Navigating the process of filing for long term disability benefits with an insurance carrier like Reliance Standard can be a challenge, even for the most well-organized claimant. Insurance carriers often seem to speak their own language, which can make claim denials seem unfair and arbitrary. At Disability Insurance Attorneys Dell & Schaefer, we’ve handled literally hundreds of claims against Reliance Standard and know exactly what they’re asking (and not asking) in their disability claim forms. Read on for some tips to make handling your Reliance Standard disability claim a little easier.
GREGORY DELL: Hi, I’m attorney Gregory Dell joined today by attorney Alex Palamara. And we’re going to talk about Reliance Standard and how to get your disability claim approved with the Reliance Standard. And Alex, the reason I asked you specifically to join me today in this video is because you have handled probably hundreds of Reliance Standard disability appeals.
ALEX PALAMARA: Of course.
GREGORY DELL: And from someone who knows what happens extensively when a claims denied and how to get a claimant put back on claim by winning an appeal, I thought it would be great for you to talk about different tips for someone who’s looking to apply for these Reliance Standard benefits. Now, you know that we’ve helped tons of clients to apply. And we’re going to share our knowledge. And if someone is interested in having us assist them, certainly you can contact us to discuss that.
But I want to get into it right away and talk about, first of all, what’s the first thing you think about, someone calls you. They want to apply. What’s the single most important thing right off the bat?
#1: Your Medical Support is The Most Important Thing to Obtain a Reliance Standard Disability Approval
ALEX PALAMARA: It’s medical support and support from your treating providers. So I’ve got to know what type of objective evidence that you have to support your claim and whether your doctors are on board saying that you should stop working right now.
GREGORY DELL: OK, and you know, people call. And you always ask them, hey, does your doctor support you? And they go, I think they do. But why is it so much more than just the doctor saying, yes, I’ll support your claim? What is the documentation that’s often lacking that leads to claim denial that you have to fix on an appeal? And what would you suggest that would help someone to get approved from the beginning to avoid that claim denial?
ALEX PALAMARA: Well, it could be a lot. I mean, you’ve got to realize that doctors are not treating you and– doctors actually are writing your medical records not to approve a disability insurance claim. They’re writing medical records that treat you and get you better ultimately.
So your medical documentation might not be written in the sense to prove to an insurance company that you are disabled and they should start paying you monthly benefits. So not only do you have to talk to your doctor and get your doctor to say whether he or she says, yes, I’ll support your claim. It’s more than them just saying they support your claim. They’re going to have to fill out forms for you, attending physician statements that are giving your reasons why they believe you’re disabled. And they might have to change the way they write some of their medical documentation to help support your claim and your application for benefits.
But the one thing you have to realize, that insurance companies love to accept premiums. And they love to deny claims at the same time. So it’s so important to make sure your application is as strong as possible.
GREGORY DELL: So when a claimant goes to a doctor– and often some of them try to do their claim on their own, which they certainly can apply on their own. But when it comes time to talk to the doctor, they don’t really know how to get the doctor to fill out the claim form. And I always tell claimants, what we do is we work with the claimant in educating them as to what exactly should be in that form. Like, what’s needed? Because we know what Reliance Standard’s looking for and what’s going to be missing in that. And not only that, in terms of educating your treating doctor in terms of what the definition of disability is, what your occupation was beforehand–
ALEX PALAMARA: And the requirements of your occupation.
GREGORY DELL: And you know, sometimes it changes. Sometimes someone’s maybe been on claim already. And now it’s in any gainful occupation, or unable to do the duties of your occupation, but not gainfully employed.
So it might just be that you can’t do your job, but you could do something else. And the doctors really need to understand that, because one thing we know Reliance Standard does is, they’ll go ahead and call the doctor. And what’s your advice for someone who is applying and their doctor is going to get called? What do you tell the claimant they should do about that?
#2: All Your Treating Doctors Must be Prepared For A Phone Call With Reliance Standard Medical Experts
ALEX PALAMARA: Well, first and foremost, like you were saying, you have to educate the doctor. I mean, every single policy has a definition of disability that’s a little bit different. And your doctor has to know the ins and out of that definition of disability. Also they’re going to call your doctor at a random time. Your doctor probably has office hours, probably treating multiple patients. I mean, they’ll be lucky if they reach the doctor.
And a lot of times, the insurance companies play this game. Well, we called your doctor. They didn’t respond back to us. We left a couple of voicemails and no one ever got back to us. They give them like a 24-, 48-hour period to respond, which is ridiculous, because again, doctors have a busy practice. They’re not focused on one patient and have the ability to call back immediately.
So you have to have the support of your doctors, have your doctors to be willing to write letters of support, and hopefully be willing to return phone calls. I like to be involved as much as I can. And I like to set up the phone conferences for the doctors and the insurance companies to speak.
So we have a specific time period where the doctors are going to be available for 10 to 15 minutes, and the insurance company representative will be available, and I’ll be available as well, just so we can ensure that a conversation will take place. And if one doesn’t take place, it’s not our fault for it not taking place. And we can tell the insurance company, in this instance, you guys messed up. It’s your fault why it didn’t happen.
GREGORY DELL: So that being said, I always tell my claimants, tell your doctor that if the insurance company calls, tell them that you’ll call them back or have an assistant say, can you please submit your questions in writing? Then we can work with the claimant and the doctor to make sure that the response addresses everything that we know Reliance Standard’s looking for.
ALEX PALAMARA: Yeah, we certainly prefer to be in writing. It gives us a better idea. Because a lot of times when they have conversations with the doctors, they try to trap them in a sense. They ask them vague questions.
And we see this medical record saying this, do you agree with this? And they don’t let the doctor respond or expand upon his answers. Or maybe the doctor is just in a rush and just says yes, yes, yes, and gets off the phone as quickly as possible so he can you back to his practice. In writing, having the questions posed in writing is even better or having us available for the phone call to make sure that they don’t fall into any traps and get taken advantage of by the insurance companies.
GREGORY DELL: One of the– we talked about the doctor understanding the occupation. And a claimant has to understand how occupation is defined in their disability policy. Reliance Standard, in my opinion, is usually not a true own occupation. Can you explain what I mean by that and why it’s important for a claimant to understand that?
ALEX PALAMARA: Well, they don’t just take a job description that your employer gives them, if they actually do actually try to get the actual job description, but they go into a national definition of what your occupation entails. And I’ll just say, let’s say that your specific job, for some reason you’re lifting boxes that are 50 pounds each, but a typical accountant does not do that. So the insurance company is ignoring the requirements of your own occupation and looking at the national standard for how your occupation is performed.
And a lot of times they use that to take advantage of people as well and deny claims saying, you know, you have the ability to sit there. And a lot of times, they make it either one of the main categories, which is sedentary, light, heavy, a medium-level occupation. And if they believe they have medical documentation to support you can perform a sedentary job, they just deny you from the get go without doing a true review of your occupation.
GREGORY DELL: So what do you recommend in terms of how can someone supplement a application to show not only how their occupation is performed, but how it’s performed in the national economy?
#3: Occupational Experts Can Be Very Helpful in Establishing Your Occupational Duties
ALEX PALAMARA: Well, we have experts that we utilize on a regular basis that we trust. And we get their opinion on our clients’ specific job duties and their specific occupation to have pretty much a charted-out map of what those requirements are so the insurance company cannot say that, you know, they can’t overlook the requirements of that job and say that person can actually do the duties of their own occupation.
#4: Know the Level of Review Your Claim File Will Receive
GREGORY DELL: When you’re dealing with someone who calls you with Reliance Standard, how do you view their initial review of a claim? Because when you get an appeal, the claimant’s has been denied. And then you get a copy of their complete claim file. So you are like an expert at looking how the underlying claim was reviewed by Reliance. What is the level of review that you find they do on an initial claim that someone– on Reliance Standard that you should expect, that a claimant should expect?
ALEX PALAMARA: I mean, sometimes they’ll have a nurse, only a nurse perform a review of the medical records. Sometimes they’ll have a sometimes independent doctor, but more often than not, they’re having their own people look at the files, their own doctors on staff, nurses on staff, the kind of people that I like to think that are not unbiased, but they typically are pretty biased. You know I mean, some of the reviews I see done by the insurance company are not that good.
And it’s kind of sad to say, because someone’s waiting on this disability insurance benefit. They have no income coming in. They’re almost homeless sometimes. And the insurance company is having biased people look at the medical records and essentially denying the claim.
Sometimes they’ll do, quote, unquote, “independent” physician reviewers, where they go out and hire an independent company who utilizes, I guess, a bigger list of potential doctors to use. And it could be some doctor in a corner of the country that actually has never seen you, laid eyes upon you, and is performing a paper review of all your medical documentation. Some of the results are just– you know, it’s sad to see what the output they give when they conduct these reviews. So it’s very important that when you apply for benefits, you do the best job you possibly can with as much support from your treating providers, as much support from your treating documentation, that the documentation is well-written, and essentially, everything put together on a silver platter with a bow around it so the insurance company can’t have a reason to deny your claim.
#5: Your “Date of Disability” is Important
GREGORY DELL: Pre-existing condition provisions is a big thing for Reliance Standard. And that’s an investigation they always do. Can you talk about what that is and how that coordinates with the importance of choosing a data disability?
ALEX PALAMARA: All right, so many are most disability insurance policies, especially the group policies, have a pre-existing condition clause that says they will not pay you benefits for any pre-existing condition. Sometime there is a look back period of three months. So if you were treated, diagnosed, or suffering from a condition that’s now leaving you disabled for the three-month period prior to your date of disability, the date you stop working, they will not pay benefits. Sometimes the look-back period is as long as a year.
So if you have a pre-existing condition, the insurance company might not be paying your claim. So you have to figure out your date of disability to figure out whether that pre-existing clause will apply or not. And what I’m saying is that, sometimes the pre-existing condition clause will no longer be in effect if you’re covered under this long-term disability insurance policy for longer than a year.
Under most group policies, if you’re covered longer than a year, then there is no more effective pre-existing condition clause. You don’t have to be worried about it anymore. So let’s say you got diagnosed with, God forbid, cancer three years ago and you’ve been treating it ever since or having follow-up visits–
GREGORY DELL: And still working.
ALEX PALAMARA: –and still working, and it comes back again, now it forces you to apply for disability insurance benefits. So long as you have been working with this employer for a long period of time and covered under the policy for longer than a year, you have to have no worries whatsoever– or maybe not, no worries, but less worries about a pre-existing condition. But if you’re working at an employer less than a year, we have to do an evaluation for you to figure out when is the best time to stop working, when is the best time to claim this disability, because it might be too soon. You may have to stick it out for a few more weeks or a few more months.
GREGORY DELL: And the other thing that’s important in choosing a date of disability is, number one, giving reasonable notice to Reliance Standard in terms of when their policy requires it. And some people think, you know, you have 180-day elimination period. And some people think they have to call them within 30 days.
But if you’re going to– if you have to be out for 180 days, you don’t necessarily have to call within 30 days, even though the policy may suggest to give us notice within 30 days. But it’s not against the law or the policy provision to wait, because you may not be eligible. So what’s the point if you’re only going to be out for 90 days?
And what I think is, as soon as you notify Reliance, that’s when they start running their video surveillance, their background checks on top of you and all of your doctors. And Reliance Standard actually recently has been really weird. They have this intake department now that is kind of just like gathering all the information, like, quickly.
Like, they jump on getting to you right away, because they want to try to– like, their goal is to get you back to work. And then that may not be the person who’s deciding the claim. It’s like this bare-bones factory-type assembly line type thing where they’re going to just quickly review the claim, maybe give it to a nurse. If there is nothing there, they’re going to shut you down immediately.
And that involves the initial interview where they’re going to call you. So I would wait to contact them within the time frames of the policy so that you don’t prejudice and waive your claim, which is something obviously we’ll discuss with you when you call us. But keep in mind that I think they’re running an assembly line. They write a lot of policies, a lot of coverage for low-dollar premiums.
And they’re trying to push them through right away. And what they’re doing now I think is an injustice to the claimants. I think it’s leading to more denials than approvals.
So you know, the purpose of this video is to let you know that you’ve got to be prepared when filing a claim with Reliance for long-term disability, and really, any disability carrier, for that matter. If you’re not prepared, especially with Reliance, your claim is going to get denied. And that preparation involves medical support, understanding occupation, understanding your disability, and really making sure everything is consistent, which is not an easy thing to do.
So very easy to work with either Alex, myself, or any of our lawyers– we ask you to please click the free consultation form on our website, call the phone number at the bottom of this video. Your call will be answered by an attorney. We’re going to ask you to send us a copy of your long-term or short-term disability policy.
We’ll review it for you right away. And we’re going to let you know right away whether or not we can assist you. We help clients all over the country. And we hope that we’re going to be able to work with you to guide you towards getting your claim approved for disability benefits with Reliance Standard.
With so many moving parts, the disability claims process can be a lot to handle for anyone, especially those who are battling medical conditions and, in many cases, the resulting medical bills. Let the experienced disability insurance attorneys at Dell & Schaefer help guide you through this process and take the stress and paperwork off your plate. We’ll work with you and your doctors to create the most comprehensive disability claim, improving your odds of approval or overcoming an initial denial letter on appeal. Give us a call today or visit our website to schedule your FREE consultation with a member of our experienced team of long term disability insurance attorneys.