The Standard Long-Term Disability Denials And Appeals

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

It can be challenging to navigate a long-term disability denial from The Standard Insurance Company. The Standard is known for its stringent review process, so claimants must be prepared when filing an appeal. Understanding the appeals process and your rights can significantly increase your chances of a successful outcome.

At the Ortiz Law Firm, we have extensive experience handling claims with The Standard, having represented clients in countless claims involving this insurer. Whether we are appealing long-term disability denials, filing lawsuits, or negotiating settlements, we are deeply familiar with the tactics The 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 The Standard operates. Over the years, he has built professional relationships with many of the defense attorneys that The Standard frequently hires. In fact, Nick speaks with these attorneys frequently, 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.

If The Standard has denied your long-term disability benefits, our experienced attorney can review your denial letter for free and develop an appeal strategy to get your benefits back. Call the Ortiz Law Firm at (888) 321-8131 or contact us through our website to get started with your free case review.

Get a Free Case Review

Understanding Why The Standard Denies Long-Term Disability Claims

Understanding why The Standard Insurance Company may deny a long-term disability claim is crucial for individuals navigating the claims process. Here are common reasons why your claim could be denied:

You Do Not Meet the Definition of Disability

You may be denied because The Standard finds that your condition does not satisfy The Standard’s specific definition of disability. It is essential to carefully review your policy’s terms and conditions to ensure your condition aligns with the insurance company’s criteria.

Insufficient Medical Evidence

Another common reason for denial is when there is a lack of comprehensive medical evidence to support your disability claim. This means the insurer does not think your medical problems are severe enough to keep you from working. However, the insurance company may not have all of your medical records.

And even if you have evidence from your doctors, you could still face a claim denial. Your doctors may mistakenly fill out your forms in a way that leads to a wrongfully denied claim. It may be up to you to ensure the information from your healthcare providers is thorough and accurate to establish the severity and limitations of your condition.

Policy Exclusions and Limited Benefit Periods

Review your policy carefully before filing a claim. The fine print on your plan document can affect whether you qualify for disability insurance benefits. Some disabilities are limited or excluded from coverage altogether.

Denials can also occur if your disability falls under a policy exclusion or you have reached the limit of your benefit period. Understanding the specifics of your policy can help you anticipate and address potential issues that may lead to denial.

Pre-Existing Condition Exclusions

There are typically exclusions for pre-existing conditions. Here is an example from a Standard disability insurance policy:

1. “Pre-existing Condition means a mental or physical condition whether or not diagnosed or misdiagnosed:

• For which you have done or for which a reasonably prudent person would have done any of the following:

2. Consulted a physician or other licensed medical professional;
3. Received medical treatment, services, or advice;
4. Undergone diagnostic procedures, including self-administered procedures;
5. Taken prescribed drugs or medications;
6. Which, as a result of any medical examination, including routine examination, was discovered or suspected;

at any time during the 90 days just before your insurance becomes effective.

2.   You are not covered for a Disability caused or contributed to by a Pre-existing Condition or medical or surgical treatment of a Pre-existing Condition unless, on the date you become Disabled, you:

1. Have been continuously insured under the Group Policy for 12 months; and
2. Have been Actively At Work for at least one full day after the end of that 12 months.”

Standard Long-Term Disability policy

Mental Disorders and Substance Abuse

Exclusions for mental disorders or conditions related to substance abuse are also common. Here is an example from a Standard disability insurance policy:

“Payment of LTD Benefits is limited to 24 months during your entire lifetime for a Disability caused or contributed to by any one or more of the following, or medical or surgical treatment of one or more of the following:

1. Mental Disorders; or
2. Substance Abuse.

Mental disorder means any mental, emotional, behavioral, psychological, personality, cognitive, mood, or stress-related abnormality, disorder, disturbance, dysfunction, or syndrome, regardless of cause (including any biological or biochemical disorder or imbalance of the brain) or the presence of physical symptoms.

If you are confined in a Hospital solely because of a Mental Disorder at the end of the 24 months, this limitation will not apply while you are continuously confined.

Substance Abuse means use of alcohol, alcoholism, use of any drug, including hallucinogens, or drug addiction.

1. If you are Disabled as a result of a Mental Disorder or any Physical Disease or Injury for which payment of LTD Benefits is subject to a limited pay period, and at the same time are Disabled as a result of a Physical Disease, Injury, or Pregnancy that is not subject to such limitation, LTD Benefits will be payable first for conditions that are subject to the limitation.
2. No LTD Benefits will be payable after the end of the limited pay period unless on that date you continue to be disabled as a result of a Physical Disease, Injury, or Pregnancy for which payment of LTD Benefits is not limited.”

Standard Long-Term Disability policy

A Medical or Vocational Expert Hired by The Standard Determined You Are Not Disabled

The Standard Insurance Company may enlist the opinion of their medical or vocational experts to evaluate your disability claim. The Standard uses paper and in-person medical evaluations to pick apart cases involving various medical conditions.

If these experts determine that you are not disabled according to their assessments, your claim could be denied. In such cases, seeking a second opinion or challenging their findings may be an option. Your denial letter may state, “It is determined based on your medical records and the physician consultant review that you do not meet the Group Policy Definition of Disability.” or “Your condition does not cause sufficient limitations to prevent you from working.”

The Standard Conducted Video or Social Media Surveillance

It’s not uncommon for insurance companies like The Standard to conduct surveillance, including observing your social media activity and recording videos of your daily life. Inconsistencies between your reported limitations and observed behavior may lead to a denial of your claim.

In many of our cases, the insurance company does not grant claimants the benefit of the doubt. They may say that your activities on video are inconsistent with your claim. Despite all the evidence, the insurer will doubt your claim’s credibility.

Understanding these common reasons for denial can better prepare you to navigate the long-term disability claims process with The Standard Insurance Company. Stay informed, provide thorough documentation, and seek assistance from legal professionals if you encounter challenges in securing the benefits you deserve.

How to Appeal a Long-Term Disability Denial from The Standard

After receiving a denial letter for your long-term disability claim from The Standard, it is crucial to take immediate action to appeal the decision. Here are the essential steps to guide you through the appeal process.

Initial Steps

When faced with a denial, start by carefully reviewing the denial letter. Understand the reasons behind the decision and the deadline for submitting an appeal. Notify your employer and request a copy of your employee benefits plan and the insurance policy from The Standard to comprehend your coverage and rights better.

Gathering Evidence

Collecting relevant evidence is critical to a successful appeal. Focus on developing the weaker sections of your claim. You must obtain strong evidence to dispute the denial and support your claim. Obtain copies of all your medical records, test results, and any documents supporting your disability claim.

It is also helpful to gather statements from healthcare providers, co-workers, and family members documenting how your condition affects your daily life and work capacity. Having a disability insurance expert guide you through the appeal process may also improve your chances of approval.

Writing an Effective Appeal Letter

Crafting a compelling appeal letter is essential to present your case persuasively. Address each reason for the denial, providing additional medical evidence and explanations to counter the concerns raised by The Standard. Be concise and factual, and emphasize the impact of your disability on your ability to work.

RELATED POST: LTD Appeal Guide: How to Appeal a Long-Term Disability Denial

Understanding The Standard’s Appeal Review Process

Familiarize yourself with The Standard’s appeal review process to know what to expect. The insurance company will typically reevaluate your claim, consider new evidence, and decide on your appeal. A claim representative may ask you for more information about your symptoms, limitations, and daily activities. The insurer may also request information about personal injury or Social Security Disability claims. Be prepared for potential delays and be persistent in following up on the progress of your appeal.

Working with The Standard’s Representatives

Maintaining open and transparent communication with The Standard’s representatives is crucial throughout the appeal process. Keep detailed records of all conversations, emails, and documents exchanged. Be proactive in providing any additional information requested promptly and professionally.

Navigating a long-term disability appeal can be challenging, but being well-prepared and strategic in your approach can increase your chances of a successful outcome. Stay organized, seek guidance from legal professionals if needed, and advocate for your rights throughout the appeal process.

RELATED POST: How to Choose the Best Disability Lawyer to Appeal a Long-Term Disability Denial

How to File a Lawsuit Against The Standard

When filing a disability lawsuit against The Standard, there are different avenues to consider depending on the type of policy you hold. Understanding the process and your rights can be crucial in navigating this complex legal procedure.

ERISA LTD Claims

If you have a long-term disability (LTD) insurance policy through your employer, it likely falls under the Employee Retirement Income Security Act (ERISA). Filing a lawsuit under ERISA regulations involves a structured process that begins with appealing the denial of your disability claim directly with The Standard.

To file a lawsuit under ERISA, you must exhaust all administrative remedies, which means going through the internal appeals process provided by The Standard. This typically involves submitting additional documents, providing medical evidence, and presenting your case before The Standard’s review board. You can file a lawsuit in federal court if your appeal is denied.

Under ERISA law, federal courts cannot take up new evidence or updated medical records submitted during case proceedings. Federal courts can only review documents that are already in the claim file. You must submit all the relevant evidence during the administrative appeal process.

Individual Disability Insurance Claims

For those with individual disability insurance policies purchased independently, the process of filing a lawsuit may differ from ERISA claims. Individual policies are not governed by ERISA regulations, which can impact the procedures involved in disputing a denial with The Standard.

If The Standard denies your individual disability insurance claim, you may have the option to file a lawsuit directly without having to exhaust internal appeals. However, that does not mean that it would be beneficial for you to skip the appeal process. Consulting with an attorney specializing in disability insurance law can help you understand the pros and cons of appealing your denial and the specific steps and legal requirements for pursuing a lawsuit against The Standard in this scenario.

Navigating the process of filing a disability lawsuit against The Standard demands attention to detail, persistence, and a thorough understanding of your policy’s terms and conditions. Seeking legal guidance and support can significantly enhance your chances of successfully challenging a denial and obtaining the disability benefits you deserve.

How the Ortiz Law Firm Can Help with Standard Long-Term Disability Denials

The Ortiz Law Firm is dedicated to assisting individuals who have faced long-term disability denials and appeals with The Standard Insurance Company. Here’s how the firm can help you navigate through this challenging process:

Experienced Legal Representation

The Ortiz Law Firm specializes in handling disability insurance claim denials and appeals. Nick Ortiz is an experienced disability lawyer who has dealt with The Standard’s wrongful claim denials since 2005. With years of experience in this area, our legal team has in-depth knowledge of the laws and regulations surrounding long-term disability claims, ensuring you have expert representation on your side.

RELATED POST: Why You Don’t Need an Attorney In Your State to Appeal an ERISA LTD Denial

Personalized Case Assessment

When you contact the Ortiz Law Firm, we will thoroughly review your case to understand the specifics of your situation. This personalized approach allows us to tailor our appeal strategies to suit your needs best and increase your chances of a successful appeal.

Strategic Appeals Process

Navigating the appeals process can be overwhelming, but the Ortiz Law Firm will guide you through each step. The effort and attention to detail needed to win an administrative appeal is much more in-depth than most claimants realize. From gathering the necessary documentation to preparing legal arguments on your behalf, they will work diligently to present a compelling case for overturning your denial.

Effective Communication

Communication is vital in any legal matter, and we prioritize keeping clients informed and involved throughout the appeals process. You can rely on our team to provide clear updates, answer your questions promptly, and address concerns.

Proven Track Record of Success

The Ortiz Law Firm has a proven track record of helping clients secure the long-term disability benefits they deserve. Their dedication to client advocacy and commitment to achieving positive outcomes sets them apart as a trusted and reliable partner in your fight for justice.

“I was fighting a long-term disability company whose policy I had bought and who refused to pay any of my benefits after I became disabled. Nick agreed to take my case and though there were many hoops he had to jump through, he never gave up. I will always be grateful to Nick and his staff for all the work they did on my behalf.” – Teacher in North Carolina with a Denied Disability Claim

By choosing the Ortiz Law Firm to assist you with your long-term disability denial and appeal with The Standard Insurance Company, you can benefit from our expertise, personalized approach, and unwavering support during this challenging time. You only have a limited-time appeal, so contact us as soon as possible. Call (888) 321-8131 for a free case evaluation.

Frequently Asked Questions