How do you file a Long-Term disability claim with The Standard?
How do you file a Long-Term disability claim with The Standard?
Author: Attorney Lonnie Roach
The Standard Insurance Company, now known as The Standard, is a subsidiary of StanCorp Financial Group and provides insurance and financial products.
Headquartered in Portland Oregon, The Standard was founded in 1906 by Leo Samuel, a German immigrant, as Oregon Life Insurance.
At that time the Northwest was experiencing an economic boom due to abundant natural resources and most insurance companies were located on the east coast. Samuel recognized the dangers in the timber industry and the need for loggers to have insurance in case of injury or illness. The company changed its name to Standard Insurance company in 1946.
The Standard now has 40 offices across the United States and $27.74 billion in total assets.
With approximately 3,000 employees it serves approximately six million customers in 50 states, the District of Columbia, and the Territories of Guam and the Virgin Islands. Best’s Review recognized The Standard in July 2017 for maintaining an “A” rating or higher since 1928 – more than 75 years.
The Standard’s suite of insurance and financial products include:
- Group life
- Group disability
- Individual disability
- Group dental
- Group vision
- Group accident, critical illness and Hospital insurance
- Retirement plans
- Absence management services
Short term disability is designed to pay benefits for a short period of time due to covered illness, injury, pregnancy or mental disorder and replaces a portion of an individual’s weekly income.
Group long term disability provides a monthly income for a covered illness, injury or pregnancy. Individual disability insurance, promoted by The Standard in its Platinum Advantage plan, allows a person to choose benefits to meet individual needs through different policy riders.
If you have been denied disability benefits don’t give up! Contact a Disability lawyer at 512-454-4000 for a free consultation and get the benefits you deserve.
Family Care Benefit:
The Family Care Benefit allows you to take time away from work to care for a child, parent or spouse with a serious health condition and provides a monthly benefit for an income loss of 20 percent or greater.
Own Occupation Rider:
The Own Occupation Rider is designed to provide coverage if you become disabled and are unable to perform the substantial and material duties of your regular occupation, even if you can work in another occupation for wage or profit.
Automatic Increase Benefit:
This rider automatically provides basic monthly benefit increases of 4 percent each year, for six consecutive years, without evidence of insurability
The Benefit Increaser Rider gives you the option to purchase additional coverage once every three years on your policy anniversary, without going through medical underwriting.
Residual Disability Rider:
The Residual Disability Rider provides a benefit if you are residually disabled, rather than totally disabled, based on loss of income, duties and/or time.
The easiest way to file a claim under an individual disability policy, is to call The Standard at 800.628.9797.
You may also send written notice by fax or mail and The Standard will mail you a claims packet. After receiving the completed forms, company staff will contact you and inform you about the status of your claim.
For Group short term and long-term disability claims can be filed online, faxed or mailed.
Claim packets for both long term and short-term disability can be found on the company’s website and include the following forms:
- Employee’s Statement
- Employer’s Statement
- Attending Physician’s Statement
- Authorization to Obtain and Release Information.
You are responsible for sending all completed forms to The Standard.
Report a claim as soon as you believe your absence from work will extend beyond the benefit waiting period as stated in your policy. A claim may be reported up to four weeks in advance of a planned disability absence, such as childbirth or a scheduled surgery.
When an STD claim is filed, it takes approximately one week to make a decision.
If a decision is not made within one week, the claimant will be contacted for additional information. Short Term Disability benefit payments are usually paid on a weekly basis for the previous week. Benefit payments for a claim that is approved for a date in the past are mailed immediately following the claim’s approval.
If you file an LTD claim, a benefits analyst will contact you in approximately one week to complete processing your claim, request any further information, and answer questions.
If you reach the maximum benefit period on your STD claim and need to apply for LTD benefits, you do not need to file a new claim. The Standards uses all of the information from your STD claim in making a LTD benefits decision and will follow up with you, your doctor, and employer for additional information.
Long Term Disability benefit payments are paid for on a monthly basis for the previous month.
Benefit payments for a claim that is approved for a date in the past will be mailed immediately following the claim’s approval. Claims are monitored continuously and updated medical information is requested as necessary. If the status of your claim changes, you will be notified immediately.
Most long-term disability policies are provided by or purchased through an employer and are governed by The Employee Retirement Income Security Act or ERISA which requires a claimant to “exhaust administrative remedies” before filing suit.
If a claim is denied, claimants have 180 days to appeal and insurers have 90 days to consider the appeal which equals 270 days a disabled person is without income. ERISA permits insurers to administer their own plans and a denial can only be reversed by demonstrating that the insurer abused that discretion – which is very difficult to do. If an internal appeal is denied, filing suit in U.S. District Court is a claimant’s last option.
It is important to note that some of the Standard group disability policies are not governed by ERISA if they are sold to an organization such as a medical society.
A disability policy offered through a group in which the policyholder is not an employee of the group, would be ERISA exempt. A disability claimant is entitled to full discovery and a jury trial if their policy is exempt from ERISA.
A Standard Claim:
A Fort Worth client’s physician certified that she suffered from “constant neuropathic pain.” The same physician also certified that her condition would impair her for the remainder for her life, that she had regressed, and that he never anticipated a fundamental or marked change in her condition. The doctor did not anticipate that the client would ever be able to return to work. These conclusions were supported by two other physicians, but The Standard chose to deny her claim. We were able to get her a lump sum settlement.
The Standard employs well qualified claims examiners and reviews all of their disability claims very closely before making a determination. They also have a network of physicians and medical providers to evaluate claims as well as in-house vocational rehabilitation consultants. That is why it’s important to have a qualified attorney with extensive experience in LTD disputes and ERISA to organize and manage your case. Partner and long-term disability attorney Lonnie Roach of Bemis, Roach & Reed has successfully overturned denials of disability benefits at the administrative level, in United States District Court, and at the United States Court of Appeals. Presently Lonnie represents clients who have been denied or lost insurance, long term/ ERISA or Social Security disability benefits in all four federal districts in Texas. If you have been denied long term disability benefits, Bemis, Roach & Reed offers a free consultation to determine if we can assist you in obtaining or reinstating those benefits. Call 512-454-4000 and get help today.
ERISA – Employee Retirement Income Security Act
ERISA Long Term Disability Claim and Appeal Process
Author: Attorney Lonnie Roach has been practicing law for over 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion rated by Martindale Hubbell. Through his extensive litigation Mr. Roach obtained board certifications from the Texas Board of Legal Specialization. Lonnie is admitted to practice in the United States District Court - all Texas Districts and the U.S. Court of Appeals, Fifth Circuit. Highly experienced in Long Term Disability denials and appeals governed by the “ERISA” Mr. Roach is a member of the Texas Trial Lawyers Association, Austin Bar Association, and is a past the director of the Capital Area Trial Lawyers Association (Director 1999-2005) Mr. Roach and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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