Reliance Standard lawsuit guide: Learn why disability claims are denied, your appeal rights, legal options, and next steps.
When I first looked at a denial letter, it was a very ‘official’ looking letter and gave me the impression that this decision was final. The actual fact was very different; the reality is there is an appeal process. There is additional evidence you may need to gather and an additional path available to take.
Therefore, many people are searching for information involving a Reliance Standard lawsuit or a Reliance Standard Disability lawsuit. They are not simply searching for the legal jargon associated with a denial but rather, they want to understand what happens when a disability claim is denied, terminated, delayed, etc. They want clear answers, they want to know if the insurance company has followed the terms of the policy, fairly considered all of the medical evidence submitted, and whether an Employment Law dispute or civil action involving disability benefits will produce a workable result.
This guide breaks everything down in a manner that is very clear and easy to read and contains information regarding how these types of disputes arise, what the legal process entails, what types of things the courts generally focus upon, and what steps will be important to you after receiving a denial.
What is a Reliance Standard lawsuit?
Lawsuits involving Reliance Standard generally involve disputes regarding insurance benefits. Often, these insurance benefit disputes deal specifically with long-term disability coverage and/or life insurance benefits, such as other types of benefit plans offered as part of an employer’s plan. The vast majority of these disputes are under ERISA, the federal law that regulates most private employee benefit plans.
In a nutshell: an individual will submit a claim. The insurance company will review that claim. The insurance company will either deny the claim or terminate the claim. The individual will then take action against the insurance company in court.
This generally encompasses the basic elements of a Reliance Standard Disability Claim lawsuit.
A lot of searchers are not looking for theories; they want to know the answers to specific questions, such as:
- Why was my claim denied?
- Can I appeal a Reliance Standard decision?
- Will the insurer consider my medical doctor’s records?
- Can I sue after my final denial?
- What will happen in court if my appeal fails?
These are the most relevant questions. They go directly to the essence of how these cases are handled.
Why people file lawsuits against Reliance Standard
The majority of the lawsuits against Reliance Standard can be boiled down to only a few problematic situations. The policyholder believes the insurance company made an incorrect determination of their eligibility for benefits. Medical evidence can support this view; however, there can also be confusion about policy wording or the documents that were used in making the determination. In addition, when there is insufficient evidence, the company may take the position that the claimant no longer meets the requirements of being disabled according to the plan definition.
Common reasons these lawsuits happen
Wrongful denial of benefits
This occurs most frequently because a claimant believes Reliance Standard wrongfully denied long-term disability benefits, even though the medical evidence supports their claim.
Termination of previously approved benefits
In some instances, an insurer approves a claim but subsequently terminates the claim. This creates an even deeper frustration than the initial approval process, as the claimant has already been through one round of claims approval.
Disputes over medical evidence
In most cases, there will be divergent opinions between a claimant’s treating physician who believes the claimant is unable to work, versus the insurance company’s physician who believes the claimant should be able to work. The disagreement between their respective opinions often becomes a central issue within the case.
Policy interpretation disputes
There are some disputes that arise from the specific wording of the policy. Definitions are important, but so are exclusions, waiting periods, occupation requirements, and medical requirements.
Bad faith allegations
The policyholder may also claim that the insurer acted in bad faith when he/she delayed payment or denied payment on a claim. These claims can be difficult to prove and generally require substantial proof.
Breach of contract
An insurance policy is also considered a contract. If the insurer does not pay benefits pursuant to the policy, the claimant may assert that the insurer has breached the contract.
Misrepresentation or fraud
Although less frequent, claims of misrepresentation regarding the terms of the policy and/or claims handling may also exist.
Violation of state insurance regulations
Other lawsuits may involve violations of state insurance law or consumer protection statutes, depending on the material facts and type of claim.
Why ERISA matters so much
This is among the most significant pieces of the overall subject matter. Most Reliance Standard disability claims arise from employer-sponsored benefit plans that are governed by ERISA. ERISA sets forth a specific legal obligation for the insurance carrier to provide an explanation of the reasons for denying benefits under a plan and include instructions regarding how a claimant may contest or appeal that determination.
The claimants will typically be required to exhaust the administrative review process of the plan prior to bringing an action in federal court. For this reason, it is important for the claimants to act as quickly as possible to gather complete information concerning their claim, such as a copy of their medical and vocational records, prior to appealing the denial.
The denial letter is more than just a form document – it is the foundation of an appeal. Failure to file an appeal within the specified time frame may result in a claimants forfeit their rights to appeal the denial of benefits. For this reason, individuals who receive a denial should take immediate action to collect the entire claims file and provide significant medical and vocational evidence in support of their appeal.
What courts look at in a reliance standard disability lawsuit
When determining these matters, the court does not base their decision on emotions. The court will have to look at:
- The policy language,
- The denial letter,
- The appeal file,
- Medical records,
- Physician opinions,
- Test results,
- Vocational evidence, and
- The insurer’s review process.
For example, if the insurer has stated that the claimant is able to work then the court may inquire as to why that was said. If the insurer is stating that the policy excludes certain types of injuries then the court will carefully examine those words, if the insurer has failed to consider the evidence from the treating physicians then that may mean something to the court. If the insurer has dependent on incomplete documentation then that may mean something to the court.
One of the best examples of this is found in Hardt v. Reliance Standard Life Insurance Company, where the Supreme Court first dealt with issues of disability benefits and attorneys’ fees under ERISA and whether or not the lower court’s ruling was accurate. This is important because it highlights how scrupulously a court will scrutinize a denial of benefits when the record shows that the Insurer did not conduct a thorough or adequate review of a claim.
This is one reason why so many searchers continue to search for cases involving reliance standard lawsuits, they would like to see examples of cases where the courts supported policy holders. The answer to this question is yes, there have been and continue to be various outcomes for each case, however, courts will reverse or dispute the insurer’s decisions when the record supports the claimant.
The legal process in a Reliance Standard lawsuit
Usually, there is a standard way of going through the litigation process with certain rules and procedures (the formal way of doing things).
1. Filing the complaint
The plaintiff (the person who has made the claim) will file their complaint with the court. The complaint will explain what happened, who was denied their benefits, and what legal basis for the claims has been utilized by the plaintiff.
2. Service of process
Reliance Standard has been served with a copy of the lawsuit. The service is a form of notification to the company, and they are required to respond.
3. Answer and discovery
Once the company has received service of process, they will file an answer, and the discovery period begins. During this time, both parties will exchange relevant documents and other evidence needed for trial preparation. Discovery can be completed through:
- Requests for documents;
- Interrogatories;
- Depositions;
- Reviewing medical records;
- Analyzing the claims files.
Discovery will typically determine how strong of a case you have against Reliance Standard.
4. Motions and settlement talks
Either party may file a motion to dismiss the case or a motion for summary judgment. At the same time, both parties may begin negotiating a potential settlement. Many cases settle during this stage, without having to go to trial.
5. Trial
The matter will go to trial if a settlement cannot be reached. The judge, or jury, will hear all of the evidence and make a decision based on the presented evidence.
6. Appeal
If either party does not agree with the trial court’s decision, they can appeal the decision to an appellate court. The above lists represent the full legal process for many disputes between an insurer and its insured.
Why claim denials happen so often
Many readers want to know the answer to this question. There may not be a single answer to this question, but many different reasons exist for an insurer’s denial of claim or termination of benefits. For example, the insurer may believe medical records do not show a disability, that the claimant has improved from the date of claim submission, that a claimant may do sedentary work, that some psychiatrist, psychologist, or other mental health limitation is preventing them from working, or that the claimant has a pre-existing condition exclusion.
The frustrating part of bodily injury claims is that two different people can look at the same documents and come to completely different conclusions. This is why a denial feels so much more personal than simply being a legal issue; it touches on a person’s livelihood, daily routine, self-confidence, and how they will live in the future. Many individuals search for a way to challenge the insurer’s decision through litigation after receiving a denial or termination letter because they want to know if the insurer has really looked at all the aspects of their claim before making their determination.
What to do after a Reliance Standard denial
If you receive a denial letter from your insurer, the first step is to remain calm and read through it thoroughly. This may seem simple, but it’s very important.
Check these details right away
- What exactly was the reason for the denial?
- What sections of the policy did the insurer rely on to deny the claim?
- What is the time limit to appeal the denial?
- What files did the insurer say it used to make its determination?
- What steps does the insurer require to proceed with an appeal?
The next step is to start constructing your appeal file. The following items are examples of strong supporting evidence you may want to include within your appeal file:
Gather strong supporting evidence
- Current medical records
- Statements from your doctor
- Test results
- Reports from specialists
- Evidence of the functional capacity of the applicant
- Work restrictions, if any
- Vocational evidence, if applicable
Any other documentation that you believe may be missing from the insurer’s original claim file An appeal is often the last opportunity to provide additional documentation for the administrative record before a claim is reviewed by the courts. Therefore, an appeal should be detailed, organized, and thorough.
Finally, do not miss the deadline for appealing the denial. It is critical to adhere to strict timeframes associated with ERISA claims. Once the time limit to appeal the denial has passed, it will be very difficult to pursue the claim.
Why legal help can matter
Each of these circumstances is difficult. There can be a lot of confusing language contained in insurance policies, as well as strict deadlines and technical review procedures. Since the insurance company will develop experience dealing with claims on a daily basis, they usually know how to handle them better than you do.
Therefore, it is recommended that you have an attorney who is familiar with both insurance and ERISA law to assist you in your claim process. Attorneys can provide assistance in the following ways:
- Review denial letter.
- Interpret ambiguous language within insurance policies.
- Collect necessary documentation.
- Prepare your appeal.
- Negotiate with the insurance company.
- File a lawsuit if your claim remains denied.
- Represent you as your attorney in court.
However, not all cases require litigation. Many cases are resolved through the appeal process alone or through negotiation with the insurance company. But, when an unfair claim has been denied by the insurance company, legal assistance can help ensure you receive the benefits that you deserve.
Can a case settle without trial?
Of course. There is a chance that litigation will take a long time and be costly; this is one reason why most disputes are settled or resolved through mediation or other forms of alternative means of resolving disputes. These alternatives are frequently less stressful for the parties concerned than going through a full trial, and they may enable claims to be settled more quickly than if they were litigated.
However, settlement may not always be the best option. In some cases, it may be necessary to proceed to preserve the claimant’s rights. This will depend on available evidence, the applicable insurance policy provisions, and the insurance company’s current position regarding the claim.
What makes a strong reliance standard lawsuit?
There are several elements that most strong cases have in common.
- Medical Evidence is Clear.
- Doctors’ Opinions are Similar.
- The Overall Appeal File is Complete.
- Policy Language Supports the Claimant.
- The Insurer Overlooked or Downplayed Important Evidence.
- The Stronger the Paper Trail, the Higher the Success Rate.
This is why preparation is critical, as most cases are won before they ever reach the Courtroom.
Key Takings
Reliance Standard lawsuits are primarily for denied or terminated insurance benefits or (in most cases) denial of a disability claim through ERISA guidelines. A Reliance Standard disability lawsuit generally involves an analysis of the type of ERISA rules involved, the quality of the medical evidence submitted with respect to each claim, the particular policy language used in the applicable policy of insurance, and the quality of the appeal record.
Some cases will prevail and others will not; the results of these cases can vary significantly from one case to another; however, the process does exist, and individuals with insurance coverage have certain rights.
The best course of action following a denial of a claim is to:
- Read the denial of your claim carefully;
- Meet all deadlines;
- Obtain substantiating evidence (if possible) ;
- Understand how to follow the appeal process.
Additional Resources
- U.S. Department of Labor, Filing a Claim for Your Health or Disability Benefits: This explains denial notices, appeals, and claimant rights under ERISA.
- U.S. Department of Labor, Benefit Claims Procedure Regulation FAQ: This gives a clear overview of the ERISA review and appeal process.
- Hardt v. Reliance Standard Life Insurance Co: A key Supreme Court case involving Reliance Standard and ERISA attorney’s fees.
