Reliance Standard Life Insurance

Very poor service.
Been trying to get my disability insurance check for over 2 months.
Everything I called the insurance company I got little to information or left several voicemail without any one returning my call.
My company approved my medical disability but yet I have received any assistance in reference to the payments.
Very lousy way to take care of the clients.

Review: I have a disability income policy with Reliance Standard. The policy states that "An insured who is partially disabled will be considered Totally Disabled, except during the elimination period" and "We consider the Insured Totally Disabled if due to injury or sickness he or she is capable of only preforming the material duties on a part-time basis or part of the material duties on a Full Time basis" I have had a 14% total partial disability since 2004. When reviewing my claim for Total Disability, RSLI used a Doctor looking over records without a personal exam as the final determination, overlooking the fact that 5 doctors signed off on me never working again, and overlooking the Permanent Partial Disability records that were submitted. RSLI also had my occupation wrong.Desired Settlement: 1) An exam by a doctor

2) Reinstatement of monthly income

3) Contract settlement

Business

Response:

See Attachment.

Review: I got injured in the maritime industry and havnt been able to return to work for over a year the company paid me short term disibaility when it came time to start paying long term they sent me a letter and stated they overpaid me on my short term and weren't going to pay any of my long term so I have been barely making it with the 57.00 dollar a day payment that my employer is paying me "even as the problem happened on boat".Desired Settlement: how do I get the insurance company that I have paid for to start paying me my dues.

Business

Response:

July 1, 2014Your inquiry dated June 19, 2014 (received June 24, 2014), referencing the handling of [redacted]s Long Terrn Disability (LTD) claim, has been forwarded to my attention for response, Thank you for the opportunity to address **. [redacted]s concerns.The abovementioned policy is a group LTD plan, which provides benefits at a flat rate of 1600,00 per month to a maximum of 6,000.00 if he (among other requirements) meets the definition of Total Disability” as defined by the policy. The policy situs state is Texas.According to the documents included with the inquiry filing, **. [redacted] contacted your office for assistance with getting his LTD claim paid. As **. [redacted] advised, we are currently withholding his net LTD payment to satisfy an overpayment that occurred on his Short Term Disability (STD) claim. In our letter to **. [redacted] dated March 26, 2014, we explained how the overpayment occurred and the policy provisions) that allowed us to recover the overpayment. We have enclosed a copy of this correspondence for your review, As explained in the above referenced letter, **. [redacted] has a right to file an appeal on the determination rendered; however, he has not exercised that right to date.In our letter to **. [redacted] dated April , 2014, we explained that his LTD claim was approved but we were withholding all benefits and applying them to the overpayment that occurred on his STD claim. As of April 1, 2014, the overpayment balance is $7,053.45.At the present time we are unable to determine if **. [redacted] remains Totally Disabled (and continue to credit his monthly benefit to the overpayment balance) as he has not responded to our request for additional information. In our letter to **. [redacted] dated April , 2014, we advised him that additional information was needed for benefit consideration beyond April 1, 2014, on May 21, 2014, we received updated records from **. [redacted]s primary care physician. The records indicate **. [redacted] has been referred to other physicians for treatment; however, we do not have contact information for those physicians on file. In a letter to **. [redacted] dated May 28, 2014, we asked him to provide contact information for all physicians he has treated with from April 2013 to present. **. [redacted] was further advised that his response was due by June 28, 2014 or his claim would be considered incomplete and his file closed. We are beyond the date by which **. [redacted] was required to respond and the information requested has not been provided. We will grant **. [redacted] a fifteen day extension (from the date of this letter) to provide the information requested, If the information is not provided by that date, **, [redacted]s claim will be closed. In that event, he will be provided with additional appeal information.We trust our response is sufficient for your needs. Enclosed with this correspondence is a copy of the letters referenced above as well as the group policy. If you have any questions, please do not hesitate to contact me directly at ###-###-####.

Review: As of the time of filing this complaint, I have received no confirmation of benefits or issuance.

It has been well over two months since the claim process was initiated for long term disability. I understand that there is a 90 day period before benefits are initiated. I can understand the up to 45 business days for the medical investigation, but the additional 5 to 15 business days for upper management to include their authorization is unfair. That is 9 to 11 weeks after I became eligible.

I suffered my stroke on July 7, 2014. I have had no income since then. I ran out of sick days and vacation time that I had accrued by the middle of July. My savings and checking were exhausted at the beginning of October. I've had to miss one car payment already. All of my utilities are past due. My medicine runs out on Saturday. I don't even have enough money to get to the doctor to authorize my refills. I need my long term disability before Thursday.Desired Settlement: Immediate issue of benefits already due for the month of October, 2014 and the timely release of the November, 2014 benefits.

Also, this company could do better to communicate the claims process with and steps involved for approvals so that people who are dependent upon them can have a little hope.

Business

Response:

December 2, 2014Dear [redacted]:We are writing to acknowledge receipt of the above-mentioned correspondence. We have forwarded this complaint to the following department at the same address:NAME: Theresa K[redacted] ????,?. Manager DEPARTMENT: Integrated Disability Claims[redacted]We are presently looking into this matter and you will be hearing from us shortly.Please note! If at any time you correspond directly with the individual listed above, it would be appreciated if a copy of that correspondence were sent to me as well, so that we can track all correspondence and ensure that timely responses are provided to you.Sincerely,Denis B Law/Consumer Relations Department

Consumer

Response:

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Regards,

Eddie Dollgener

Review: When I bought this insurance I was told that there was no preexisting issues that would cause any problems. When I was diagnosed with stage 4 breast cancer for the 3 time I filled a claim. Now they are denying it because I was under going treatment. I will ALWAYS have to take a pill for the cancer, but my chemo did not start again until May 2013. I NEVER received a policy for the insurance I am paying for. This has been a HUGE let down to be paying for something that you can't even depend 9n when you need it.Desired Settlement: I would like the money that my policy shows I would receive for a diagnosis.

Business

Response:

August 20, 2013

We are in receipt of your correspondence dated August 13, 2013. We appreciate the opportunity to respond to **. [redacted]’s concerns.

On June 3, 2013, due to **. [redacted] submitted a claim for Voluntary Critical Illness benefits, under Policy VCI [redacted], a copy of which is enclosed for your reference. On June 17, 2013,

**. [redacted] was advised by the Life Claims Department, that her claim for VCI benefits had been denied, due to the terms and provisions of her Policy. Specifically, it was determined that her claim was barred under the Pre-Existing provision of the Policy. This decision was made upon completion of the investigation performed by the Life Claims Department, which included obtaining information from the employer, White River Health Systems. In accordance with ERISA, RSL does afford its insured’s the right to an appeal. **. [redacted] was provided her appeal rights and on June 18, 2013, she submitted a request that we re-evaluate her claim. This appeal was assigned to our Quality Review Unit for handling. Upon receipt, we began our investigation into this matter.

Please be advised that Policy VCI [redacted] contains the following relevant provision:

PRE-EXISTING CONDITIONS: The Insured or Insured Dependent will be considered to have a Pre-existing Condition and will be subject to a Pre-existing Conditions Limitation if:

(I) a Critical Illness is diagnosed in the first twelve (12) months after the Insured’s or Insured Dependent's effective date; and

2) he/she has received medical Treatment, consultation, care or services, including

diagnostic procedures, or took prescribed drugs or medicines for a Sickness or Injury, whether specifically diagnosed or not, causing or contributing to such Critical Illness, during the twelve (12) months immediately prior to the Insured's or Insured Dependent's effective date of insurance.

Benefits will not be paid for a Critical Illness:

(1) caused by;

(2) contributed to by; or

(3) resulting from;

a Pre-existing Condition unless the Critical Illness is diagnosed after twelve (12) consecutive months from the Insured's or Insured Dependent's effective date of insurance.

"Pre-existing Condition" means any Sickness or Injury whether specifically diagnosed or not, for which the Insured or Insured Dependent received medical Treatment, consultation, care or services, including diagnostic procedures, or took prescribed drugs or medicines, during the twelve (12) months immediately prior to such Insured's or Insured Dependent’s effective date of insurance.

(Emphasis added).

We have confirmed that **. [redacted]’s coverage under this Policy became effective on January 1, 2013. The fact that **. [redacted] had pre-existing medical conditions, did not bar her coverage under the Policy. In accord with the Policy, if a claim is submitted within the first 12-months of coverage, it is necessary to review her medical history to ascertain whether she treated for her reported critical illness for which she sought benefits. However, due to the fact her claim was submitted less than 12-months from the date her insurance became effective, it was necessary to perform a pre-existing investigation of the 12-months prior to the effective date of her coverage. The relevant period to be investigation was January 1, 2012 to January 1, 2013.

Upon our review of the information contained within **. [redacted]’s claim file, we determined we would require the opinion of an independent physician, to ascertain whether she did in fact undergo any medical treatment, consultation, care, or services, during the relevant period of January 1, 2012, to January 1, 2013. We utilized the services of a third-party vendor, and arrangements were made for **. [redacted]’s medical file to be reviewed by [redacted], M.D. Specifically, we sought the medical opinion of a physician to ascertain whether **. [redacted] did in fact treat for the conditions for which she was seeking benefits, during the period of January 1, 2012 to January 1, 2013.

On July 18, 2013, we received **. [redacted]’s Peer Review report. Based upon his review of **. [redacted]’s medical records, **. [redacted] confirmed that **. [redacted] treated for the same medical conditions for which she sought benefits, during the period of January 1, 2012 to January 1, 2013. As such, we determined that the previous decision to deny her claim for Voluntary Critical Illness benefits, in accord with the language of her Policy.

**. [redacted] indicates that she was told “that there was no preexisting issues that would cause any problems.” We have communicated with the Sales Agent for this policyholder, and confirmed that he did instruct **. [redacted] that her pre-existing medical conditions would not necessarily bar her coverage. For instance, if she were disabled by a condition that was not pre-existing, this would have been covered. What’s more, had a claim for a pre-existing condition been submitted after 12 months of coverage, the pre-existing provision to the Policy would not apply. However, in accord with the terms and provisions of the Policy, pre-existing conditions become significant if a claim for that pre-existing condition is made within the initial 12 months from the date of coverage. Herein, as explained above, **. [redacted] submitted her claim six months after her coverage became effective. Therefore, a pre-existing investigation was mandated.

**. [redacted] also contends she was not tendered a copy of the Policy. Please be advised that RSLI is the Claims Review Fiduciary for Policy number VCI [redacted] and not the Plan Administrator. As such, the Policy would have been provided by the employer upon her request. Moreover, a copy of the Policy was provided to **. [redacted] upon her request, on August 16,2013. On that date, she was also provided a complete copy of her file.

In conclusion, upon thorough review of **. [redacted]’s claim for Voluntary Critical Illness benefits, we remain in our position the claim was properly and appropriately denied.

Should you require anything further, please do not hesitate to contact me. I can be reached at ###-###-####, ext. [redacted], or via email at [redacted].

Sincerely,

Review: I recently enrolled for insurance on-line August 22 ,2013 and the deductions of $ 49 started October 11, 2013 . I called customer service October 17, 2013 to cancel my insurance and to stop my payroll deductions , since I have decided to have insurance through my wife's employer . I have called them numerous times to have this resolved , but they insist in NOT cancelling my insurance or giving me the refund for the unused premium .Desired Settlement: I would like my insurance cancelled , stop deductions taken from my payroll checks , and refund for unused premium.

Business

Response:

November 26, 2013

Dear Sir/Madam:

Your letter dated November 7, 2013 has been referred to me for review and response. Reliance Standard Life Insurance Company is the underwriter for the group insurance program under which [redacted]. is a group policyholder. [redacted] is the third-party administrator of the program.

Our records indicate that [redacted] contacted our office on October 8, 2013 to request ID Cards; no other calls have been logged to his account.

Because the [redacted] program medical premiums are taken on a pre-tax basis per the allowances of Section 125 of the Internal Revenue Code, [redacted] may not cancel his coverage unless he experiences a qualifying life event and submits a Life Event Change Form with 31 days of the qualifying life event. He may obtain the Life Event Change Form from his branch office to initiate the cancellation. Cancellations are not taken over the phone.

Information on cancelling coverage is found on page 13 of the Field Employee Benefits Guide -Paying for Your Benefits section and has been included with this letter. The benefits guide was provided to all employees prior to enrolling in the coverage.

As a result of the above, [redacted]’s coverage remains active under the group insurance program and cannot be terminated until the end of the current plan year - December 1, 2013.

We trust that this letter addresses your concerns.

Sincerely,

Review: I am a disabled physician and Reliance is reducing my monthly payment against my contract terms.Desired Settlement: Do not reduce my "contract monthly payment."

Review: I received long term disability from this company. A service that I was entitled too because my employer paid into it. After I received SSD the company wanted to to pay them back all the money that they gave me over a year's span including whatever SSD that my children received. They sent a letter with the exact amoun tthat I received from SSD back pay as there payment when asked to provide a bbreakdown of what my children received they fold me they could not because my children didn't recieve a. He k just me. If this is so how can you be entitled to my chidrens back pay. This mispresents it's intentions.. disguising themselves as a saving brace for the disabled but they are loan sharks. I am not the guardian of my childrens money and have no access yet they tell me that I still must pay back an overage because they combined my kids income to mine.Desired Settlement: If I the individual received compensation then , I the individual should pay back if my SSD is over the amount given to me. But if my individual income does not exceed what I was given lets just be done. Practice fair business stop trying to railroad people's that are permanently disabled and have no other ok income.

Business

Response:

Please see attached

Review: I payed for short term disability for years from reliance standard and when I had to recieve a major back surgery they send my payments at there will. I am approved untill oct-29-2013 the last check I recieved was sept-11-2013. It is now almost 1 month I have no income. I have followed my doctors orders, been to all appointments and answered all of reliance standaeds requests and needs. I still have not recieved so much as a letter or phone call telling me the september 11 2013 bennifit check would be my last. They are under contract to compencate me if I became disabled and the now just ignore me. I payed them faithfully and they dont care if my children go hungry. I would go back to work if I was released by my dr. but he says I have not healed enough. Please help me and future victims from reliance standard preying on those who have no choice but to depend on them.lDesired Settlement: I would like them to honor the agreement we signed. Pay my Bennifits . Fix the dammage they caused to my credit.

Business

Response:

October 21,2013

Dear **. [redacted]:

We are in receipt of the complaint filed by the customer named in the Revdex.com Complaint ID noted above.

The above-mentioned policy is a fully insured group disability plan that provides 26 weeks of Short Term Disability benefits at a rate of 60% of a covered employees salary if he/she is deemed Disabled as defined by the policy.

In adjudicating this claim, we took into consideration the applicable policy provisions and the medical documentation submitted by the customer’s physicians. Our determination on whether or not he meets the group policy’s definition of disability will be based on the medical evidence in his claim file. We have no basis on which to measure subjective complaints or medical opinions not substantiated by medical findings.

Our records indicate this claim was received on April 29, 2013. Information on the claim form documents his last day worked was April 22,2013. Based on the medical documentation provided with the Initial Statement of Claim , benefits were medically supported to July 22,2013. An approval letter was sent to the customer explaining that he was approved for benefits to July 22,2013 and informed him that should his disability continue beyond this date, he would have to submit a Supplementary Claim Form and medical records. The customer received weekly disability benefits for the period of April 30,3013 to July 22, 2013.

On July 16, 2013, the claim’s examiner faxed a request for medical records to the customer's physician. Medical records were received on July 18? 2013. A copy of this request was mailed to the customer. Our medical department reviewed the records on July 22, 2013 and supported the customer’s ongoing disability until September 16, 2013. Following this review, weekly disability benefits resumed and the customer received weekly benefits for the period of July 22, 2013 to September 16,2013.

On September 4,2013, the claim's examiner faxed a request for updated medical records to the customer’s physician.

The records were required to support the disability beyond September 16, 2013. A copy of the request for records was mailed to the customer on this date as well

Medical records were received on October 7, 2013 and the file was again referred to our medical department for review. The medical review was completed on Octobcr 9,2013 and additional benefits were approved for the customer.

Payment was issued to the customer on October 9? 2013 in the amount of $3,399,24 for the benefit period of September 16, 2013 to October 28, 2013. A final payment was mailed to the customer on October 14, 2013 in the amount of $80.93 for the period of October 28, 2013 to October 29,2013. At this time, the customer’s Short-term disability benefits are currently exhausted and no additional benefits are payable under this plan.

The customer’s stated in his complaint that he feels that he has been ignored and that he has not received a call or letter regarding his benefits. Our records document that he has been sent copies of the requests for medical records. In addition, we have spoken with the customer via telephone regarding his claim status as well as with his employer.

If you have any additional questions or concern?, please feel free to contact me directly at ###-###-####.

Sincerely,

Review: I have had a life insurance policy w/ Reliance Standard for about 13 years. I recieved a letter on 3/11/2013 that was dated 3/3/2013 stating my policy has lapsed and I am no longer covered. I called them on 3/12/2013 spoke w/ [redacted] & told her I never recieved a past due notice of any kind. They just cancelled my policy. I explained I had an accident , had to have operation & was an excellent customer of theirs w/o any past late payments. She called back & said my policy was cancelled.

If I had recieved a PAST DUE letter I would have resolved this before being cancelledDesired Settlement: To be reinstated w/ no penalty.

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because: I did not recieve second notice of payment.

Regards,

Business

Response:

Please see attached

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because:I have been a good customer paying my bill on time for 10 years and should not be penalized for not recieving PAST DUE NOTICE> This is life insurance I was depending on. Do the right thing & reinstate me w/o penalty.

Regards,

Review: Because I could only claim one "nature of complaint" these other issues were omitted, but are included here in this written complaint; Inappropriate behavior by customer service personnel. Failure to respond to phone calls or written requests for assistance or [redacted]. Customer service failed to provide assistance. Failure to honor a contract or agreement. The authenticity or validity of a contract is in question. Company has unethical collection practices. Advertising term the seller will not honor. Advertisement misrepresenting a service.

I have paid for insurance with Reliance Standard Insurance for quite some time, but can not get them to honor our contract now that I have filed a claim. The claim has been pending since September and I have been given nothing but the 'run around' since I filed this claim. My phone calls have been ignored as well as voicemail [redacted]sages to supervisors and emails to customer service representatives. My insurance premium was paid regularly, from my paycheck, but they now are not honoring thier end of our contract.

By the Reliance Standard definition, I was eligible for benefits of 60% of my income for 3 months (and possibly eligible for Long Term Benefits as well). They eventually denied the initial claim, and upon my appeal and detailed documentation, the senior analyst sent me to a physician whom it appears they have paid to report in their favor.

The physician would only view medical documentation sent to her by Reliance and refused to look at anything I brought to her office to help with her assessment. I asked the senior analyst for a copy of the report 3 ti[redacted] (& eventually included customer service in my 3rd request) for a copy of the physician's report. I was not answered until I included customer service in the requested email for the report (the 3rd request). Though I still have not gotten a response from a customer service representative, I did get a copy of the report right away.

Upon reviewing the report from the Dr., which Reliance Standard sent me to, it appears the Dr has been paid $1898.78 by Reliance to observe the records sent to her by the insurance company and to evaluate me. That's a pretty expensive evaluation. Even the visits I have had to the [redacted] Clinic weren't that expensive. This leads me to believe they are paying her for more than just an office visit. Her records are in direct contrast of the records I had brought for her review, which it seemed she had not seen, and would not look at the copies I brought for her. The Dr. was very limited with her words and limited in what she would allow me to say, or show her.

The problem is that Reliance Standard Insurance Company has not provided proper customer [redacted] nor have they fulfilled their end of a contract. They have, however, done everything in their power to avoid fulfilling their side of our contract.Desired Settlement: The desired outcome is simply for Reliance Standard Insurance Company to honor our contract to pay benefits to me. The amount agreed to was 60% of my income for 12 weeks. This amount would be approximately $3100-$3300. Interesting they have paid the Dr. more than half of what the agreed contract amount is for my benefit.

Business

Response:

March 27, 2014Dear **. [redacted]:We are in receipt of your letter dated March 18, 2014. We appreciate the opportunity to respond to **. [redacted]’s concerns.In responding to your request, please note the disclosure of medical related information is subject to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the accompanying regulations. Thus, we are unable to provide and or release details specific to **. [redacted]’s medical history without her written consent to do so. As a result, we shall provide clarification regarding the basis of the Short-Term Disability (“STD”) denial in absence of any details specific to **. [redacted] medical history.In determining if **. [redacted]’s met the group Policy definition of “Disabled', we reviewed the claim file in its entirety. When we considered the applicable medical evidence we concluded that the information did not substantiate a physical or mental health condition that was at a level of severity precluding **. [redacted] from performing the full-time material duties of her job as of the work stoppage date, September 18, 2013. The remainder of this correspondence further outlines the facts utilized in reaching our decision.The group Policy VPS [redacted] defines “Disabled” as follows:"Disabled' means the Insured is:(1) unable to do the material duties of his/her job; and(2) not doing any work for payment which he/she is qualified by education, training or experience; and(3) under the regular care of a physician.Further, please be advised that the group Policy VPS [redacted] contains the following provisions relevant to this appeal:DA Y BENEFITS BEGIN: Benefits, for one period of disability, will be paid as follows:INJURY AND SICKNESS: We will pay benefits from the fifteenth consecutive day of disability.The DEFINTION section further states:"Injury" means bodily injury resulting directly from an accident, independent of all other causes. The injury must cause disability which begins while an Insured is covered under this Policy"Sickness" means illness or disease causing disability which begins while an Insured is covered under this Policy. Sickness includes pregnancy, childbirth, miscarriage or abortion, or any complications therefrom.Information in the claim file revealed that **. [redacted] last worked for our Policyholder, [redacted] of [redacted], Inc., as a [redacted], on September 18, 2013. Thus, our decision as whether or not **. [redacted] met the group Policy’s definition of “Disabled” was based upon her ability to perform the material duties of her job subsequent to the work stoppage in relation to the medical documentation within the claim file. Upon review, it was concluded that **. [redacted] did not meet the group Policy definition of “Disabled” and, as a result, her claim was denied as of November 27, 2013.**. [redacted] was granted an opportunity to request a review of the original determination by submitting a written request for an appeal, which we ultimately received on January 9, 2014. Upon reviewing **. [redacted]’s appeal request, it was determined that an Independent Medical Examination (“IME”) would be necessary.In arranging an IME, we used a third party vendor, [redacted] (“[redacted]”), who specializes in acquiring independent and evidence based medical opinions. [redacted] identified a physician within a relevant specialty and within a reasonable distance of **. [redacted]’s residence. To maintain the unbiased nature and validity of the IME, RSL had no input regarding the identification of a physician. In fact, RSL and **. [redacted] were notified of the details regarding the exam simultaneously. In addition, RSL does not have dircct communication with the physician in question; all communication is initiated by [redacted] throughout the duration of the IME process. Also, please note that compensation specific to the IME is made payable by RSL to [redacted], who then issues payment to the physician for services rendered after deducting their own fees for arranging the examination. As a result, no forms of direct communication and or compensation are ever exchanged between RSL and the physician acquired to conduct the IME.In regards to **. [redacted], it is noted that the IME was completed as of February 18, 2014. Upon receiving the results of the IME and given the physician’s opinion, we concluded based on our review of all the materials submitted to RSL, **. [redacted] was not considered “Disabled”, as of her September 18, 2013, work stoppage date. Thus she was not entitled to STD benefits in connection with this claim. While we regret that our decision could not have been more favorable to **. [redacted], we were limited by the provisions of the group Policy. **. [redacted] was informed of this decision as of March 21, 2014. **. [redacted] was also instructed that our decision was final as she exhausted any administrative remedies available to her under the terms of the group Policy.We hope this clarifies our claim handling. If you have any questions regarding this matter, please feel to contact me at ###-###-####, extension [redacted].Sincerely,

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because:

...because of several reasons. First of all my medical condition DID (at the time) and DOES (now) meet the requirements of "disability" according to the Reliance Standard definition. Since my condition DOES meet that definition of 'disability' the insurance company has gone to other measures in order to deny my claim, and appeal. Once they realized I met the requirements for 'disability' Reliance Standard then pulled out a phrase from the policy which states the "sickness or disability" is defined as pregnancy, abortion or complications of those. It's ridiculous that disability and/or sickness be defined as pregnancy or abortion (or complications thereof)! It appears Reliance Standard has a skewed perception of the policy definition of sickness. Thirdly, the insurance company has ignored the recommendations of my own Drs (which I gave reports from many) and Reliance Standard hired a physician of their own. It doesn't matter if they found the physician themselves or if they paid someone else to find her. The important factor is that they PAID her $1898.78 to give medical information to assist them in denying my appeal. Several statements were false in her medical report which she wrote up for Reliance Standard. One particular area in her report the Dr addressed the tenderness of my body. She stated, "wasn't really tender" but I remember shrieking and grabbing for her hand at one point due to the tenderness of my hip area when she was examining me. She stated the medical records from my Drs didn't provide sufficient evidence of the disability, but she refused to look at the medical records I brought to her office. She said very little to me, while typing during most of the office visit. She added her opinion about another a medication my Dr had given me for weight loss which had nothing to do with this case whatsoever, calling it inappropriate. My Dr has been in practice much longer than she- and has known me for many years, making him more aware of how to treat me and my condition. It's odd that Reliance Standard would use the opinion of a Dr that has examined me once (who was PAID) rather than a Dr who has examined me many times over the years, watched my illness progress, who has watched me fight the disease and the limitations and was NOT paid nearly $2000, but what the insurance would cover for the office visits to him.

Review: I was receiving insurance benefits through my job with a recruiter - [redacted], who provides insurance through this company. I had stopped working at the company and was waiting for notification concerning COBRA. On January 21, 2014, I had work done at a dentist's office. That morning both me and the dental assistant called to make sure I was still insured. We were both told that I was. I had my work done and now Reliance Standard is refusing to honor their insurance obligations. They are telling me that my insurance terminated on January 20, 2014, which is extremely convenient for them. When I finally received the COBRA packet, I called twice to make sure that I would be covered retroactively from whatever the date of termination ended up being. I was told that I would be covered for any days I was not if I paid the total amount to cover any weeks of missed insurance payments. I did everything they told me to, they told me several times I would be covered and now they are refusing to live up to what I was told.Desired Settlement: I need them to accept the claim.

Consumer

Response:

---------- Forwarded message ----------

From: [redacted] <[redacted]>

Date: Fri, May 2, 2014 at 11:48 AM

Subject: complaint ID #[redacted]

To: [email protected]

To whom it may concern:

Every time I call them, I never get the same answer! I never no who to believe!

use a different company, not professional, very unorganized and are not looking to help I have been using them for long term disability through my past job I would not recomend this company

Review: I became disable on October 2011 in which through my employer was on Short Term Disability with Reliance Standard Insurance. On January 2012 it rolled over into Long term disability with Reliance at which time I applied for Social Security Disability. Until I was approved for SSD Reliance Standard was sending me money. Every six months they would review my case and have me send in information from my doctors to continue disability with them. On two occasions they would not approve my case based on their claims that they did not receive on the documentation requested. and I had to appeal and won. The second time they sent me to one of their doctors and I won. The process took 4 to 5 months before they would continue my payments and this has put me in severe hardship to the point threats of foreclosure. I have now been approved for SSD and they have back paid me. I am now getting letters from Reliance wanting me to refund them the money they have paid. I think this is so wrong that they pray on the week. This insurance is something that I elected through my employer and money was taking out of my check for it.Desired Settlement: I do not feel I need to pay back any money that they have given me for disability. This why we pay premiums.

Business

Response:

June 2, 2014 Dear [redacted]:We are in receipt of your letter dated May 23, 2014, which was received in our Law Department on May 28, 2014. Your inquiry has been forwarded to my attention for a response.As part of her complaint, [redacted] recounts what she considers to be a difficult claim history with Reliance Standard (our). She cites the fact that her Long Term Disability (LTD) claim has been denied on two separate occasions and that she successfully appealed each time. She states that she had undergone financial hardship due to our adverse determinations on her claim.[redacted] continues towards her ultimate complaint for which she requests resolution; the overpayment that has occurred on her claim. She states, in part, I have now been approved for SSD and they have back paid me. I am now getting letters from Reliance wanting me to refund them the money they have paid. I think this is so wrong that they pray on the week. This Insurance is something that I elected through my employer and money was taking out of my check for it.” [redacted] further states, I do not feel I need to pay back any money that they have given me for disability. This is why we pay premiums.” The desired settlement noted is, Stop Contacting Me.The group policy number under which [redacted] in insured states, in relevant part:BENEFIT AMOUNT: To figure the benefit amount payable:(1) multiply an Insureds Covered Monthly Earnings by the benefit percentages), as shown on the Schedule of Benefits page;(2) take the lesser of the amount:(a) of step (1) above; or(b) the Maximum Monthly Benefit, as shown on the Schedule of Benefits page, and (3) subtract Other Income Benefits, as shown below, from step (2) above.We will pay at least the Minimum Monthly Benefit, as shown on the Schedule of Benefits page.OTHER INCOME BENEFITS; Other Income Benefits are benefits resulting from the same Total Disability for which a Monthly Benefit is payable under this Policy. These Other Income Benefits are:(1) disability income benefits an Insured is eligible to receive under any group insurance plans), -(2) disability income benefits an Insured is eligible to receive under any governmental retirement system, except benefits payable under a federal government employee pension benefit;(3) all permanent as well as temporary disability benefits, including any damages or settlement made in place of such benefits (whether or not liability is admitted) an Insured is eligible to receive under:(?) Workers' Compensation Laws;(b) occupational disease law;(c) any other laws of like intent as (a) or (b) above; and(d) any compulsory benefit law;(4) any of the following that the Insured is entitled to receive from you:(?) wages, excluding the amount allowable when engaged in Rehabilitative Employment; and(b) commissions or monies, including vested renewal commissions, but, excluding commissions or monies that the Insured earned prior to Total Disability which are paid after Total Disability has begun(5) that part of disability or Retirement Benefits paid for by you that an Insured is eligible to receive under a group retirement plan; and(6) disability or Retirement Benefits under the United States Social Security Act, the Canadian pension plans, federal or provincial plans, or any similar law for which:(?) an Insured is eligible to receive because of hisher Total Disability or eligibility for Retirement Benefits; and(b) an Insureds dependents are eligible to receive due to (a) above.Disability and early Retirement Benefits will be offset only if such benefits are elected bythe Insured or do not reduce the amount of hisher accrued normal Retirement Benefits then fundedRetirement Benefits under number (6) above will not apply to disabilities which begin after age 70 for those Insureds already receiving Social Security Retirement Benefits while continuing to work beyond age 70.Benefits above will be estimated if the benefits:(1) have not been applied foror(2) have not been awarded; and(3) have been denied and the denial is being appealed.The Monthly Benefit will be reduced by the estimated amount. If benefits have been estimated the Monthly Benefit will be adjusted when we receive proof(1) of the amount awarded; or -(2) that benefits have been denied and the denial cannot be further appealedIf we have underpaid the Monthly Benefit for any reason, we will make a lump sum payment. If we have overpaid the Monthly Benefit for any reason, the overpayment must be repaid to us. At our option, we may reduce the Monthly Benefit or ask for a lump sum refund. If we reduce the Monthly Benefit, the Minimum Monthly Benefit, if any, as shown on the Schedule of Benefits page, would not apply.As the above policy provisions state, we are to subtract any disability or retirement benefits that an insured is eligible to receive under the United States Social Security Act from the LTD benefit amount. In our initial telephone interview on January 26, 2012, we discussed this provision with [redacted] and explained to her that her LTD benefit would be reduced by any amount that she is eligible to receive from the Social Security Administration. We further explained that the policy affords us the right to estimate the amount that she would be eligible to receive for Social Security Disability Income (SSDI) and to reduce her LTD benefit by this amount.Upon the approval of her LTD claim, we sent [redacted] a letter dated March 23, 2012 reiterating that the policy allows us to reduce her LTD benefit payments by the amount of any estimated SSDI benefits for which she may be eligible. We explained that if she wished to receive her full LTD benefit without this estimated reduction, she needed to provide us proof that she has applied for SSDI and a completed Reimbursement Agreement. We further explained that in the event that her request to waive the estimated offset is approved, an overpayment may result if she or her dependents are awarded benefits from the Social Security Administration. We continued to explain that in the event of a benefit overpayment, she would be required to reimburse us in full within 15 days of her receipt of the notification by us.[redacted] signed and dated the Reimbursement Agreement on April , 2012 (see attached copy). The Reimbursement Agreement is a formal request from [redacted] for Reliance Standard to waive any estimated SSDI offset and to pay the full LTD benefit with no reduction. By signing and dating the Reimbursement Agreement, [redacted] acknowledged the terms listed in the agreement, which includes a statement that she must reimburse us for the full amount which may be overpaid to her in the event that she is awarded SSDI benefits, including retroactive awards.On July 30, 2013, we contacted [redacted] by telephone and advised her that we were in need of an update on the status of her SSDI application. She stated that she spoke with her attorney three weeks prior and was told her appeal may be reviewed sometime in September. We requested that she contact her attorney and have them send us a letter indicating at what stage of the application process she was at. On July 31, 2013, we received a letter from her attorney revealing that the SSDI application was pending.On April , 2014, [redacted] contacted us to advise that she was awarded SSDI benefits and would forward a copy of the award letter to us. We received the Notice of Award letter from the Social Security Administration on April 14, 2014.We sent a letter to [redacted] dated May , 2014 which explained that due to her entitlement to SSDI benefits that began on July 1, 2012 at the rate of 1,969.00 per month, her claim has been overpaid in the amount of 35,480.27 for the time period of June 3, 2012 to April 3, 2014.As explained above, the policy stipulates that we have the right to recover the overpayment that has occurred on [redacted]LTD claim. [redacted] does have the right to file a formal appeal within 180 days of his receipt of the May , 2014 letter. It should be noted that we did receive a formal appeal from [redacted] on May 16, 2014. The file has been sent to our Appeals Department for review. We will not take further action in collecting any debt that is owed us until our Appeals Department has completed their review of the file. Once the review is complete, we will continue to request repayment of any debt that is owed us.Sincerely,

Review: Disability claim submitted on 03/06/14 and was suppose to take 30-45 for standard claim, but they said mine was extended due to review of 3 month time frame to check or pre-existing conditions. I asked and had proper forms filled out promptly by needed doctors and insurance company and returned.

During this 75 day (so far) run around, they constantly kept saying policy rhetoric and I was given wrong answers by many reps throughout process because I had to constantly call and try and find someone to speak with because they never called or contacted me, never returned calls.

They have sent my information back and forth within the company about 5 times saying it's policy and saying it will take 7-10 business days for them to complete. If I had not completed the paperwork for them quickly to try and expedite process, this claim would easily push into the 120 day mark by their "standards"

I contacted a supposed manager at end of April when it was hitting 2 month mark and she said her rep would call by following Thursday with update, in which she did not, she called Friday only because my company had called her to let her know I left the company. She at that time told me she was sending of to the manager I had spoke with the prior week, for final approval.

I called 4:30pm Wednesday (after they apparently closed at 5pm ET) and she had promised response withing 24 hours, which I contacted her Friday morning after no response yet, and she stated that the claim did not get sent to her for final approval until the 05/13/14 and that it will be 7-10 business days for her to approve.

Again, during all of this time period I was not contacted until I was constantly calling to speak to someone about not being communicated with in anyone to keep me abreast of the claim.

Everything was delayed to last possible "policy" moment if not further to delay this claim, which I did most of the leg work for myself in order to try and expedite.

I even had to fax same information to them numerous times because they said they never received, but never called to state they never received, yet it is the same fax number time and time again I sent the documents too. I tried asking to send directly to reps email, but she would not give out and kept giving fax number.

Rep was very discourteous, cut me off constantly and would restate same thing over and over again about previous question when I was trying to ask a new question, but she would not listen.

Reps would just bring up the fact that due to me not knowing I should file for the possible coming LTD before the 90 day wait period ended, that it is my fault for not starting claim until 91st day and not being paid and for the hardships, stress, anxiety I've been dealing with not having money to pay bills.Desired Settlement: I would like a formal apology for their lack of communication throughout the process and the discourtesy of reps involved. Along with prompt finalization of claim along with a expedited check sent for bills.

Business

Response:

May 30, 2014Dear [redacted]:Your inquiry dated May 16, 2014 (received May 20, 2014), referencing the handling of [redacted] Long Term Disability (LTD) claim, has been forwarded to my attention for response, Thank you for the opportunity to address **. [redacted]' concerns.The abovementioned policy is a group LTD plan, which provides benefits at 66.67% of the covered employees monthly earnings to a maximum of $5,000.00 if he/she (among other requirements) meets the definition of Total Disability as defined by the policy. The policy situs state is Louisiana.According to the documents included with the inquiry filing, **. [redacted] contacted your office on May 16, 2014 for assistance with getting his LTD claim paid. According to our records, we resolved **. [redacted] concerns on My 20, 2014 when his LTD claim was approved. Benefits have been paid for the period March 5, 2014 to March 28, 2014, totaling $1,099.67, A copy of the approval letter sent to **. [redacted] has been enclosed for your review.We trust our response is sufficient for your needs. Enclosed with this correspondence is a copy of **. [redacted] payment history, group policy and approval letter. If you have any questions, please do not hesitate to contact me directly at ###-###-####.

Review: I was diagnosed with breast cancer on 3-6-12, and after a waiting period, I was put on LTD by my employer and my compensation was provided by Reliance Standard insurance co. The company miscalculated my benefits. Although the amount of the checks seemed a little high, I did not know that I was only being paid 60% of my pay and I figured there were no taxes taken out. Also the company was remiss in sending payments, and sometimes, I waited 6-8 weeks for payment, so all in all, I didn't have reason to question the amount, and honestly, I was so sick from chemotherapy that my though processes were not normal. In March of 2013, the company notified me that they had overpaid me $23,249.66. So in the tax year of 2012, I paid taxes on the over paid money, which decreased my refund by $4609.00. In 2013, I let the company withhold all my benefits, so the over payment could be paid back. In October, I returned to work full time and had a balance of $8,858.33 for the over payment, so I sent a check to the company for that amount, which completed paying off the over payment. When I did my taxes for 2013, I was not able to benefit for the amount paid back because, I was already receiving a full refund of my taxes paid. My accountant has done an outline of how the company's error caused me a financial loss. I can forward that letter upon request.Desired Settlement: I believe if the company could have provided me with an amended W-2 for 2012, I could have recovered the taxes I over paid, but they said they could not do so. I feel due to their mistake, they should pay me the money I lost during my tax filing process.

Business

Response:

July 23, 2014Dear [redacted]:This letter is in response to your inquiry regarding a Long Term Disability (LTD) claim for [redacted]. Thank you for the opportunity to address and respond to [redacted]'s COOCCITIS,I have attached our response to the Insurance Department, State of Connecticut dated April 22, 2014 regarding this matter. It outlines our position regarding [redacted] request that we amend and reissue her W2 wage statement for 2012.Should you have further questions in regards to the status or handling of [redacted]’s claim, please contact our office.Sincerely,Martha M[redacted], LTD Supervisor Group Disability Claims Department

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved] Review: [redacted]I am rejecting this response because: The company has not accepted responsibilty for causing me a financial loss. Attached is a spreadsheet fromn my accountant showing that the mistake cost me to have to pay extra taxes on money I ultimately paid back. If they do not reimburse me soon, I will have no choice but to file a law suit.Regards,[redacted]

Review: I have signed up for a policy through this company. The cost came out of my paycheck in September and October. I was notified at the end of September (by mail) of my application needing additional information. I could not determine what information was needed. I called the 1800 number and was told my policy had not begun. She sent me to the medical underwriter to let me know what additional information was needed. He did not answer, so I left a message. I got no return call. I called multiple times and left more than one voice message. I called the 1800 number again like 3 or 4 days later. The lady told me she couldn't help me and I complained that they only person who could help me wouldn't answer/return my call. She proceeded to tell me he wasn't an answering service. My question back to her was why am I being sent to him then to answer my question?! I told her this was horrible customer service and I didn't understand why he won't call me back and why I am being charged for this policy, but it isn't active. She told me I would hear back from him today. I still have not received a phone call or any help from them.Desired Settlement: I expect a phone call apologizing for my inconvenience and a clear explanation for what additional information is needed to process my application. Also, I expect my policy to be activated from the time I began paying for it (in September) or a refund.

Business

Response:

Oct/28/2014Dear [redacted]:We are writing to acknowledge receipt of the above-mentioned correspondence. We have forwarded this inquiry to Ms. S[redacted] of our Underwriting Department who has reached out to [redacted] and addressed her concerns, Below is Ms. S[redacted] contact information.NAME: Margaret S[redacted] TITLE: Manager, Medical Underwriting and VGTL Departments TELEPHONE ###-###-####, Extension [redacted]Please feel free to contact us if we can assist you further in this matter,Sincerely,Law/Consumer Relations Department

Review: I filed for disability with this company and told them that my middle initial must be included on everything, especially the mailing address label. They have continuously ignored my request and failed to correct my name. Due to my disability (amputation) I have had to move in with my parents. My father shares the same first name but our middle names are different. I have included my middle initial in my name for over 20 years in order to prevent being mixed up with him, even when I was living somewhere else.

I don't see why it is so difficult to put one initial into my name so the mailing label is correct and the envelopes are sent to me and not my father. In the past this has caused both our credit reports and histories to be intertwined and I have spent years trying to correct these problems. I have asked, directed and begged Reliance Insurance to add the "*" to the mailing label but they refuse to do so.Desired Settlement: Put my middle initial on the mailing label.

Business

Response:

July 9, 2014Dear [redacted]:We are writing to acknowledge receipt of the above-mentioned correspondence. We have forwarded this complaint to the following department at the same address:NAME: [redacted]TITLE: ManagerDEPARTMENT: Integrated Disability Claims###-###-####We are presently looking into this matter and you will be hearing from us shortly.Please note! If at any time you correspond directly with the individual listed above, it would be appreciated if a copy of that correspondence were sent to me as well, so that we can track all correspondence and ensure that timely responses are provided to you.Sincerely,

Consumer

Response:

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Regards,