Founded in 1820, Indiana University has eight campuses in the State of Indiana and is a world leader in professional, medical and technological education. With over 17,000 employees state-wide, IU offers a generous benefit package which includes long term disability coverage through Standard Insurance. At the O’Ryan Law Firm, we have represented numerous IU employees who have become disabled and have been denied their long term disability benefits by Standard Insurance. We have represented professors, Human Resources professionals, and IT professionals, among others, employed at IU who applied for disability benefits with Standard, after their medical conditions made it impossible for them to continue working, and Standard Insurance denied those benefits.
“Disabled” or “Disability” is defined for IU employees in the Standard Insurance Policy as:
You are Disabled if you meet one of the following definitions during the period it applied: A. Own Occupation Definition of Disability; B. Any Occupation Definition of Disability; or Partial Disability Definition
A. Own Occupation Definition of Disability
During the Benefit Waiting Period and the Own Occupation Period you are required to be Disabled only from your Own Occupation. You are Disabled from your Own Occupation if, as a result of Physical Disease, Injury or Pregnancy or Mental Disorder, you are unable to perform with reasonable continuity the Material Duties of your Own Occupation.
B. Any Occupation of Disability
During the Any Occupation Period you are required to be Disabled from all occupations.
You are Disabled from all occupations if, as a result of Physical Disease, Injury, Pregnancy or Mental Disorder, you are unable to perform with reasonable continuity the Material Duties of Any Occupation.
Any Occupation means any occupation or employment which you are able to perform, whether due to education, training or experience, which is available at one or more locations in the national economy and in which you can be expected to earn at least 80% of your Indexed Predisability earnings within twelve months following your return to work, regardless of whether you are working in that or any other occupation.
Material Duties means the essential tasks, functions and operations, and the skills, abilities, knowledge, training and experience, generally required by employers from those engaged in a particular occupation that cannot be reasonably modified or omitted. In no event will we consider working an average of more than 40 hours per week to be a Material Duty.
C. Partial Disability Definition During the Benefit Waiting Period and the Own Occupation Period, you are Partially Disabled when you work in your Own Occupation, but as a result of Physical Disease, Injury, Pregnancy, or Mental Disorder, you are unable to earn 80% or more of your Indexed Predisability Earnings, in that occupation.
To deny these claims under the policy, Standard Insurance routinely utilizes their in-house physician, Dr. Richard Handelsman, to review the medical records and opine that the IU employee is not disabled. Dr. Handelsman is the Medical Director for Standard Insurance and a salaried employee of Standard. Dr. Handelsman never examines the claimant and bases his opinion solely on medical records; therefore, his opinion is limited to only a review of the medical records. Also, we have found that Dr. Handelsman’s reports oftentimes fail to address important symptoms, like chronic pain, which are critical components to the disability claim.
Standard also likes to classify disabilities as mental impairments in order to limit the number of benefit payments they are required to pay under the policy. Specifically, if a disability falls within the category of a mental impairment, Standard Insurance is only required to pay disability benefits for 24 months. The Standard policy limits payment on Mental Disorders as follows:
Mental Disorders: Payment of LTD Benefits is limited to 24 months during your entire lifetime for a Disability caused or contributed to by Mental Disorders, or medical or surgical treatment of Mental Disorders. However, if you are confined in a Hospital solely because of a Mental Disorder at the end of the 24 months, this limitation will not apply while you are continuously confined….Mental Disorder includes, but is not limited to, bipolar affective disorder, organic brain syndrome, schizophrenia, psychotic illness, manic depressive illness, depression and depressive disorders, anxiety and anxiety disorders.
We have found that Standard will attempt to classify a disability as a mental disorder in order to limit their liability in the claim to 24 months of payments.
Standard Insurance will also refer IU employees to a company called Allsup to assist them with applying for Social Security Disability benefits. An award of Social Security benefits to an IU employee dramatically lessens the amount Standard is required to pay under the disability policy. The policy authorizes Standard Insurance to offset the amount in Social Security disability benefits that an IU employee receives against the long term disability benefits that Standard is required to pay under the policy. Confusingly, Allsup may be successful in helping to obtain SSDI benefits for the IU employee but then Standard Insurance will claim that the IU employee is not disabled under the Standard policy and deny the claim. The standard for obtaining SSDI benefits is higher than the definition of disabled under the Standard policy and therefore it oftentimes doesn’t make sense for Standard Insurance to deny these claims.
If you are an Indiana University employee whose disability benefits have been denied by Standard Insurance, please contact the O’Ryan Law Firm for further assistance at oryanlawfirm.com.