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Appealing a Denial of Disability Benefits from Reliance Standard

Osterhout Berger Daley > Insurance Companies > Appealing a Denial of Disability Benefits from Reliance Standard

Having disability insurance coverage through Reliance Standard may help to protect your finances if you are ever disabled and unable to work. This type of insurance replaces a pre-determined percentage of your income to you for a specific duration according to the terms of your policy. The company sometimes denies claims for disability. If your claim is denied, the experienced disability lawyers at Osterhout Berger Daley may help you with your appeal.

Background on Reliance Standard

Reliance Standard Life Insurance Company was founded in 1906 and is headquartered in Philadelphia, Pennsylvania. It is a member of the Tokio Marine Group. The company offers a variety of different employee benefits options, including life insurance and disability income insurance to people in all U.S. states other than New York.

Disability insurance from Reliance Standard

Reliance Standard offers short-term and long-term disability coverage through employers as well as voluntary coverage options. The group short-term disability offers weekly income coverage up to $2,309 and percentages of up to 70 percent. The duration of the coverage is up to 52 weeks. The group long-term disability coverage offers income coverage of up to $24,000 per month with income percentages ranging from 40 percent to 66 percent. The benefits may be paid for 12 to 60 months or on a long-term basis. The voluntary short-term plans offer maximum weekly benefits of $1,250. The voluntary long-term plans offer maximum monthly benefits of up to $7,500 for a duration of up until the normal Social Security retirement age.

More about Reliance Standard’s short-term disability insurance

While it’s important to understand the features your Reliance Standard short-term disability policy offers, it’s also important to understand its limitations. One such limitation is the elimination period. Every disability insurance policy has an elimination period, so this is not unique to Reliance Standard. However, it does affect the length of time you’ll have to wait until you can start receiving your benefits. For a short-term disability policy, the elimination period can be as short as 7 days to as long as 90 days. This will all depend on the length your employer chooses.

Another limitation is around a pre-existing condition. Reliance Standard has a “3/12 pre-existing condition limitation”. The insurance company defines this limitation as “any condition (whether diagnosed or not) for which an insured received treatment, consultation, care or services, including diagnostic procedures, or for which he/ she took prescription drugs or medicines, within the 3 months before the individual effective date of coverage (or the effective date of an increase). Benefits would not be payable for a disability due to a pre-existing condition, should the insured become disabled due to such pre-existing condition within the first 12 months of: (a) initial coverage effective date; or (b) effective date of an increase in coverage.”

This insurance company also excludes injuries that are self-inflicted on purpose. This company also won’t cover any disabilities that are as a result of war, in the act of committing a felony, cosmetic or plastic surgery, and more. Be sure to read to your policy in its entirety to make sure you understand everything that you’re entitled to under the policy and everything that’s excluded or limited.

More about Reliance Standard’s long-term disability insurance

The long-term disability insurance offered by Reliance Standard is very similar to its short-term disability insurance, but its elimination period is longer and it has more limitations and exclusions. The elimination period could be anywhere between 120-360 days. If you have both the short- and long-term disability plans, you may be able to go through the elimination period for the long-term plan while you receive benefits from the short-term plan.

In addition to the limitations mentioned in the short-term disability plan, this insurance company also sets limitations on mental or nervous disorders, substance abuse, and a few other disorders under the long-term disability plan. The limitation for individuals suffering from a mental or nervous disorder states that the insurance company will provide benefits for up two years, but once those two years are up, the individual must be admitted to an institution/hospital in order to continue receiving benefits. The limitation for individuals with substance abuse states that the insurance company will provide benefits for up to two years as long as the individual participates in a “Substance Abuse Rehabilitation program”. For other certain disorders, the insurance company will pay partial benefits up to 24 months. You’ll want to read which illnesses and injuries are within this list to check to see if your disability falls under this limitation.

For exclusions under Reliance Standard’s long-term disability plan, the insurance company actually has less exclusions under this policy than it does for its short-term policy. The only exclusions include disabilities that were a result of a self-inflicted injury, act of war, in the act of committing a felony, and disabilities that occurred in a penal or correctional facility. Again, you’ll want to make sure that you read your policy completely to ensure that you understand everything that you’re entitled to and everything that is limited or excluded under this policy.

What you need to know about Reliance Standard disability claims

While this insurance company has been around for a long time, the company doesn’t always seem to have its act together. In a survey, a majority of this insurance company’s customers stated that they’re very unsatisfied with this insurance company and wouldn’t renew their insurance plan. A majority of the customers also stated that they were either unsatisfied or very unsatisfied with the way Reliance Standard handled their claims. Be aware of this as you go through the process of submitting a disability claim to this insurance company.

How to submit a disability claim to Reliance Standard

You can download the necessary forms on Reliance Standard’s website. Be sure to choose your state and click on the disability claim forms that pertain to your policy. All three types of disability claim forms will require you, your employer, and your attending physician to fill out each respective section. Please be sure that each section is filled accurately and completely. If any information is missing or is incorrect, the insurance company will use this as a reason to delay or deny your claim. You don’t want to give them any reason to do either of these things. Also be aware of the timing for filing your claim. If you’re filing for long-term disability, you’ll need to file a disability claim two months before your elimination period ends. If you’re filing for integrated benefits (short- and long-term disability), then you’ll need to file the claim the day after the last day you worked. The insurance company doesn’t specify the timing for the short-term disability claim, but you should check with the insurance company to make sure you don’t miss the deadline if there is one. Once you, your employer, and your attending physician complete the form, you can either fax or mail in the form (along with the required attachments) to the insurance company. The fax number and address are on each of the forms.

What to do if Reliance Standard delays your disability claim

If you feel as though Reliance Standard is delaying your disability claim, you’re going to want to reach out to the insurance company to check the status of your claim. If they don’t give you an answer or continue to give you vague answers, you may want to reach out to an experienced disability lawyer to help get your claim processed. Our experienced disability lawyers at Osterhout Berger Daley can detect tactics used by insurance companies that are intentionally delaying claims.

What to do if Reliance Standard denies your disability claim

If you submit a claim and Reliance Standard chooses to deny it, you will receive a notice outlining the reasons for the company’s decision. Your letter will also tell you that you have the right to appeal directly through the insurance company and provide you with instructions about how to do so. You must follow these instructions and file your appeal with the company directly. You cannot try to skip this step and file a lawsuit in court. If you miss the company’s deadline for your appeal, you will be unable to try to recover your benefits in the future.

After receiving your notice, contact Reliance Standard and request your file at the company. Inside of your file, you will find all of the evidence that Reliance Standard collected about your claim in order to deny you.

If your internal appeal is denied, you’re going to want to consult an experienced disability lawyer. Our experienced lawyers will provide a free consultation to review your case. Make sure to bring your file and your letter to Osterhout Berger Daley. Our knowledgeable attorneys will review the information in order to determine how to best proceed.

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Appealing a denial from Reliance Standard

When you are working with your lawyer, it is important that you listen to him or her and that you are always honest about your symptoms. Some people make the mistake of thinking that they might make their cases stronger if they exaggerate their symptoms. This can backfire because if the company decides that you are malingering, it will be much harder for you to prevail on your appeal. Your attorney will also ask you to help with your claim. While your appeal is pending, you should keep all of your medical appointments and follow your doctor’s treatment recommendations. Your attorney may also ask you to submit to functional evaluations, medical exams and objective medical tests. The reason why your lawyer may want you to do these things is to build a strong record that supports the basis for your claim. Adding evidence that is favorable to you makes it much more likely that your appeal will be granted by the company without you ever needing to file a lawsuit in court. To learn more about your rights, contact Osterhout Berger Daley today to schedule your free consultation.