A Woman with Serious Health Conditions
Ms. X, 55, faces many health issues that limit her ability to function. She has chronic migraines, worn-out spinal disks, a narrowed spinal canal, nerve pain, numbness in her limbs, and widespread muscle pain. These problems cause her constant pain, headaches, and confusion, making meaningful work impossible for her.
Health evaluations found that Ms. X can sit or stand for a maximum of two hours during a workday. She cannot sit comfortably for six hours or more. Therefore, Ms. X cannot reliably do any full-time work, even a sedentary one. Courts agree that if an employee can't sit for more than four hours in an eight-hour workday, they can't do a sedentary job. Up to this point, she has been engaged in work that requires her to sit most of the time.
Ms. X's primary physician, Mr. R., is quite familiar with her health concerns. He writes that she has back and neck pain that spreads to her arms and causes numbness. On November 10, 2023, he filled out a form stating Ms. X can't sit, stand, or walk for more than two hours a day. He also says her symptoms would make her lose focus for at least a quarter of the workday. Dr. Ramos believes Ms. X cannot do a desk job.
An Unfair Decision
Mrs. X was denied her short-term disability claim, but she completed all required tests and filed every piece of paperwork. Her situation demanded support, yet the response was negative. Such a setback brought financial and emotional stress to her already challenging circumstances.
As a plan administrator and fiduciary, Reliance Standard Life Insurance Company holds significant power over the terms of a disability claim. Because of its power, the company must adhere to standards that exceed those found in the typical marketplace. It must act with heightened diligence and fairness, reflecting the trust placed in its role.
By stopping Ms. X's benefits without showing her condition improved, reliance has failed to fulfill its responsibilities. Records show Ms. X's symptoms have worsened since she first received Short-Term Disability (STD) benefits. Reliance initially confirmed her disability, and Ms. X’s condition has declined. She still can't work today, so she deserves ongoing benefits.
Reliance must not ignore the duties it owes Ms. X. The evidence proves Ms. X cannot return to work as a Community Manager. With new proof of her ongoing disability, Reliance must grant her the short-term and long-term disability benefits as agreed.
A Firm Upholding the Law
Our firm took decisive action to assist Ms. X. We applied effective legal precedent effectively, citing the Shaw v. Delta Airlines, Inc. case. This case highlights an insurer’s duty to act fairly. This principle was critical for Ms. X's situation. We also cited Mutual Life Insurance Company v. Russell. Russell reinforces the expectation that insurers provide promised benefits.
We vigorously informed Reliance about its financial obligation. Our team reminded the firm of its duty to honor its policy terms. We also pointed out that Reliance's actions could lead to severe penalties. These penalties come from non-compliance with the policy agreement.
By leveraging our legal knowledge, we were able to secure a successful outcome. Ms. X received her short-term disability benefits. Thanks to our firm's efforts, she can now focus on her health without financial stress.
Help from a Lawyer with Expertise in Disability Insurance
This law firm was built to be a disability insurance law firm. That focus means:
- All of our lawyers specialize in disability insurance claims.
- We have experience with every major disability insurance company.
- We have won important long-term disability lawsuits.
Our disability lawyers can help you with:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- Negotiating a lump-sum settlement; and/or
- Filing a lawsuit against your disability insurance company.
Hiring an experienced disability attorney is important. Because federal law applies to most disability insurance claims, our lawyers do not have to be located in your state.
Call (800) 969-0488 to request your free consultation with an experienced disability attorney. Pay no fees or costs unless you get paid.
