.” The company is notorious for pushing claimants into litigation, particularly in ambiguous cases. It adopts an uncompromising attitude toward emerging issues such as COVID-19.

Exclusions and Limitations

Reliance Standard is also known to misapply the pre-existing condition exclusion to deny claims from the start or terminate a disability claim after 24 months. Reliance Standard may use one of several standard policy provisions to justify a claim denial at the two-year mark. Claims for specific mental health or pain disorders, self-reported conditions, and even some musculoskeletal disorders are often limited to 24 months.

A Change in the Definition of Disability

Another common occurrence at the two-year mark is a change in the definition of the term “total disability” or “disabled.” Under most policies, Reliance Standard will initially define disability as an inability to perform one’s own occupation. However, after benefits have been payable for 24 months, Reliance Standard will define disability as an inability to perform any occupation.

How to Avoid a Reliance Standard Long-Term Disability Denial

Meet Your Policy’s Definition of Disability

No specific laws determine what is and is not considered a disability in long-term disability claims. The term “disability” is defined in your disability insurance policy. The following policy excerpt is from a published court opinion that included a policy issued by Reliance Standard. However, it would be best to look at your policy to determine the exact definition of disability Reliance Standard will use to evaluate your disability claim.

“As defined by the policy, to qualify for disability during the initial 24-month period of coverage, an Insured must demonstrate an inability to perform material duties of her regular occupation. To qualify for benefits after 24 months, a claimant must be unable to perform the duties of “any occupation,” which is defined as an inability to perform the material duties of any occupation that her education, training, or experience reasonably allow. In addition, under the Mental or Nervous Disorders Limitation, benefits are not payable beyond 24 months for any disability that is caused by or contributed to by a mental disorder, including anxiety and depression.”

Click here to review the complete, redacted long-term disability insurance policy from Reliance Standard.

Submit All Medical Records That Support Your Disability Claim

A claims examiner and a reviewing physician within the insurance company will review your disability claim, both of whom may selectively sift through your medical records to find information that justifies denying your claim. It is crucial to submit a comprehensive set of medical records, including detailed results from diagnostic tests such as MRIs or CT scans, to protect against this selective assessment.

Furthermore, ensuring that your physician and any attending specialists document the specific limitations resulting from your injury or disability is essential. If you provide thorough documentation, the insurance company will find it significantly more challenging to find a reasonable basis for denying your claim.

Be Prepared for Video and Social Media Surveillance

Reliance Standard has substantial resources and will likely employ a private investigator to uncover any activity inconsistent with your disability claims. Investigators can utilize background checks and photo and video surveillance. They are also known to monitor your social media profiles. They want to “catch” you doing something you “shouldn’t,” like carrying a trash bag or enjoying time with family.

It would help to be mindful of your activities and what you share on your social media profiles. However, everyone has “good days,” and an insurer might catch you on one of your more active days. An attorney can assist you in demonstrating that a brief period of activity on one of your best days does not indicate that you can return to work.

The Reliance Standard Appeal Process

Outside Medical Reviewers

These third-party vendors should conduct an “independent” medical examination or file review to determine your eligibility for long-term disability benefits. However, there is little evidence that these so-called independent doctors base their findings on proper medical criteria. It is common for doctors hired by Reliance Standard to discount or disregard the disabling effects of pain, fatigue, medication side effects, and even the opinions of your treating physicians to deny claims.

How Can an Attorney Help Appeal My Long-Term Disability Denial?

A seasoned and experienced long-term disability attorney can help you navigate the complex ERISA rules and regulations. The Ortiz Law Firm can ensure you understand your policy and ERISA laws, help you with the claims and denial process, and fight for your rights in a lawsuit against Reliance Standard. We work on a contingency fee basis, so you do not need to pay any fees upfront. We won’t give up until we have recovered the long-term disability benefits you deserve.

Understanding Your Coverage

Disability insurance policies are contracts that are usually very complex and hard to understand. The most crucial document in the entire process is the disability insurance contract, which defines the type of coverage Reliance Standard provides and the duties and responsibilities of all parties to the contract (i.e., the claimant and the insurance company).

Moreover, long-term disability insurance policies are often subject to change and are written in favor of the insurance company. The disability policy governs the type of coverage afforded by a disability insurance policy, so we will ensure you understand your policy’s terms.

Preparing Your Appeal

If you receive a claim denial, one of the most important things you can do is prepare a good appeal. Disability appeals are not only essential to reverse a denial, but they are also important to strengthen the administrative record before filing a lawsuit. When you file a lawsuit, the court will only review the medical records submitted during the administrative review process. Since the appeal process is so restrictive, we recommend that claimants request a free case evaluation before moving forward.

Suppose you hire the Ortiz Law Firm to represent you as your attorney for an administrative appeal. In that case, we will obtain the complete claim file, conduct a medical review, and evaluate all the medical records and vocational evidence considered by Reliance Standard disability insurance company. You can focus on your health while we do the heavy lifting to defend your claim.

Obtaining Additional Evidence

We ensure we maximize the chances of reversing your disability insurance benefits claim denial. We seek additional medical and vocational opinions. We utilize customized residual functional capacity forms to support your claim. We will review the terms of your policy or plan and help you document all the evidence that supports a favorable disability determination.

Determining If You Have to Appeal

An internal appeal may not be necessary for some policyholders, such as those with an individual disability insurance policy. ERISA law does not govern these policies, so you may not be required to appeal before filing suit. An experienced ERISA disability attorney can help determine if ERISA governs your long-term disability claim.

ERISA and Long-Term Disability Insurance Claims

The Employee Retirement Income Security Act, a federal law, regulates most employer-sponsored long-term disability plans. Federal Employee Retirement Income Security Act (ERISA) laws heavily favor insurance companies like Reliance Standard and are not consumer-friendly with individual claimants.

Under ERISA, you typically have 180 days after receipt of your disability insurance claim denial to submit information to support the disability claim. This evidence is critical, and that’s because a federal court usually will not accept or consider new evidence presented during the lawsuit.

Remember, the court is limited to seeing what was in the administrative record when the insurance adjuster decided your long-term disability claim. You or your attorney should submit all relevant evidence and documentation in support of your disability claim to the insurance carrier or plan administrator with the initial administrative appeal.

FREE RESOURCE: Whether ERISA governs your policy or not, we encourage you to check out our free step-by-step guide to appealing a disability insurance claim denial. The guide includes instructions and appeal templates for ERISA and non-ERISA claims.

Lawsuits Against Reliance Standard Life Insurance Company

If Reliance Standard denies your administrative appeal, or if Reliance Standard denies your initial claim and you have an individual policy that ERISA does not govern, you can file a lawsuit against Reliance Standard for denying your claim.

It is critical to have a skilled lawyer knowledgeable about ERISA appeals and lawsuits to defend your case. Reliance Standard has its own ERISA lawyers and strategies for success in federal disability lawsuits. It would be best to have an ERISA disability attorney on your side to help you strengthen your claim, which means retaining an attorney before you even file your appeal.

Litigation Against Reliance Standard

Below, we have provided several examples of litigation against Reliance Standard.

• Okuno v. Reliance Standard: Court Rules in Favor of Reliance
• Bradshaw v. Reliance Standard: Pre-Existing Condition Exclusion Does Not Apply
• Bey v. Reliance Standard: Court Rules Reliance Did Not Act Arbitrarily or Capriciously

Note: The Ortiz Law Firm did not handle these claims, but our firm has summarized them to help claimants better understand how federal courts interpret disability law.

How The Ortiz Law Firm Can Help

Applying for Disability Benefits from Reliance Standard

You may be preparing to submit your claim for long-term disability benefits. If so, we have a Disability Insurance Claim Guide and Toolkit to help you through the process. This free resource will guide you through the claim process and help you gather the information needed to support your claim. We also have a free eBook called the “Top Ten Mistakes That Will Destroy Your Long-Term Disability Claim.” Read this book to avoid common mistakes that could destroy your claim.

Appealing a Disability Claim Denied by Reliance Standard

A long-term disability policy can be very complex. It may be hard for a layperson to understand the contract terms and when a claimant is entitled to disability coverage. If your insurance company refuses to pay your disability benefits, an experienced ERISA lawyer at the Ortiz Law Firm can help you recover the benefits you deserve under your Reliance Standard disability insurance policy.

Many of the Reliance Standard claims we handle are approved on appeal. The following are just a sample of some of the claims we have brought to a favorable resolution.

• Claim approved for benefits under “any occupation” definition of disability: Reliance Standard performed a full file review with a vocational expert after paying benefits for nearly eight years and concluded that available information did not support the inability to perform “any occupation.” We appealed, prompting Reliance Standard to order a peer review report. The report supported the decision to terminate benefits, but we argued that the doctor ignored the claimant’s need for “frequent unscheduled breaks.” Reliance Standard then reversed its decision to terminate the claim.
• Claim reinstated after termination due to mental health limitation in policy: Reliance Standard initially denied our client’s long-term disability claim because he had been terminated. We appealed, arguing that his disability began before his termination, and the denial was overturned. The claim was paid for two years, then terminated due to a policy provision limiting benefits for mental health conditions. We appealed again and proved that our client was still disabled due to frequent headaches, chronic neck and back pain, and chronic fatigue.

If Reliance Standard denies your claim for long-term disability benefits, the disability lawyers at the Ortiz Law Firm can help. Disability lawyer Nick Ortiz represents disability insurance claimants anywhere in the United States. Let the Ortiz Law Firm fight for the Reliance Standard disability benefits you deserve. Call us at (888) 321-8131 to request a free consultation with an experienced disability lawyer to discuss your claim for long-term disability benefits.