Reliance's Termination of Disability Benefits was Arbitrary and Capricious When it Discounted Supporting Medical Evidence Without Reason
In Leo Noga v. Reliance Standard Life Insurance Company (Reliance), Plaintiff, a financial advisor with Fulton Financial, stopped working on February 27, 2015. At the time, he was covered under a disability insurance policy issued by Reliance. The terms of the policy granted Reliance the discretion to determine benefit eligibility. Those covered must submit satisfactory proof of total disability in order to qualify for long term disability (LTD) benefits.
Total disability as defined by the policy means that as a result of an injury or sickness, the insured “cannot perform the material duties of his/her Regular Occupation.” The Regular Occupation is defined as the occupation the insured “is routinely performing when Total Disability begins.”
Although Plaintiff’s job as a financial advisor with Fulton was sedentary, it also required him to stand or walk for brief periods and required him to drive to client meetings. He applied for total disability benefits based on the diagnoses of neurogenic muscular atrophy, diabetes, hypothyroidism, and hypertension. He had “leg weakness” and he reported to Reliance that “I cannot drive to work, can’t stand, walking limited.”
On August 25, 2015, Reliance approved Plaintiff’s claim for total disability benefits. The approval was based on Plaintiff’s medical records that were reviewed by its in-house medical reviewer, Nurse Finnegan. In addition, Reliance management reviewed “this matter” and agreed that Plaintiff was entitled to total disability benefits.
On August 15, 2017, Plaintiffs file was referred for review to another member of Reliance’s medical staff, Nurse Moore. She recommended that Reliance obtain pharmacy records and “medical records from all actively treating providers.”
The additional records were reviewed by Nurse Vicho, who noted Plaintiff suffered from “persistent diabetic neuropathy on lower legs along with contained painful left shoulder following rotator cuff repair. Co-morbid with chronic fatigue, poor endurance and obesity.”
Nurse Moore requested an independent medical examination (IME) which was conducted by Dr. Kline who concluded that Plaintiff exaggerated his symptoms and would be capable of gainful employment with some restrictions.
Based on Dr. Kline’s report, on December 27, 2017, Reliance notified Plaintiff that his total disability benefits were terminated. On January 2, 2018, Plaintiff appealed the termination and submitted additional medical records. In January and February 2018, he was evaluated by three treating physicians. All opined that Plaintiff could not work.
Reliance had another member of its medical staff, Nurse Toth, review the new medical records. She concluded that Plaintiff could not work due to his “multiple symptoms related to his neuropathy.” Based on this opinion, on March 22, 2018, the claims manager, Jamil Jackson, informed Plaintiff the decision to terminate benefits was overturned and benefits were reinstated effective December 27, 2017.
One day later, On March 23, 2018, Jackson requested two peer reviews of Plaintiff’s medical records. Dr. Brathwaite, Board Certified in Internal Medicine, issued an opinion on April 4, 2018, that Plaintiff’s diabetes was well-controlled, but she deferred giving an opinion on whether his diabetic peripheral neuropathy affected his ability to work.
Dr. Ayyar, Board Certified in Occupational Medicine, reviewed the medical file and concluded that although Plaintiff suffered from peripheral neuropathy and lower extremity neuromuscular dystrophy, the conditions were not severe enough to keep him from working.
Based on the peer review report by Dr. Ayyay, on May 18, 2018, Reliance informed Plaintiff that its prior decision to terminate benefits was appropriate. Plaintiff then filed an ERISA lawsuit.
The United States District Court for the Eastern District of Pennsylvania held that “After a thorough examination of the administrative record, I find that Reliance acted in an arbitrary and capricious manner when it denied [Plaintiff’s] disability benefits.”
Standard of Review: Arbitrary and Capricious
Relying on precedent, the Court noted that the deferential standard of review applied to this case which means the Court “is not free to substitute its own judgment for that of the defendants in determining eligibility for plan benefits.” But, “irregularities in the review process cast doubt on the administrator’s impartiality.” A few procedural “anomalies that suggest arbitrariness include:”
- Reversing a decision to award benefits without new medical evidence to support the change.
- Relying on opinions of non-treating over treating physicians without providing reasons.
- Conducting self-serving paper reviews of medical files.
The Court stated that “In determining whether a benefits determination is arbitrary and capricious, the court must evaluate whether the determination was reasonable. After a review of the administrative record, I find Reliance’s benefits determination was not reasonable and therefore, was arbitrary and capricious.”
Evidence Supporting Court’s Decision that Reliance’s Denial was Arbitrary and Capricious
Reliance rejected, without reasons, “the opinions of its own nurses and claims manager regarding [Plaintiff’s] disability and rejected the opinion of [Plaintiff’s] treating physician and its nurses without explaining the justification.”
The Court was particularly concerned that just one day after Reliance relied on the conclusion of its employee, Nurse Toth, that Plaintiff could not function on any work level and reinstated his benefits, the claims manager sought another peer review. The Court inferred that “reliance was seeking an opinion that would allow them to overturn the decision to reinstate [Plaintiff’s] benefits.”
The Court concluded that the appropriate remedy for the arbitrary and capricious actions of Reliance was to retroactively award benefits and stated, “I find as of December 27, 2017, the date his benefits were terminated [Plaintiff] was totally disabled.”
The Court also ordered Reliance to pay prejudgment interest as part of Plaintiff’s benefit award.
This case was not handled by our office, but we think it can be helpful for those who have had their benefits terminated shortly after they were reinstated. If you have questions about this case, or any questions about your own disability claim, contact one of our disability attorneys at Dell & Schaefer for a free consultation.
Resources to Help You Win Disability Benefits
Disability Benefit Denial Options
Submit a Strong Reliance Standard Appeal Package
We work with you, your doctors, and other experts to submit a very strong Reliance Standard appeal.
Sue Reliance Standard
We have filed thousands of disability denial lawsuits in federal Courts nationwide against Reliance Standard.
Protect Your Benefits
Get Your Reliance Standard Disability Application Approved
We help claimants throughout the entire application process.
Prevent a Reliance Standard Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.
Negotiate a Reliance Standard Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Reliance Standard Reviews
(660)
Policy Holder Rating
5
0%
4
0%
3
0%
2
57%
1
42%
Timely Payments
1.8out of 5
Handling Claim
1.9out of 5
Customer Service
2.2out of 5
Dependable
2.0out of 5
Value
2.0out of 5
Showing 8 of 660 Reviews
Reliance Standard
Short Term Disability Claim/Inconsistent to NO Communication
When I did call & reach a live person they were kind & helpful. The person assigned to my claim left one phone message & I have not spoken to her since. Information she re... read more >
Reliance Standard
Staff Lie
I had my disability cut off the day I was scheduled to find out whether I should have surgery. The claims examiner was aware that I had an appointment on that date and sai... read more >
Reply
Reliance Standard
Reliance Standard denied my LTD benefits because COVID-19 limited my ability to provide proof of continued disability.
Hello, I have a LTD policy with Reliance Standard and it has been paid (considered disabled) for 14 plus years. However, due to limited doctors visits / records this past ... read more >
Reply
Reliance Standard
Reliance Standard cut off my LTD benefits claiming I'm fit enough to work even though I'm more sick than before.
It should be criminal that this company treats sick people like this who just want PTO be left alone! I received a call from Reliance on 7/6/20 cutting me off after 1 year... read more >
Reply
Reliance Standard
Reliance Standard notified me that my benefits were being stopped with no warning or reason.
Horrible company! Phoned me on June 4th to let me know that I would no longer be receiving benefits as of June 3rd. Just like that! No questions asked and no info given!
Reply
Reliance Standard
I was receiving LTD from Reliance Standard due to breast cancer until they suddenly denied me my benefits.
I was diagnosed stage 2 breast cancer June 2015 and went out on std with Reliance. Within 4 months following my status changed to stage 4 with Mets to my spine. STD conver... read more >
Reply
Reliance Standard
Reliance Standard never answers or returns my calls, has not provided me my benefits, and falsely claims I never provided necessary paperwork.
I have been on STDI since April 28th, 2017 and I have only received what they say is a “courtesy payment” because they know the hardship which I am facing. I call mult... read more >
Reply
Reliance Standard
Reliance Standard is unreasonably prolonging the transition from STD to LTD for my boyfriend.
In August 2016 my boyfriend was placed on disability by his family physician. A short background, he is a type I Diabetic since age 4 and had to have multiple lumbar back ... read more >
Reply
Answered Questions by Our Lawyers
(25)
Showing 8 of 25 Answered Questions
Q: Are VA disability payments considered “other income” by Reliance Standard?
A: The disability policy may allow Reliance Standard to deduct and offset your monthly benefit payment by your VA... Read More >
Q: Denied short term disability and need to file for long term with same insurer
A: We would be more than happy to speak with you and review your denial letter and policy and discuss how we can ... Read More >
Q: Will Reliance Standard reduce my LTD payments due to my pension benefits or rental income?
A: ARH, I am happy to hear of your LTD approval, though I am sorry to hear of your medical conditions. The LTD po... Read More >
Q: Why is Reliance Standard trying to recover payments I was awarded through another company?
A: Dani, your disability plan may contain a provision which allows Reliance to claim and recover an overpayment o... Read More >
Q: Do I have to provide additional proof of my disability that's specifically requested by Reliance Standard?
A: Fred, I am sorry to hear all that you have been through medically and in dealing with Reliance Standard. Unfor... Read More >
Q: How do I access a copy of my STD policy with Reliance Standard?
A: Vicki, I am sorry to hear the trouble you are having with the Standard. It seems they are certainly make thing... Read More >
Q: If I'm not receiving the SSDI benefits for my children from Reliance Standard due to custody, should my SSDI benefits increase?
A: Bill, it depends on terms and conditions relating to “other income benefits” and “offset” under your f... Read More >
Q: How can Reliance Standard not coordinate with both of my disability insurance policies?
A: Jerry, you will need to review your RSL policy to determine what it deems to be a source of “Other Income”... Read More >
Helpful Videos
(910)
Showing 12 of 910 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips
How to Apply for Reliance Standard Disability Benefits & Top 5 Reasons for a Claim Denial
At Dell & Schaefer we’ve handled hundreds of long term disability insurance claims against Reliance Standard, and have learned a few things in the process. When you’re experiencing an injury or illness that makes it difficult (or impossible) to work, it can be tempting to file a claim as quickly as possible – but unless a claimant has all their ducks in a row, this could actually delay the ultimate r... Read More >
Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?
When it comes to securing your disability insurance benefits, it's vitally important that your disability insurance lawyer thoroughly understands the symptoms and impact of your disabling condition. Doctors can help you create strong medical records, but they're not accustomed to dealing with the rigorous documentation disability insurance companies require. Lea... Read More >
Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak
If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >
Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company
When you're seeking disability insurance benefits, your medical records and treating physician's statement are two of the most important components of your claim. But because the insurance company has a vested interest in denying your disability insurance claim, it often will rely on tactics like ambushing your doctor with a phone call in an attempt to get them ... Read More >
Disability Benefit Denial Reason #3 - Video & Social Media Surveillance
One thing many disability insurance claimants don't know about (or expect) from the claims review process involves video and social media surveillance. Disability insurance carriers often hire people to follow claimants around with a telephoto lens - or even send social media friend requests from fake accounts - to glean whatever information they can about the c... Read More >
How Do You Fight a Long-Term Disability Denial?
Getting a denial letter from your disability insurance company is one of the ultimate insults. You are sick and not able to work, yet your disability insurance company is telling you to return to work. The disability insurance company has denied your disability benefit claim and is basically calling you a liar. When receiving a disability denial letter or a ph... Read More >
Disability Denial Reason #2 - Change of Disability Definition & Vocational Review
One of the top reasons for terminating a claimant's long term disability benefits involves the change in the disability insurance policy's definition of "disability." This definition change often happens in conjunction with a vocational review, or an analysis of a claimant's medical records that tells the insurance company which jobs the claimant should be able ... Read More >
Disability Denial Reason #1 – Paper Review & IME
At Dell Disability Lawyers, we've seen insurance companies give countless reasons to deny long term disability benefits. However, most disability benefit denials tend to fall into one of a few categories - and one of the biggest ones is the paper review and independent medical exam (IME). Learn more about what this review process entails and what your claim file... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases
How does Reliance Standard deny long term disability benefits after paying for three years?
A former Payroll Manager for Solairus Aviation, a large Private Jet Charter and Aircraft Management Company was significantly injured in a serious motor vehicle accident which occurred on June 26, 2017. This accident changed her life forever. Due to the accident, our now client suffered from a traumatic brain injury which led to diagnoses such a post-concussi... Read More >
Reliance Standard overturned its previous denial of long term disability benefits for Texas Retail Store Manager
Our client, Mr. S, formerly worked as a Store Manager for a large national retail chain. In August 2016 Mr. S suffered from multiple Transient Ischemic Attacks (“TIAs”) or mini-strokes which left him with debilitating physical and cognitive impairments. Mr. S made several attempts to return to work failed but continued to suffer slurred speech, headaches, pressure in the back of his head and memory loss, h... Read More >
Reliance Standard overturned LTD denial for Tennessee Technology Sales Consultant
Our client, Mr. L, formerly worked as a Sales Consultant for a global technology company. In September 2014 a number of medical issues following an ischemic stroke forced Mr. L to stop working and submit his claim for disability benefits under his employer's long-term disability (LTD) policy, which was funded and administered by Reliance Standard. Under his employer's disability policy he would be considered t... Read More >
Reliance Standard overturns decision to deny long-term disability benefits to Paediatrician with Ovarian Cancer
Prior to her disability Dr. Julie worked as a pediatric physician for a nationally recognized health system based in Florida. In 2015, Dr. Julie received a diagnosis of ovarian cancer and underwent a total abdominal hysterectomy and chemotherapy. Although the chemotherapy and treatment likely saved her life, she remained suffering from residual neuropathy in her hands and feet, as well as chronic and severe fa... Read More >
Reliance Standard reinstates disability benefits to Project Manager
Our client, a former Senior Project Manager for a national corporation, was receiving long term disability benefits from Reliance Standard due to debilitating chronic pain stemming from a multitude of lumbar and cervical spine disorders. Reliance Standard initially approved his claim for short term disability benefits and without issue approved his claim for long term disability benefits once the period of sho... Read More >
Reliance Standard Reinstates Benefits for Former Employee of Parent Company, Delphi Financial, Following Successful Appeal
Our client, Ms. L, formerly worked as a National Account Manager for Delphi Financial Group, the parent company of Reliance Standard Insurance Company. In 2015, a number of medical issues, namely, chronic daily pain, sleep difficulties, fatigue and cognitive and memory impairments forced Ms. L to stop working and submit her claim for long-term disability benefits. In addition to these symptoms her doctors susp... Read More >
Reliance Standard Overturns Denial of Benefits on Appeal After Claiming It Failed to Receive Medical Records
Ms. L was employed as a registered nurse when she was diagnosed with anterior ischemic optic neuropathy, optic atrophy and visual field defect. Her employer, a large medical healthcare system, provided Ms. L and its other employees group long-term disability insurance through Reliance Standard Life Insurance Company ("Reliance Standard"). In 2014 Ms. L's vision degraded so severely that her doctors diagnosed h... Read More >
After sending claimant to a psychiatric IME, Reliance Standard realizes its decision to deny benefits was incorrect
Reliance Standard Incorrectly Denies BenefitsThe claimant had been suffering from severe depression and anxiety due to many stressors in his life including a child custody battle which threw him into major depression and severe anxiety preventing him from being able to work in his occupation as an engineer. The claimant contacted Dell Disability Lawyers to assist him with his appeal as he did not believe h... Read More >
Disability Lawsuit Stories
(765)
Reviews from Our Clients
