Reliance Standard Misuses Look-Back Period to Deny Back Pain Claim

At just 54 years of age, our client was forced out of his occupation as a project engineer in Detroit, Michigan. Fortunate to have a long-term disability (LTD) policy with Reliance Standard Life Insurance Company, he filed a claim for LTD benefits. In the claim, our client cited back pain in his lumbar and cervical spine as disabling medical conditions and the reason(s) for his claim.

In response, Reliance Standard fixated on the fact that our client had previously received diabetes treatment. Dabdoub Law Firm redirected the insurance company’s attention from our client’s diabetes (irrelevant to his claim) and to his claim for LTD benefits due to back pain. When Reliance Standard focused on the medical evidence instead of trying to misuse the look-back period of our client’s policy, the company had no choice but to award LTD benefits.

Our Client’s Back Pain

Our client suffers from debilitating lumbar and cervical back pain that prevents him from sitting, standing, or walking for prolonged periods of time. As such, he cannot fulfill the duties of his occupation as a project manager.

As MRIs demonstrate, our client has mild to moderate degenerative disc disease in his cervical spine and moderate degenerative disc disease with mild osteoarthritis in his lumbar spine. Our client also has bulging discs, disc herniation, foraminal stenosis, multilevel disc desiccation, and spondylotic changes in both his lumbar and cervical spine.

What Is a Look-Back Period?

In disability insurance policies, a look-back period is a 3-month period that ends before the effective date of LTD coverage. Under the look-back period, insurance companies do not have to pay for pre-existing conditions that caused, contributed to, or resulted from a disability.

For example, if someone receives treatment for cancer in the 3 months prior to purchasing disability insurance, they cannot make an LTD claim for cancer because cancer is a pre-existing condition that is exempt under the look-back period.

Our client filed an LTD claim for back pain, and Reliance Standard identified diabetes as a pre-existing condition within the look-back period. In this situation, however, our client’s diabetes had nothing to do with his claim for back pain.

Diabetes Diagnosis Irrelevant to LTD Claim for Back Pain

For several years, our client has struggled with and work through diabetes. Although unpleasant, dealing with diabetes did not prevent our client from working. Nevertheless, our client was unable to work through his back pain, which was in no way connected to his diabetes.

Reliance Standard made up a link between our client’s pre-existing diabetes treatment and his debilitating back pain, but the insurance company did nothing to prove its claims.

Dabdoub Law Firm Reminds Reliance Standard of Its Duties Under ERISA

Under the Employee Retirement Income Security Act of 1974 (ERISA), Reliance Standard must not only act in our client’s best interest but also provide proof of any reasons it gives for denying his claim. In this case, the insurance company claimed our client’s back pain was connected to his diabetes with no proof.

Instead, the company used our client’s irrelevant diabetes diagnosis to misuse the look-back period and deny our client’s claim.

Dabdoub Law Firm highlighted Reliance Standard’s mistakes and gave the insurance company another chance to do the right thing. To avoid litigation, the company complied.

Lawyers Specializing in Disability Insurance Claims

Disability insurance law is complicated, so you need legal help from a lawyer who focuses on disability law.

As a law firm built to focus on disability insurance, Dabdoub Law Firm specializes in disability insurance. Our lawyers spend every day working to get our clients’ long-term disability benefits approved.

Because federal law applies to most disability insurance claims, we do not have to be located in your state to help.

If your claim for long-term disability benefits was denied or is being delayed by an insurance company, contact us to speak with a disability insurance attorney.

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We can help you, too. Call us at (800) 969-0488 or contact us online for a free consultation with an experienced disability attorney.