A leader in disability insurance, the company known as The Standard is a subsidiary of StanCorp Financial Group, Inc. The Standard sells individual and group disability insurance plans for both short-and long term disability insurance coverage throughout the United States.
Marc Whitehead & Associates have assisted hundreds of clients in their fight against wrongfully denied disability insurance claims. We routinely represent policyholders in their appeal of The Standard LTD denial of benefits.
Recently, we had the pleasure to assist an over 60 woman from Texas who suffers from lateral ischemia of the heart, hypertension, diabetes and herniated discs in her appeal of a Standard LTD disability denial.
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In their review of our client’s file, administrative appeal to counter every statement The Standard made against our client’s disability status.
Our client’s diagnoses include lateral ischemia of the heart, hypertension, diabetes, lymphedema, shortness of breath and herniated discs. Her medical records also document chronic pain, breathing difficulty, inflammation and limited range of motion.
The “constellation” effect, which is the interaction between her concurrent physical conditions and their combined effect on her level of disability, appears to have not been considered by Standard in its determination of her ability to work.
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Our Disability Lawyers Dismantle The Standard LTD Denial Tactics
Our client experienced shortness of breath and severe leg edema due to her congestive heart failure. She is unable to walk long distances due to this medical condition. She is under medical management for her heart failure, diabetes mellitus, and hypertension. But due to a lack of medical insurance, she has not been able to seek further treatment, especially a cardiologist.
This is something that affects many of our clients and unfortunately is used as a tool by insurance companies to try and prove that a person is not disabled. The insurance company may state that because a person does not visit the doctor on a regular basis, they must not be disabled.
This could not be farther from the truth when a person’s disability and inability to keep steady employment has caused financial hardships.
Treating Physician’ Statements Aided in Appeal Argument
The Standard ultimately did not consider the totality of our client’s conditions; neither did The Standard appear to have otherwise considered the cumulative impact of her conditions.
Failure to consider the totality of her conditions weighs in favor of finding The Standard’s decision to terminate her benefits arbitrary and capricious. The Standard’s reports did not convey explicitly that The Standard has considered the interactions among her conditions, which may well be greater than the sum of their parts.
The records we submitted in our client’s appeal, specifically containing her treating physician’s opinion, clearly contradicted Standard’s determination. Our client’s impairments preclude the performance of her own occupation, and further of any work at all. Rather than rely on the opinions of treating physicians, The Standard has presumably supported its conclusions with the opinion of non-treating consultants.
Our comprehensive appeal contested each of The Standard’s determinations that our client was “not disabled.” We proved that she does not retain a residual functional capacity (“RFC”) that would allow for the performance of any occupation even at the sedentary level.
Standard’s decision to close our client’s claim constituted an incorrect determination and was counter to federal law.
The Standard’s Vocational Analysis of Our Client’s Disability is Unreasonable
In some cases an insurance company will have a “Physician Consultant” review the medical records of a person seeking long term disability benefits. This Consultant is paid by the insurance company and is therefore more than likely to side with the insurance company’s view of a particular claim.
The Standard had a Physician Consultant review our client’s claim previous to their denial of benefits. This Physician Consultant confirmed that our client suffered from shortness of breath and severe peripheral edema.
The Consultant then offered an accommodation that is not available in most competitive work environments. He suggested that our client elevate her legs at least 30 degrees for 30 minutes at a time. This amounts to extra unscheduled work breaks. He also suggests she give up her lunch break to elevate her legs. That is unreasonable.
Our appeal also pointed out that The Standard cannot rely on a traditional analysis of a claimant’s age, training and experience because of our client’s unique circumstances. We proved that The Standard must take into account all of our client’s circumstances such as her age and vocational experience.
We concluded our appeal with this point:
Within the parameters and exhaustive medical documentation we provided, the phrase “any occupation” in the context of The Standard’s plan may not reasonably be read as terminating benefits to a person who is physically capable of any employment whatsoever, so long as it earns a nominal profit. Instead, “Any Occupation” must fall within a percentage of the person’s previous salary and must be in an employment range that corresponds to the education, vocation, and experience of the person being considered.
Our appeal was received by The Standard and within a short timeframe, the previous Standard LTD denial was overturned and substantial disability benefits were awarded to our client including back due benefits.
Attorneys for The Standard Disability Claims
We represent claimants at all stages of the disability claim process. Be sure to view our Long Term Disability Videos for tips about beginning a disability insurance claim, how to appeal a denial, insurance company denial tactics and much more.
If you need help today, call us at 800-562-9830 for a free case evaluation.
