With more than $1 billion worth of in-force premiums as of 2022, Standard Insurance Company—more commonly branded as The Standard—is one of America’s largest providers of long-term disability insurance. Their offerings include employer-provided group plans, as well as individual policies for those who choose to insure themselves.
Insurance giants like The Standard don’t get as large as they are without denying a lot of claims. Unfortunately, those denials are often unfair or in error. Or it could be that claimants failed to provide the correct evidence during the initial application.
Either way, if you believe your long-term disability claim was incorrectly denied by The Standard, you need to respond quickly and correctly—particularly if you have group disability insurance. You may have only one chance to correct the record before you permanently lose the benefits you deserve.
Working with an experienced long-term disability lawyer can greatly increase your chances of success, so we recommend contacting our team as soon as possible for a case review. In the meantime, we hope you find this breakdown of your legal options helpful as you navigate a path forward.
Group Plans and Individual Policies Have Different Appeals Processes
If you bought your own long-term disability coverage privately, directly from The Standard, the appeals process will likely be governed by state contract laws (often the state where the policy was purchased or based on a “choice of law provision” within the policy itself). But if you are covered by a group plan through an employer, it’s very likely that your plan is governed by a federal law known as ERISA.
If your plan meets the following criteria, it’s almost certainly an ERISA plan:
- You have group long-term disability through your employer
- Your employer is not a government entity or qualified religious employer
This is an incredibly important distinction. ERISA places a very strict set of rules on how long you have to appeal, what that appeal looks like, when (or if) you can sue, and more.
The Standard Long-Term Disability Appeal Process: ERISA Plans
Since the majority of LTD plans are employer-provided ERISA plans, we will start there first. If you need to appeal an LTD policy you purchased independently, feel free to skip ahead to that part of the article.
With all ERISA plans, you’ll need to complete the administrative appeals process before you can file a lawsuit against The Standard. This means they get to internally review your case and either grant or deny your appeal before you can take them to court.
Even if your case goes to court, you usually cannot add any new evidence. The judge must base their decision strictly on the information already in your claims file during the administrative appeal. So even if you trust The Standard to do the right thing during the administrative appeal, it’s still extremely important to protect your interests and follow the process outlined below.
Step 1: Review Your Claim Denial Letter
Whenever an insurance company denies an ERISA-governed long-term disability claim, they are required to provide claimants with a denial letter outlining:
- Why they denied the claim
- How to appeal
As you review your denial letter, keep the following points in mind:
- The rationale for the denial often includes valuable information about what type of evidence you’ll need to provide to reverse the decision. This might include additional medical evidence to prove the severity of your limitations, or a more accurate and detailed explanation of your specific job functions to show why your condition prevents you from working.
- While the letter will provide you with the deadlines and procedures for how to file an appeal, it won’t tell you how to file a good one. It’s in The Standard’s best interest to underplay how difficult it actually is to win an appeal so you won’t take it as seriously as you should.
- Under ERISA, you have a maximum of 180 days to appeal and probably only one chance to add evidence to the record. If you are late or forget to include crucial evidence, it could permanently cost you your benefits. That’s why it’s critically important to contact a long-term disability attorney as soon as possible after you obtain your letter.
Step 2: Contact a Long-Term Disability Lawyer
Given the strict time limit and requirements, it’s critically important to contact a long-term disability attorney as soon as possible after you obtain your letter. Your appeal needs to be as airtight as possible. The sooner you talk with an experienced attorney, the better your chances of success.
Step 3: Request a Copy of Your Claims File
If The Standard did not provide you with a copy of all the documents and records they used to decide your case, you and your attorney should request it right away.
By reviewing your full claims file, you can see what pieces of the puzzle The Standard is missing, whether certain key facts have been ignored or misinterpreted, and what new evidence you’ll need to provide to prove your case.
Step 4: Gather the Evidence
After you and your attorney have a chance to review the evidence The Standard already has, it’s time to add to (or correct) the record.
The exact types of supplemental evidence you’ll need will vary based on the circumstances. But they might include things like:
- Medical records that were missing from the claims file (or have been added since the initial application was filed)
- Letters of support from doctors and specialists familiar with your medical conditions
- Letters of support from colleagues, acquaintances, family, and others who are familiar with your physical, mental, and emotional capabilities (both before and after you became disabled)
- Results from tests that measure fitness for work, such as functional capacity evaluations
- Vocational evaluations that assess and project your future employability and earning capacity
- Personal photos, videos, and journal entries documenting your daily experiences
- Other evidence and documentation as determined by your long-term disability lawyer
RELATED POST: How Do You Prove You Are Disabled? – Bryant Legal Group
Step 5: File Your Administrative Appeal
Once you’re confident you have the evidence you need, you must submit it to The Standard using the company’s appeal guidelines—along with a detailed appeal letter.
A good appeal letter should, among other things:
- Clearly state your name, contact information, and claim number
- Summarize the relevant new evidence you are providing
- Identify and respond to the specific determinations made by The Standard that you are contesting (for example, that The Standard failed to consider the full impact of your disability or misrepresented your actual work duties when determining your ability to perform your job)
- Restate your request for approval and reference your right to file a lawsuit if the appeal is not granted
A detailed, accurate, comprehensive letter is important. This is another reason why working with an experienced disability attorney is a huge advantage.
Step 6: Wait
Under ERISA, The Standard has 45 days to respond. They can reverse their decision and approve your benefits, deny them again, or request a one-time extension of an additional 45 days. In our experience, big insurance companies like The Standard often use as much of their allotted time as possible to make a decision.
Step 7: File a Lawsuit if Your Claim Is Denied Again
The frustrating reality is that, even after administrative review, a significant percentage of legitimate ERISA appeals are still denied by the insurance company.
The reason is simple. ERISA protects insurance companies from bad faith claims. That means there’s often very little downside for them to simply deny claims even if the evidence is against them. At worst, they might have to pay your attorney fees in addition to the benefits you should have had in the first place.
So, don’t lose hope if your administrative appeal is denied. An impartial judge is probably going to be a lot more favorable to your side of the story than The Standard’s own internal review team.
The Standard Long-Term Disability Appeal Process: Non-ERISA Policies
As noted above, if you purchased your long-term disability policy directly from The Standard (i.e., not via an employer), or through a public or religious employer, your rights and responsibilities will be determined by state law rather than ERISA.
Claimants usually have a much larger variety of legal options at their disposal when appealing a non-ERISA plan. For example:
- You can go through The Standard’s administrative appeals process if it’s offered to you, but you do not have to. In most states (including Illinois, where we handle most of our cases) you can sue them at any time.
- If you do file a lawsuit, you may be able to submit even more evidence, including expert opinions, or have your treating physicians testify in support of your case.
- You also can seek damages above and beyond your benefits and attorney fees, including bad faith damages if you believe The Standard willfully refused to fulfill its contractual obligations to you. This raises the stakes significantly for the insurance company and makes it less likely that they’ll deny an obviously valid claim simply because they can.
Because you have so many options, and the precise rules and restrictions depend on the specific state law being applied, there is no single process that works best for all non-ERISA cases. The ideal legal strategy will depend on the circumstances.
For this reason, there is only one truly essential step you need to take: talk to an experienced long-term disability lawyer as soon as you can.
Contact Bryant Legal Group Today
Bryant Legal Group is one of Chicago’s premier long-term disability law firms. Over the years we have built a strong reputation for handling disability claims and appeals quickly, professionally, and successfully.
If you believe The Standard unfairly denied your long-term disability insurance claim, call us today at 312-971-5654 or complete our online form for a confidential consultation.
References
Rudden, J. (2024 November 1.) Leading group long-term disability insurance in the U.S. 2019-2022, by premiums. Statista. Retrieved from https://www.statista.com/statistics/866401/group-long-term-disability-insurers-usa-by-premiums/
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.
The post What to Do if The Standard Denies Your Long-Term Disability Claim appeared first on Bryant Legal Group.