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AMLO wins against Reliance Standard for disabled client

Written by AMLO.

Federal Judge issues opinion critical of Reliance Standard's procedure for denying claim

The federal judge rightfully was critical of the handling of the claim, ordering Reliance Insurance to re-evaluate the claim. The Federal opinion said:

Reliance Standard’s ignoring Ron’s Social Security disability determination weighs against finding that Reliance ever engaged in a “deliberate, principled reasoning process.”

Having benefited financially from the government’s determination that Ron was totally disabled, Reliance Standard Insurance Co. was obligated to weigh that determination, which it did not even consider.

In the instant case, the fact that the defendant benefited financially from the SSA determination and later ignored the Agency’s findings justifies a higher degree of concern about a conflict of interest because Reliance is both deciding whether to pay and also the entity that is to pay the benefits.

By failing to provide its reviewers with all relevant medical records, Reliance undermined the integrity of its own “Residual Employability Analysis” upon which it relied, which in turn undermines the integrity of its decision-making process. Reliance failed to consider Pemberton’s SSA determination at each stage of its decision-making process. This failure increases the significance of Reliance’s conflict of interest inherent in its determining eligibility and also being the entity that pays benefits. The fact that the second REA was based on insufficient information further undermines the integrity of Reliance’s decision-making process.