If You Can Afford It, Then You Should Only Buy An Individual Disability Insurance Policy
In the case of Fleisher v. The Standard Insurance Company filed in New Jersey Federal Court, the court recently rendered a decision which can have a negative impact for numerous physicians and other business professional that have Group Association Policies and also have an ERISA governed group policy from their employer. Numerous medical, dental, legal, accounting, nursing and other professional associations across the country offer a group disability insurance policy to all of their members. These policies are almost always exempt from ERISA, which is a great, but these association disability policies according to a recent New Jersey Federal Court opinion are not considered individual disability policies and can be considered a deductible source of income against other disability policies. Whenever possible a person looking for disability coverage should buy an individual policy from a licensed insurance agent. The price may be higher, but you always get what you pay for. Disability insurance policies sold by associations can still be good, but the case I will discuss below is a limitation that must be considered when buying disability coverage.
This article summarizes a disability Case where the court was asked to determine whether a “franchise insurance” policy can be considered “group insurance” and thus be used as an offset by the insurance company. Court agreed with Standard that the plaintiff’s other policy can be deducted.
Case Facts
Plaintiff alleges that Standard improperly reduced disability benefits by subtracting benefits he received under a separate policy issued by North American Insurance. Standard claims the deduction was proper b/c the policy provides for the subtraction of benefits received under “other group insurance coverage,” and the North American policy qualifies as “group insurance.”
Standard’s Policy provides that Standard has “full and exclusive authority to control and manage the Policy, to administer claims, and to interpret the Policy and resolve all questions arising in the administration, interpretation, and application of the Policy.” In that regard, Standard’s “authority includes, but is not limited to,… the right to determine: …eligibility for insurance; …entitlement to benefits; …the amount of benefits payable; and… the sufficiency and the amount of information Standard may reasonably require to make those determinations.”
Plaintiff argues that the North American policy, which was issued through the American Association of Endodontics, is most appropriately characterized as “individual insurance,” b/c (1) it was individually underwritten for Plaintiff; (2) Plaintiff paid the premiums directly; (3) Plaintiff “enrolled directly”; (4) Plaintiff submits claims directly to North America; (5) North American issues Plaintiff individual billing statements; and (6) the policy automatically renews at the end of each term.
Plaintiff asserts individual and class claims for breach of contract and breach of fiduciary duty under ERISA.
Insurers have developed two subsets of collective insurance products: (1) Group Insurance: an arrangement by which a single insurance policy is issued to a central entity-commonly an employer, association, or union-for coverage of the individual members of the group; and (2) Franchise Insurance: where all members of the group receive individual policies.
Holding: Because the North American policy bears the characteristics of a kind of collective insurance called “franchise insurance,” and because the phrase “group insurance coverage” can reasonably include franchise insurance, the Court finds no basis to disturb Standard’s interpretation or application of the Standard policy.
The North American policy is certainly not a pure individual policy because it plainly states that it was issued pursuant to a group policy held by AAE. Thus, it was not unreasonable for Standard to conclude the North American policy was not an “individual policy” exempt from deduction.
Resources to Help You Win Disability Benefits
Disability Benefit Denial Options
Submit a Strong Standard Appeal Package
We work with you, your doctors, and other experts to submit a very strong Standard appeal.
Sue Standard
We have filed thousands of disability denial lawsuits in federal Courts nationwide against Standard.
Protect Your Benefits
Get Your Standard Disability Application Approved
We help claimants throughout the entire application process.
Prevent a Standard Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.
Negotiate a Standard Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Standard Reviews
(660)
Policy Holder Rating
5
0%
4
0%
3
0%
2
60%
1
40%
Timely Payments
1.9out of 5
Handling Claim
1.8out of 5
Customer Service
2.0out of 5
Dependable
1.9out of 5
Value
2.0out of 5
Showing 8 of 660 Reviews
Standard
Standard insurance just dropped me with no communication with me.
I was put on Standard insurance by my employer in 2019. I was told by them when I was first on disability that I would be on this for the rest of my life. After 2 years of... read more >
Reply
Standard
Standard is one of, if not the worse, company in the industry now
The Standard changed after the company was acquired by Japanese based Meiji Yasuda Life Insurance Company in 2016 and subsequently being delisted from the US stock exchang... read more >
Standard
Standard is one of, if not the worse, company in the industry Standard hasn't approved or denied my claim in over a year. They keep promising to look at it 'next week'
My husband is covered by a Standard STD/LTD non-ERISA plan. He has a very rare neuromuscular disorder and was hospitalized in intensive care, was off work for 6 weeks (wai... read more >
Reply
Standard
I waited 5 weeks just to be told I can't receive benefits
After working overtime and stressing behind my job for the past 5 years, it resulted in me being diagnosed with retinopathy hypertension, at the age of 29, on 12/10/2018. ... read more >
Reply
Standard
The Standard will threaten to withhold your pay until you sign every document that they send you. The worst part is when they consider back payment for SSDI benefits
First of all, the worst thing that could ever happen to a hard-working person is a permanent disability. Fighting to secure payment is hard enough when you are well. Let a... read more >
Standard
Standard's sudden denial was inexplicable
I was placed on disability by my doctor with a diagnosis of Cognitive Impairment (supported by both a neurologist and a neuropsychologist) which severely affects my abilit... read more >
Standard
Standard has keep me jumping through hoops for years
I have been on LTD with The Standard since September 2011. The have had me jumping through hoops for all these years. Very rude if I call and ask a question. They say they... read more >
Reply
Standard
Mental health LTD should be covered under the Mental Health Parity Act
My company contracted with Standard for our short and long term disability policies. In Jan 2014 I was on STD, which turned into LTD with a waiting period, which was tough... read more >
Answered Questions by Our Lawyers
(28)
Showing 8 of 28 Answered Questions
Q: Do I have to pay back LTD after receiving SSDI?
A: Hello. In most group disability policies there is offset language which states you must pay back any LTD that ... Read More >
Q: Non-taxable benefits have become taxable.
A: I am sorry to hear what you are going through. We have seen you exact fact pattern with tax on ssdi when you w... Read More >
Q: How do I ensure Standard makes a timely decision with regard to my claim?
A: Matthew, we are sorry to hear that you are having difficulty with your claim. While the insurance company does... Read More >
Q: Why can my employer hold my disability check after The Standard sends it to them? Can I file a grievance with them?
A: Lucas, it sounds like your claim for STD benefits is under a policy that is self-funded by your employer. Thus... Read More >
Q: Should I contact you before submitting my application for a private disability benefit?
A: It is in your best interest to contact us as early as possible if you think you are going to need to file a lo... Read More >
Q: Is there any case law in which a state government employee LTD plan decided to drop the 24 month mental health limitation? Has there been any success against a state government and Standard using ADA Title I (employee) and 3 (insurance company) from a discrimination basis?
A: Marie, thank you for your compliments on our website. We strive very hard to get as much information out there... Read More >
Q: How can Standard deny my claim and expect me to work when I am disabled?
A: Debbie, unfortunately this situation occurs often as there are two different departments reviewing your claim ... Read More >
Q: I'm waiting to hear back about my appeal. Should I hire an attorney?
A: Pam, if an appeal has already been submitted there may be very little an attorney could do at this point until... Read More >
Helpful Videos
(910)
Showing 12 of 910 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips
Applying for Standard Disability Benefits? Top 5 Claim Denial Reasons
At Dell & Schaefer, we've helped hundreds of clients recover long term disability benefits from Standard Disability.What should you know about getting your Standard Disability long term disability claim approved?Understanding the Language in Your Standard Disability Policy Is EssentialGetting your long term disability claim approved on the front ... Read More >
How to Prevent Standard Insurance Company from Denying Disability Benefits
If you have an individual or group long term disability policy with Standard, you may assume that accessing these disability insurance benefits will be as easy as filling out the claim form and providing a release for your medical records. But regardless of which insurance carrier holds your policy, the disability process is rarely so simple. The below tips and ... Read More >
Can My Insurance Company Terminate My Disability Benefits After 24 Months if My Mental Nervous Disorder Contributes to But is Not The Sole Cause of My Disability?
The "But For Test"In the case of George v. Reliance Standard Life Insurance Company, The district court held that RSL did not abuse its discretion when it determined that a mental disorder contributed to George's Total Disability. On appeal, George argued that there was no evidence in the record to show that, absent his mental nervous conditions, he was able to earn close to the same amount in another occu... Read More >
Dentist and doctors: beware of the Standard Insurance Company Group's long-term disability policy
The Standard Insurance Company sells multiple different long-term disability policies to dentist and other medical professionals. The difference in each policy is usually the definition of disability. In my opinion, the following definition of Own Occupation Disability sold by Standard is called an Own Occupation definition, but it is not a true Own Occupation policy. The following definition of Own Occupation... 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 >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases
Seven Surgeries and The Standard Still Denies Disability Insurance Benefits
Our client was employed with the State of Oregon as a Technical Support Representative. She sought disability through her employer provider LTD Policy with Standard due to low back, hip, and lower extremity pain. She had two hip, two knee and three back surgeries.After paying her for 1.5 years Standard hired a board-certified neurologist to perform a review ... Read More >
After Two Appeals The Standard Insurance Approves Short & Long Term Disability Benefits for Nurse
Prior to filing for disability, our client was a Registered Nurse employed as a Senior Case Manager for United Healthcare. Our client was a dedicated employee who enjoyed her work until chronic pain, frequent headaches, and resulting cognitive dysfunction forced her to stop working in July of 2018. Fortunately, her employer provided disability insurance coverage under two policies: UnitedHealth Group’s self... Read More >
Standard Approves Disability Benefits to Attorney with Fibromyalgia
Fibromyalgia is a multifaceted illness that can affect every aspect of one’s life. While most people are aware of the debilitating pain and fatigue associated with Fibromyalgia there is a less known symptom of the condition that has as great an impact- memory problems known as “Fibro Fog.” Prior to filing a claim for disability benefits our client was a shareholding partner for a large national law firm ... Read More >
Standard overturns decision to deny disabled Project Manager long-term disability insurance benefits after first Appeal
Terry had worked as a project manager for a large national health group earning over $85,000 annually, until type 2 diabetes left him disabled and suffering from peripheral diabetic neuropathy, severe chronic pain, fatigue and depression.In addition to health insurance and other employee benefits his employer provided long-term disability insurance through Standard Insurance Company, based out of Portland,... Read More >
Another long term disability claim is reinstated after Disability Attorney Alexander Palamara successfully argues The Standard mishandled preexisting condition investigation
Insurance companies often deny benefits based on an inability to complete a preexisting condition investigation without any consideration to the merits of the disability claim. Unfortunately, an insurance company’s inability to complete a preexisting investigation is often due to its own mismanagement of the claim file and lack of due diligence.Prior to becoming disabled, our client worked as a Police Of... Read More >
Standard Overturns Denial of Benefits to Shareholder of Major Law Firm
When Mr. L contacted us he had recently left a major law firm where he had been working for 27 years. Mr. L, a commercial finance and real estate transaction attorney, was forced to stop working due to debilitating symptoms from several medical conditions. He had been suffering from these conditions for several years but his symptoms had gradually worsened over time and eventually reached the point where he wa... Read More >
Disability Attorney Alex Palamara wins LTD Benefits for Police Officer Denied by Standard
Disability insurance companies are always trying to deny disability claims based upon a pre-existing condition.In this claim our client was a police officer in Washington DC and the Standard insurance company denied his long term disability benefits. In this claim we were able to get the Standard disability denial reversed at the ERISA appeal level.In th... Read More >
Standard Overturns Denial of Disability Insurance Benefits
Prior to contacting our office our client had been on disability with Standard due to Ulcerative Colitis and several other serious gastrointestinal conditions for the prior 36 months as Standard had determined she would not be able to perform the material and substantial duties of her prior occupation as an Office Manager. However, with the change in definition to the much maligned “any occupation” standar... Read More >
Disability Lawsuit Stories
(765)
Reviews from Our Clients
