Applying for disability benefits with the Standard is a stressful process, especially if you’re not sure whether you’ll be approved. Insurance companies often seem to speak their own language – what steps should claimants (and their attorneys) take to get their long term disability claim approved? Read on to learn some of the tips the disability insurance attorneys at Dell & Schaefer have learned while helping thousands of our clients recover long term disability benefits from Standard.

GREGORY DELL: Hi, I’m attorney Gregory Dell. And I’m here with attorney Steven Jessup. And today we’re going to talk about The Standard. And specifically, we’re going to talk about how to apply for long-term disability benefits with The Standard, and based upon our years of experience of handling tons of claims on behalf of claimants against The Standard, providing tips and guidance for how to get approved and kind of what to expect as well.

Now Steve, you know we’ve helped hundreds of people to apply. And that’s a service that we offer. And we encourage you to contact us for a free consultation in which we’ll review your disability policy and let you know all of your options.

It Is Essential To Understand the Language in Your Standard Disability Policy

But today in this video, we want to share some of our experience and things that you should be aware of that could help you to get approved and obviously avoid a potential denial. So I want to get into first, obviously, someone calls you, you’re going to say, send us the policy. And why is it so important for not only us, but for the claimant to understand what’s in that policy moving forward?

STEPHEN JESSUP: Well, policy language is going to dictate everything that’s going to happen with your claim. And interesting too, Standard is one of the few insurance companies that does private individual disability policies as well as ERISA group disability policies. So it’s good to know what you’re working with. The laws are going to be different.

But we’re going to assume that most people call us, it has to do with an employer-provided group policy. And that policy language is very, very important to a claim, because Standard does right some of the most restrictive policies in the market, to tell you the truth. So you know, they’ll pigeonhole, depending on your policy language, a vast majority of medical conditions to sometimes as low as 12 months of maximum benefit payouts or 24 months. So it’s really good to know what exactly your coverage is.

GREGORY DELL: So let’s talk about some of those things, because it’s supposed to be long-term disability. And Standard’s a very savvy company. I mean, they’re smart, but they’re an insurance company. They’re in business to make money and sell policies.

We’ve seen the evolution of their policies over the last 15, 20 years. And it seems like they’re trying to get to the point where we only intend to pay certain claims for a period greater than 12 or 24 months. So what are some examples of these limitations that someone who Standard agrees is disabled, but limits them to 12 or 24 months?

STEPHEN JESSUP: Well, I think the biggest one that’s in almost every disability policy, 99% of the policy we’ll see, is a mental health limitation. That was the first of the big ones. Mental health and substance abuse were usually limited to 24 months of benefits. That’s very standard in the industry.

And then slowly they started to add a lot more medical conditions to that list. You know, I’ve recently pulled The Standard policy for one of my clients. And the limitations include a musculoskeletal and connective tissue disorder which includes things like fibromyalgia, myofascial pain, arthritis, carpal tunnel, chronic fatigue syndrome.

So any of those, whether it be from Epstein-Barr, post-viral syndrome, a lot of these common things we’re starting to see, and even chemical and environmental sensitivities, sick building syndrome, mold toxicology– so there is a plethora of conditions that we see that lead to disability that they’re saying essentially in their policy provisions, like, yeah, we understand that you’re disabled, but we only have to pay you for x amount of time. There are some restrictions or limitations that would take your condition outside of that. That’s why it’s important to know what your policy covers and then what your doctors are representing from a medical standpoint to make sure it’s there. If you go to your doctor and you just say, hey, my back’s been hurting me and the doctor writes myofascial pain, chronic pain in the back, you could be very well limited to anywhere from 12 to 24 months of a total payout, whereas if you had EMG or nerve conduction study that evidence to ridiculopathy, you could get yourself around that restriction.

So knowing what you’re walking yourself into is really important, because you’re right. a lot of people think, hey, this is long term. It’s supposed to cover me until I’m age 65 or my social security normal retirement age. But in a lot of ways, it’s just a long short-term policy, if you will. So it’s really important to know what they are going to take a look at and how it could affect you going forward.

Doctor Support Must be Strong and Consistent For Disability Claim Approval

GREGORY DELL: So a lot of claimants call. And the first thing you ask them when they’re applying is, do you have doctor support? And usually they’ll say, yes, you know, I have doctor support. But explain why it’s so much more than just my doctor says that I’m disabled.

STEPHEN JESSUP: Well, a lot of times we’ll see– you know, people will contact us after their claim has been denied. And they’ll say, oh, here is some medical information they’ll send over. And it’s like on a prescription pad where the doctor says out of work until a date.

And then when we look at the medical records, there is really no indication of what the person’s problems are, if things are getting worse, how it’s impacting work. So the doctors may say, yeah, they’re willing to help you out, but they’re not necessarily documenting your file, which is common. Doctors aren’t documenting the file for the purpose of an insurance company. They’re doing it for your treatment. But when there is even an idea there may be a disability claim, it’s very important the doctor’s documenting properly, and then also when completing forms, is completing those forms properly.

So you may have the doctor support. The doctor may agree you can’t work. But at the end of the day, Standard is going to live and die by what’s in your medical records. That’s what’s going to be the objective evidence to them. Anything outside of that, they take at a lesser level of evidence, if you will.

GREGORY DELL: So one of the things you said is that doctors aren’t documenting for the insurance company, which is absolutely true. They’re just documenting to remind themselves of what they did there, the patient’s progress, because doctors want to get the patient better, obviously. Completely different than the way Standard– and Standard is really well-trained, and has their own medical team, and nurses, and outside consultants. And they take advantage of that fact that the doctors aren’t doing this for them. And so any weaknesses or things that are left out, Standard is going to pick out every single one of them and say, we don’t see these five things in there, when they probably exist, but the doctor didn’t put them in there.

So one of the valuable things about having us work with a claimant that makes it easier is that the doctors know that these disability insurance companies can be difficult to deal with. So when a claimant goes in and says, hey, I’m working with a lawyer. His name is Steve. And he’s been dealing with The Standard and these companies for a while.

He suggested the following. It’s kind of like an intermediary where the claimant can explain, look, I need this for my income. I can’t work. And I can’t afford this get screwed up.

And my lawyer has told me that this is what needs to be there. Would you be willing to cooperate so that these things are– please make sure this is in there. Please complete this attending physician statement in this manner. And that’s difficult for a claimant to go in on their own and have that conversation with a doctor.

STEPHEN JESSUP: A lot of people are kind of shy to have that conversation. They’ll always ask, you know, how do I approach my doctor with this, even? You know, some people are even, whether it be pride or denial– they don’t want to believe that their time of workings coming to an end because of this condition. So they’ve never been candid with the doctor. So you’re right in the sense that, when there is a lawyer involved, it’s almost like the patient can deflect onto the lawyer that my lawyer needs this.

And you know anything that we’re sitting, and asking, and consulting with the doctor, it’s what our client is saying is problematic, what’s going on. We just want to make sure the doctor understands that it needs to be in the records. Some doctors, they have their own way of doing things. But at the end of the day, more often than not, we see that a client’s doctor is going to be willing to be helpful and complete forms, all that type of stuff.

GREGORY DELL: Another tip, Steve, that I know you tell everybody, and whether you’re applying or you’re on claim, the claim is only as good as it looks on paper. A lot of claimants go to the doctor. How are you feeling? And they say, I’m OK, meaning you’re OK in the sense that if you and I went to the doctor who have nothing wrong, you know, we would say we’re OK.

They go in. And their OK is like a 6 out of 10 on a pain scale or 6 out of 10 in discomfort that day because they’re used to a 9 out of 10 discomfort. So they’re OK in the sense that they’re managing their symptoms, not OK in the sense that I’m OK to go back to work.

I’m OK where, doc, you’ve got me to a point where I can live my life. I can still do things. I’m able to get out of bed. I’m not in writhing pain 24/7. But that OK doesn’t translate to the ability to return to work five days a week, eight hours a day, waking up every day, being a reliable employee.

Symptoms, Complaints and Limitations Must Be Documented in Medical Records

So the doctor is glad to hear that you think you’re OK, but you don’t get any points for that. You get annihilated for that by The Standard, because they’re going to deny the claim based on that. So I always tell the claimants, you’ve got to go in and make yourself– I mean, I hate the only way I say it is, like, messed up on paper. You have to document everything that’s going on, because of it’s not there, it didn’t happen.

STEPHEN JESSUP: Yeah. And also in a situation where treatment– the purpose of treatment is improvement. Doctors are trying to get your symptoms to improve. And like you said, outside the context of work, maybe pain scales are down, all that stuff, but you’re not working, you’re not doing things that were aggravating it.

So even in those situations where there is improvement and a doctor wants to note the improvement, it always has to be with the caveat in the context of improvement because outside of work with being able to rest more and take breaks as needed, he’s able to– the patient’s able to handle pain better. So there is going to see improvements in there, but you always, if the doctor wants to have that, in the context of what’s going on with you not being at work and all that type of stuff. So it’s very, very important.

And a lot of people– you’re right. A lot people just– some people don’t want to admit you know how bad they are exactly doing. And they say OK. And if OK ends up in a medical record, or feeling great, which we’ve seen plenty of times, and we’ve asked a client like, what’s this about?

And they’re like, I don’t even know why that’s there. It’s really important, because fast forward, if you find yourself in court litigating one of these cases, the only thing a judge is going to look at is the paperwork, is the documentation. So you really are only as– your case is only as strong as is what it says on paper.

Know That The Definition of “Disability” in the Standard Policy is Not Always “Own Occupation”

GREGORY DELL: So we’ll regularly work with the claimant, guide them through this process, and make sure that all of the medical support is dialed in as best as possible. The next thing that’s super important for this application, which is unique to The Standard, is how they define occupation, because often, even if you have an individual disability policy, you don’t get a true own occupation definition of disability. Explain what I’m talking about and why that should be very important to a claimant who’s seeking disability for what they believe is their own occupation.

STEPHEN JESSUP: One of the biggest things is this idea of the national economy. So Standard rules say, whether it be the first 12, 24 months, whatever the case may be, you’re disabled if you cannot perform the material duties of your regular occupation. Well, we all know what our jobs are. We know what we do day in day out. But the way they’re going to take a look at it is in this broader concept of how it is performed in the national economy, so not for your employer, not at your specific workplace. And we do see situations where there is a denial of benefits.

And the person is– the disability is preventing them from working. Maybe they’re having issues with their boss or at that specific job site. And you’ll see a denial saying, well, this is an occupational thing just for this employer. You could do your job in the national economy somewhere else, so you’re not disabled.

So it’s not exactly how you’re doing your job where you’re doing your job for who you’re doing your job. It’s how it’s done throughout the country. And there is books. And there is, like, documents. And there is sites that they use, government-sponsored ones, private ones, to get an idea of occupational duties.

GREGORY DELL: Yeah, and I mean, and just so we’re clear, like, let’s just take someone like an accountant. Most people think the accountant sits behind the desk all day. But what if you’re an accountant who is always on the road, always traveling, always doing audits at different customer sites, having to go– you’re always up. And it becomes more of like a light-duty job because you’re not sitting all day, but you’ve got to stand, travel, walk, lift suitcases, whatever.

STEPHEN JESSUP: Carry the boxes that have all the documentation and paperwork, you know?

GREGORY DELL: And so Standard would say to that person, no, that’s not how the job’s performed in the national economy. It’s a sedentary job. You need to be able to sit for six hours a day. You don’t have to lift more than 10 pounds.

We don’t care that you’re doing this for however your other employer is doing it or you’re an in-house account for some company and they have you doing something totally different. So that’s not going to fly, but there may be a manner in which we present the occupation differently and not necessarily label you as the accountant, because you may not actually be– if you’re not functioning as how they think an accountant does in the national economy, then maybe that’s not the right job title for you. So that’s something we’ll work through in the application process which could totally save a claim denial.

And you know, there is so much to talk about here. The last thing is, talk about what someone should expect from Standard in terms of as a company and their level of experience with their claims people compared to the– they’re not one of the top-five big, big companies. They’re a smaller unit. And how you view them and the level of preparedness that a claimant’s going to need to get approved?

STEPHEN JESSUP: Standard, like I said when we started, they write individual products. And they write the group disability. Because of that, you see that in their group disability claims handling, they treat it like they would a private policy.

Their employers are very well trained. They’re very detail oriented. So you are going to get a stronger level of a review.

I mean, there is countless times that I see a denial letter from, say, Cigna or Prudential, where you just feel like someone had it on their desk. They were overwhelmed. And they just said, eh, we’ll deny this one. We’ll see if they appeal. It’ll be the appeals department’s problem.

Standard, if you get a denial letter, they’re always very detailed. They’re very long. So you really need to be prepared for all the questions they’re going to ask you. They are a very, very thorough insurance company. And when we see claim denials from them, it’s not to say we don’t win those appeals, but it’s much harder to win those appeals because they do a lot of work on the front end of the case as opposed to other companies that really wait to do the real reviews in the appeal process.

GREGORY DELL: So Steve, you know, we do this video to stress how important it is to be prepared when applying. And whether you’re a claimant sitting at home thinking of applying or you’ve applied already, we can jump in at any time. It’s to your advantage to get us involved as early as possible, because we’re going to try to put you in the best position to get approved based upon our experience. And the process of working with us is really simple. You can call the 800 number on our video. Below you can go to our website, submit a free email consultation.

One of the attorneys will immediately contact you. We’re going to ask you to send us a copy of your disability policy. We’ll set a phone call where we will review the policy. And we’re going to let you know right away what we think are your chances of getting approved and whether we can or can’t help you.

Our clients are located all over the country. So wherever you live is not an issue for us. Whether you speak to Steven or myself, we hope that we’re able to assist you and guide you through this process to get your Standard long-term disability benefits approved.

As you can see, applying for disability benefits can be more complicated than it may first seem. Claimants who file a claim for long term disability benefits without understanding the intricate framework of Standard’s internal processes may be blindsided by denial for a seemingly arbitrary reason. Having an attorney by your side who has been through this process dozens of times before can provide you with the expertise and knowledge to quickly resolve your long term disability claim to your satisfaction. And even better, we don’t charge any fees unless we help you recover disability benefits. Give us a call or visit our website to schedule your FREE consultation with a member of the Dell & Schaefer team.