After handling hundreds of claims against Reliance Standard for long-term disability denials, the attorneys at Dell & Schaefer law firm give some tips and insights for those who need to file an appeal. Disability insurance lawyer Greg Dell and fellow attorney Alex Palamara explain that the large majority of LTD cases with Reliance Standard insurance company are ERISA appeals because the company writes group disability policies as part of employee benefits. Understanding how these policies work is crucial when it comes to appealing a disability insurance claim denial.

It’s hard to underestimate the value of submitting a strong appeal from the very beginning, stresses Greg Dell. The consequences of a policyholder doing an appeal on his or her own without a lawyer can be irreversible for one indisputable reason: a claimant’s appeal to a denied claim is the last opportunity to strengthen that claim for an eventual lawsuit. That’s because once Reliance Standard denies an appeal, it’s not possible to submit any additional information into the claim.

Some policyholders try doing an appeal on their own and then getting a lawyer later after a final denial, but it’s considerably more difficult to overturn a Reliance denial at that point. When filing a lawsuit to receive the stated policy benefits, the information that’s in the claim vault at the time of the final denial is the only information that’s going to be presented to the judge, explains Alex Palamara.

“Let’s just say there’s medical documentation of an MRI, or whatever testing you had done, but you did not submit it with your appeal prior to the final denial,” says Palamara. “The judge will never see that information.”

Even if the claimant submits an appeal and then the next day loses his leg or gets hit by a bus and becomes a paraplegic, the court is not allowed to consider that new information. Therefore, the purpose of an appeal is twofold: to get the policyholder back on claim, and to strengthen the case for the potential lawsuit that’s coming down the road.

Strengthening the Medical Claim File and Physician Support

One of the first things a disability insurance lawyer will do is request the claim file. That file is every single thing that Reliance Standard relied upon to deny the claim. The insurance company is required by law to hand it over, which is one positive aspect to an ERISA lawsuit. The lawyers will typically get all the requested information within three weeks, at which point they begin scouring from 500 to many thousands of pages of in the claim file.

And the most important thing the lawyers are looking for is the reviews that Reliance Standard conducted on the claim, because the reviews are what they’re hanging their hat on to deny the claim. These reviews are often an independent physician review in which a doctor hired by the insurance company conducts a paper review and usually concludes that the policyholder is not disabled. It can also include a functional capacity evaluation to determine if the claimant is capable of performing his job.

A disability insurance attorney will be looking for the “needles in the haystack,” finding issues with the insurance company’s conclusions, inconsistencies with the medical documentation they are citing, or even medical documentation that they are overlooking.

“What we have to do,” explains Greg Dell, “is analyze their medical reviews, analyze the medical records… and then we get together and strategize about what additional medical evidence we can obtain that is going to convince this disability company that you’re disabled.”

A valuable part of this strategy is consulting with medical experts and with the claimant’s attending physician. The goal is to prove, undisputedly, that the client is disabled and has restrictions and limitations as a result of their medical condition. A seasoned and skillful disability insurance lawyer will draft an attending physician statement that’s specific to the disabled claimant and to his condition. They’ll provide simple but targeted questions that the doctor can easily answer and give support to the patient’s claims.

Presenting the Occupation

According to Greg Dell, the next thing, which is rarely done by the insurance company, is presenting the occupation. This is where it’s essential to define the policyholder’s occupation based on the definition of disability in that person’s insurance policy. Sometimes it’s necessary to work with a vocational expert to explain the requirements of the claimant’s job so that the insurance company cannot “dumb down” the occupation to make it seem like it’s a lesser job than it actually is, explains Alex Palamara.

For example, Reliance Standard may look at a driver’s occupation and go to the Dictionary of Occupational Titles to prove that it’s a sedentary job because he sits all day. But there are many levels of driving, such as a delivery driver who is required to load and upload things out of the back of a truck. Unless a thorough occupational evaluation is included, it’s easy for the claim file to overlook the requirements of a specific occupation.

Personal Impact Statements

In addition to strengthening the medical and occupational parts of a disability claim appeal, it’s equally important to include personal impact statements. Since ERISA laws that govern these claims essentially took away testimony when the case ends up in court, a personal statement inserted into the appeal is the disabled claimant’s only testimony to how the disability affects her life. If there are job limitations, pain, difficulty multitasking or focusing – these are all things that portray to the insurance company (or eventually, a judge) that even a sedentary job is more complex than it appears.

“Reliance Standard loves to deny claims,” notes Alex Palamera,“saying, oh, look, your doctor said, or our doctor said, you can sit for eight hours a day. But there’s more to a sedentary job than just sitting there all day, as everyone knows.”

Since the claimant is never going to be afforded the opportunity to testify in front of a judge, this is how that judge can hear out of his own voice what he suffers on a daily basis. What was his life like before the disabling conditions, while he was out on disability, and he’s been denied disability benefits?

The judge will also never be able to hear from family, friends and co-workers who’ve seen the claimant suffer over the years. Therefore, personal impact statements from these individuals can help bolster and personalize the disability insurance benefit claim, according to Alex Palamara. Video statements can also be a powerful way to humanize what’s going on with the claimant, adds Greg Dell. If it’s in the claim file, the judge has to review it.

Policyholders who need to file appeals after denied disability claims from Reliance Standard can reach out to Greg Dell, Alex Palamara or any disability insurance attorney at the Dell & Schaefer law firm. They help claimants all over the country and always provide a free initial consultation and claim denial review. Just give them a call, or make contact through the Free Consultation button on the Dell & Schaefer website.