FRESNO, CA – There is a disturbing trend in denied disability claims by The Standard.
If you’re a member of the CTA, California Teacher’s Association, or other group disability insurance policy member, you need to know what to look for and how to fight it. Especially if your disability benefits have been denied or terminated by The Standard.
The Standard Insurance Company (“The Standard”) is a Portland, Oregon-based company which issues group disability policies throughout the country. They also have a New York subsidiary which issues policies in New York state.
One common feature of The Standard’s denial and termination letters in claims for disability benefits is disturbing. They sound very reasonable, but I think it’s deliberately vague. They’re using double-talk to confuse claimants.
Here is an example.
The Standard has, for many years, issued a group disability insurance policy to the California Teacher’s Association. By being members in the CTA, thousands of California teachers are eligible to get group disability benefits from The Standard. Sounds like a wise move in case they somehow becomes disabled and unable to work.
The policy defines “Totally Disabled” from the usual occupation as, “If, as a result of sickness or injury, you are unable to perform with reasonable continuity, the substantial and material acts necessary to pursue your usual occupation and you are not working in your usual occupation.”
The Policy also explains that the claimant is required to submit a “Notice of Claim.” The Standard will provide forms for the claimant to submit their notice. Plus the claimant is required to provide completed claims statements, a signed authorization to obtain information, and any other items that The Standard may reasonably require in support of a claim.
The Policy allows The Standard the right to have the claimant examined (find out more about Independent Medical Examiners here.)
Finally, the policy states that it is the entire contract.
NOWHERE IN THE POLICY DOES THE POLICY STATE THAT THE CLAIMANT IS REQUIRED TO PROVIDE MEDICAL EVIDENCE
Here’s where The Standard’s disability claim double-talk begins.
One of my clients could sadly no longer do his job as an elementary school teacher for a variety of medical conditions and submitted a claim for benefits to The Standard. He completed all the forms required by the policy.
The reply? A denial. Full of The Standard’s “double-talk.”
They wrote that, “although your physicians may have indicated that you were unable to work, we must rely on written evidence to document impairment. We must consider the medical evidence and/or lack of medical evidence and the medical opinions of the Physician Consultants and independent physicians in our review to help evaluate conflicting and/or insufficient information. Opinions about disability status must supported by medical evidence such as doctor’s progress notes, physician observations, specialist examinations, test results, medication dosages/changes in frequency or treatment. . . .”
While all of that certainly sounds reasonable, none of it is true.
Their own policy does NOT require medical evidence such as doctor’s notes, exams, tests, etc.
There is simply nothing in the policy that The Standard issued to the California Teacher’s Association that says or requires any of that!
Instead, the policy incorporates well-established rules of California disability insurance law. For an own occupation claim, California law and The Policy issued to the California Teacher’s Association requires an insurance company to consider:
- whether the claimant could reasonably be expected;
- given the claimant’s physical and/or mental capacity;
- and his station in life;
- to perform the “substantial and material” duties of his own occupation; (5) with reasonable continuity; and (6) in the usual and customary way.
Those are the questions The Standard is required to ask and answer under the policy it issued to the California Teacher’s Association. The Standard did not consider those questions or the extensive information my client provided. Instead, as stated, it simply denied my client’s claim, justifying that denial with reasons that have nothing to do with the policy requirements for benefits or the facts!
Other Standard policies have other terms and conditions. So the special brand of double-talk in that denial will be different.
If you’ve been denied your disability benefits and given a load of The Standard’s double-talk and denied disability benefits, call my office right now and we’ll work to straighten them out and get you the benefits you deserved.