Over the years, our disability insurance attorneys have reviewed thousands of disability insurance denial-of-coverage letters from Reliance Standard. Simply put, Reliance Standard makes it difficult for their policy holders to receive their disability insurance benefits. But disability claimants have the right to appeal a denial of coverage, and it’s possible to win these claims. Learn more about the litigation process and your options after a claim denial.
What to Know About the Reliance Disability Insurance Lawsuit Process
A group disability policy provided by your employer (like many Reliance Standard policies) is governed by the Employee Retirement Income Security Act (ERISA). ERISA requires insurance companies to offer certain types of policies, expanding the options available to employees; however, this comes at the cost of certain litigation rights.
For example, ERISA claimants are required to mediate their disability insurance denial claim before they can sue. If the claim settles at mediation, agreeing not to litigate the case any further will usually be an express condition of the settlement.
Claimants in an ERISA disability lawsuit who proceed beyond mediation also can’t request a jury trial and must instead try their case to a judge. This trial isn’t the typical jury trial seen on television or in the movies; instead, it’s called a “bench trial,” where the judge will review the documents and evidence over the course of a one-day hearing before coming to a decision.
How Does Reliance Standard Define Disability?
Often, claimants whose claims were denied will point out that they can’t do their current job and the Reliance Standard claims adjuster didn’t consider their actual work duties. However, most of these policies define “disability” as “unable to perform the material substantial duties of your own occupation.” The phrase “your own occupation” has been broadly defined in the national economy by your job title and a general list of duties, not on what you actually do.
If your position has evolved beyond your job title over the years, this may lead to unfair outcomes; unfortunately, this standard is the one by which your claim will be measured. If you partner with a disability attorney at Dell & Schaefer to appeal your denial of coverage, we can hire vocational experts and review records to provide the strongest possible proof of disability.
How Can Reliance Disability Claimants Prevail at Trial?
To win an ERISA case at a bench trial, a disability insurance claimant will need to prove that there was not one good reason to deny their claim. With some exceptions, a disability insurance claim will be reviewed under an “arbitrary and capricious” standard of review—in other words, the claimant will need to prove that there was not one good reason to deny their claim. Often, a judge will issue an opinion declaring that he or she believes the claimant is disabled, but that under the standard of review that allows the court to reverse only for an arbitrary and capricious denial of coverage, there simply isn’t enough evidence to overturn Reliance’s original decision.
However, in some cases, the reviewing court may apply a de novo standard of review. This allows the court to review the entire record with fresh eyes and come to its own conclusion, without providing any deference to the determination Reliance Standard has already made.
It’s important to note that this de novo review is constrained to only those documents that were originally presented to Reliance Standard. Once Reliance has denied a claim and the claimant has appealed, the claimant has lost the ability to introduce additional documents into the record to try to bolster their case. This is true even if there are substantive changes, like a Social Security Disability approval or additional evidence of injuries.
Claimants who prevail at trial can obtain monetary damages and attorney’s fees. The court can then remand the case back to Reliance Standard for another review of your claim.