BBB Accredited Business since

Standard Insurance Company

Additional Locations

Phone: (971) 321-7000 Fax: (971) 321-5243 1100 SW 6th Ave, Portland, OR 97204 http://www.standard.com


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Description

This company offers life, disability and retirement insurance services.


BBB Accreditation

A BBB Accredited Business since

BBB has determined that Standard Insurance Company meets BBB accreditation standards, which include a commitment to make a good faith effort to resolve any consumer complaints. BBB Accredited Businesses pay a fee for accreditation review/monitoring and for support of BBB services to the public.

BBB accreditation does not mean that the business' products or services have been evaluated or endorsed by BBB, or that BBB has made a determination as to the business' product quality or competency in performing services.


Reason for Rating

BBB rating is based on 13 factors. Get the details about the factors considered.

Factors that raised the rating for Standard Insurance Company include:

  • Length of time business has been operating
  • Complaint volume filed with BBB for business of this size
  • Response to 21 complaint(s) filed against business
  • Resolution of complaint(s) filed against business


Customer Complaints Summary Read complaint details

21 complaints closed with BBB in last 3 years | 10 closed in last 12 months
Complaint Type Total Closed Complaints
Advertising/Sales Issues 0
Billing/Collection Issues 0
Delivery Issues 0
Guarantee/Warranty Issues 1
Problems with Product/Service 20
Total Closed Complaints 21

Customer Reviews Summary Read customer reviews

2 Customer Reviews on Standard Insurance Company
Customer Experience Total Customer Reviews
Positive Experience 0
Neutral Experience 0
Negative Experience 2
Total Customer Reviews 2

Additional Information

BBB file opened: January 01, 1954 Business started: 01/01/1906 Business started locally: 01/01/1906 Business incorporated: 10/18/2001 in OR
Licensing, Bonding or Registration

This business is in an industry that may require professional licensing, bonding or registration. BBB encourages you to check with the appropriate agency to be certain any requirements are currently being met.

These agencies may include:

Washington Department of Revenue
6500 Linderson Way SW Fl 1, Tumwater WA 98501
http://www.dor.wa.gov
Phone Number: (800) 451-7985
bls@dor.wa.gov

Oregon Division of Finance & Corporate Securities
350 Winter St NE Rm 410, Salem OR 97301
http://www.cbs.state.or.us/dfcs
Phone Number: (503) 378-4140
dcbs.dfcsmail@state.or.us

Type of Entity

Corporation

Business Management
Mr. Justin Delaney, Vice President Mr. Greg Ness, President Ms. Shelia Noland, Legal Assistant Mr. Bob Speltz, Public Affairs
Contact Information
Principal: Mr. Justin Delaney, Vice President
Business Category

Insurance Companies


Customer Review Rating plus BBB Rating Summary

Standard Insurance Company has received 0 out of 5 stars based on 0 Customer Reviews and a BBB Rating of A+.

BBB Customer Review Rating plus BBB Rating Overview

Additional Locations

  • 1100 SW 6th Ave

    Portland, OR 97204 (971) 321-7000

  • PO Box 711

    Portland, OR 97207 (800) 368-1135 (888) 937-4783

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BBB Customer Review Rating plus BBB Rating Overview


BBB Customer Reviews Rating represents the customers opinions of the business. The Customer Review Rating is based on the number of positive, neutral and negative customer reviews posted that are calculated to produce a score.

Customer Review Experience Value
Positive Review 5 points per review
Neutral Review 3 points per review
Negative Review 1 point per review

BBB letter grades represent the BBB's opinion of the business. The BBB grade is based on BBB file information about the business. In some cases, a business' grade may be lowered if the BBB does not have sufficient information about the business despite BBB requests for that information from the business.
Details

BBB Letter Grade Scale

BBB Rating Value
A+ 5
A 4.66
A- 4.33
B+ 4
B 3.66
B- 3.33
C+ 3
C 2.66
C- 2.33
D+ 2
D 1.66
D- 1.33
F 1
NR -----
Star Rating scale

  Average Score
5 stars 5.00
4.5 stars 4.50-4.99
4 stars 4.00-4.49
3.5 stars 3.50-3.99
3 stars 3.00-3.49
2.5 stars 2.50-2.99
2 stars 2.00-2.49
1.5 stars 1.50-1.99
1 star 0-1.49

BBB Customer Review Rating plus BBB Rating is not a guarantee of a business' reliability or performance, and BBB recommends that consumers consider a business' BBB Rating and Customer Review Rating in addition to all other available information about the business. If the BBB Rating is NR then only Customer Reviews are used for the Star Rating.

Complaint Detail(s)

4/18/2015 Problems with Product/Service
4/7/2015 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: In the most recent letter dated September 26, 2014 from The Standard there was no indication that additional information was needed for my husband's claim to be decided. The LTD policy indicates that after The Standard has received documentation to initially decide a claim, the company has 105 days to make a decision. As of today, after 105 days and allowing more than a week for delivery by mail, no decision letter has been received. Further, calls to The Standard this January requesting the status of the claim have not been returned.

Desired Settlement: Please mail a decision letter for the definition change on my husband's claim number ********. If the claim is approved, then please also make the LTD benefit current.

Business Response:

Complaint Department:

We are writing in response to the Complaint Activity Report received January 29, 2014, in which you indicate ** ******* ****** has filed a complaint with your company on behalf of her husband ***** ***** concerning their lack of a decision on his Long Term Disability (LTD) claim with Standard Insuarance Company (The Standard).  As a Manager in the Employee Benefits Division responsible for the administration of LTD claims, your inquiry was referred to me for response.

** ******* claim for LTD benefits has been under review in order to determine if he continues to meet the provisions of his group policy, including its Definition of Disability.  We did not receive an authorization to release information from ** ******, therefore I am unable to comment on any of the medical information contained in his claim file.  However, in my review of his clam, I find that ** ******* has been receiving benefits from Standard since May 27, 2009 and his claim closed on May 27, 2014 as he no longer met the terms of the group policy.  He submitted additional information for review, without requesting an actual appeal, and this information has been under consideration.  We had intended to continue issuing him LTD benefits while this review was underway but have recently discovered this was not done.  Therefore, a retroactive payment has been issued to him as of today's date covering the period of May 28, 2014 through February 10, 2015 has been issued to him.  We will continue to keep him informed of the progress of our review and will provide a full explanation of our decision when it has been reached.

In the intermin, I can be reached via contact number and email below if you have any additional questions.

Sincerely,

****** ****, Manager

Employee Benefits Department

??

Consumer Response: (The consumer indicated he/she DID NOT accept the response from the business.)
For my husband's claim number ********, please provide a complete copy of his administrative record and a Group Life Conversion Materials form (that was not enclosed with the decision letter.) The administrative record includes 1. Long Term Group Disability Plan; 2. Any and all Summary Plan Descriptions; 3. Any and all Certificates of Insurance issued; 4. Copies of any and all pertinent documents upon which the decision to terminate my husband's benefits is based, as required by 29 CFR 2560.503-1 (g)(i); 5. Any and all agreements allowing you to act as Claim Administrator under the terms of the Plan; 6. A copy of the claims manual and/or all written claims handling of my husband's policies and procedures in effect at all times relevant to the handling of the claim; 7. In addition, if there is a contractual statute of limitations governing my husband's claim, please advise: (a) when it will expire; and (b) where in the Long Term Group Disability Plan I may find the language regarding the contractual statute of limitations. This weekend, I will fax (to ************) and mail (to Standard Insurance Company, *** ** ***** ******, Portland, OR 97204-1235) a letter requesting a complete copy of my husband's administrative record be mailed within 15 days of today, February 21, 2015. Please mail a Group Life Conversion Materials form within 5 days of today.

Business Response:

Complaint Department:

I am writing to provide you with an update into the complaint filed with your office concerning the Long Term Disability (LTD) claim of ***** ****** by his wife, ******** *******.

As noted in myh prior letter of February 11, 2015, we were completing our review of his eligibility for ongoing LTD benefits under the terms of the *** ***** ********* group LTD policy.  Ultimately, we have concluded that he no longer met the policy's Definition of Disability and his LTD claim as been closed as of February 12, 2015.  A full letter explaining this decision has been sent to ** ******.  This letter includes an explanation of his rights to request an independent review if he disagrees with our decision.

Thank you for your inquiry into ** **** claim for LTD benefits.  Barring further communication from your office, we will assume we have adequately addressed the issue in this complaint and will consider this complaint closed.  However, please do not hesitate to contact me should you have any questions or concerns.

Sincerely,

******* *****, Manager

2/6/2015 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: conflicting insurance information

Desired Settlement: correct calculations

Business Response: Final Consumer Response /* (2000, 11, 2015/02/06) */ PLEASE CANCEL MY COMPLAINT. I PLACED A CALL INTO THE COMPANY AND MY PROBLEM WAS IMMEDIATELY RESOLVED. THANK YOU FOR YOUR ASSISTANCE.

1/8/2015 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: The Standard cut off my Short Term Disabilities pending their evaluation of my case for Long Term Disabilities. Short term and Long term claims are different and therefore should be evaluated and executed I was told I would receive a formal decision by Dec 26, but I have not. I believe the timing of the suspension of my benefits was intentional to run though the holiday tax season to cause additional stress and pressure on me so that I would give up seeking my deserved benefit and return to work

Desired Settlement: I am seeking payment of short term and long term benefits due.

Business Response: Final Consumer Response /* (2000, 6, 2015/01/08) */ I would like to cancel my complaint in order to allow the Standard time to provide feedback.

12/9/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: I was covered under my employers disability insurance. Was off work due to medical issues and collecting payments from Standard with no issues for most of the claim period. After I was cleared to return to work by my doctor, the insurance company refused to pay the last 6 weeks of my claim. Standard Insurance Company chose to "review" my claim. They had an "independent 3rd party" (which is someone that is on their staff) review my claim and deny any further payments. After writing them and appealing through their lengthy process (which was to have yet another one of their workers review my claim) a year later now, I was again denied. They told me to take legal action if I disagree. At no time did their doctor or doctors examine me, at no time did they request further details or even questions me. Typical insurance company who makes you fight to get what you're contractually due.

Desired Settlement: I am seeking payment for the last period of the claim in which my doctor signed off. They have the details on the time period and are choosing to play hardball. I am sorry I am just a number on a piece of paper that can be denied since my claim doesn't profit your company. I am rightfully owed per the contract with my employer and I.

Business Response: Initial Business Response /* (1000, 12, 2014/10/06) */ September 25, 2014 Better Business Bureau Serving Alaska, Oregon & Western Washington Complaint Department Re: Case # ******** Complainant: ***************** Insured: Same as above Group Name: ************* NAIC No: ***** Dear Better Business Bureau: Thank you for providing the Consumer Complaint filed by *****************. I'm a Manager within the Benefits Department of Standard Insurance, and I've been selected to respond to this complaint because her Long Term Disability (LTD) claim was approved and closed by an Analyst on my team. As discussed in ************* complaint, the issue at hand is whether or not she is due LTD benefits beyond the current close date of September 15, 2013. I've reviewed the results of medical investigations completed initially and in the months that followed the original closure decision, and can confirm we've gone to great lengths in reviewing and re-reviewing the functional capacity *********** possessed beyond September 15, 2013. More specifically, we originally mailed her correspondence dated August 8, 2013, which clarified her claim would close with benefits payable through September 15, 2013, since that was the anticipated return to work date offered by her treating medical provider. *********** disputed the close date on October 16, 2013, which prompted an independent review of the closure decision by a Senior Benefit Review Specialist in our Administrative Review Unit. The closure was upheld on October 23, 2013. Following that review, *********** provided additional medical documentation, which was reviewed by an Analyst on my team, and the closure was again upheld on January 9, 2014. We provided *********** with correspondence which outlined the results of a Physician Consultant review of her records and the basis of our decision to uphold the closure. This led to a second appeal from ***********, which was performed by a different Benefit Review Specialist in the Administrative Review Unit. This additional review confirmed the correct decision was made on the claim. Since we're unable to provide scanned documentation or go into detail regarding the medical information reviewed during our investigations, I'm unable to specifically address the medical basis for our closure. However, I can assure you we've gone to great lengths to ensure *********** received a fair re-evaluation of her claim. If you have any questions or require additional information, please don't hesitate to contact me. Sincerely, ************* Manager, Disability Benefits The Standard **************, ext **** Fax: ************** Initial Consumer Rebuttal /* (3000, 14, 2014/10/08) */ (The consumer indicated he/she DID NOT accept the response from the business.) To Whom it May Concern, I am happy that Mr. ****** replied to my complaint promptly. I do agree with the timeline of events, but do not agree that all of the events were included. Firstly, the issue at hand is that I was not paid for the final weeks of my disability leave as previously stated. Correspondence stating my claim would end on September 15th was received, but this type of correspondence was received numerous times over the course of my leave. The "claim end dates" were based on the reports my Doctor filled out and filed with Standard Insurance. Every time the date would come close, new paperwork was filed with Standard stating my condition, improvements or set-backs, and also a new estimated return to work date. There were six of these total, if my memory is correct. The September 15th date was no different and the paperwork was filed promptly as it was previously during the course of the claim. Standard reviewed this just like they had in the past, only this time I was back at work before the determination of eligibility was determined. The truth is, with my condition there was no certainty as to when I would actually return to work. Per my Doctor's request, every extension was for one to two months at a time. No one knew if I would be okay to go back after a month, or a year! I wanted to return to work as soon as possible, but if I was not fit to work and lead my team, I could not go back!. I had many follow ups with the Doctor, every week and followed the policy requirements. I understand that The Standard had my case reviewed multiple times, as they stated, but ultimately it was reviewed by THEIR EMPLOYEES. At no time did their doctor or any third party doctors examine me; at no time did they request further details or even question me. The paperwork that was filed by my Doctor stated I was totally disabled past their termination date of September 15, violating their contractual obligation. It is my speculation that if my disability had been prolonged and carried into further months, that I would have continued to receive payments from Standard and this issue would have come up at that final payment time. How many people would let this go after carrying on fighting over a year later? How many others have had their final payments denied? I am sure there are analyst at Standard that know exact numbers! I am sure they have return on investment research into how much money they save (even after lawsuits) by denying a percentage of claims near the end. The reviews were done after every extension request from my Doctor. Only the final was denied. I do not agree with the determination that Standard issued. Per my employee contact, I was covered to be reimbursed for missed work based on the Doctor's determination that I was not fit to work. Best Regards. ********* *******

11/10/2014 Guarantee/Warranty Issues | Read Complaint Details
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Additional Notes

Complaint: I have paid into optional long term disability through my employer for almost 15 years. I suffered a job injury on 1/20/2011, and continued to work despite the injury until January of this year. My attending physician took me off work as of January 14, 2014 due to the level of pain I was experiencing as a result of the injury. I filed a claim with this company for benefits under my long term disability policy. After not receiving any decision for over six months, I received notification today that the disabilty adjuster had decided that she had decided that I was only disabled as of the date I received surgery for my work injury, and that I was not disabled for the six months I was off work fighting with L&I to actually have the surgery. Despite the fact that my physician indicated back in January that I was unable to complete any essential functions of my job, and that he took me off any work the insurance company has indicated that it is their position that I only became disabled as of the date of my surgery! The company should have approved this claim as of the date I was unable to work, minus the 90 day waiting period as indicated by my policy. The disability analyst reported that her decision was based on my job being what she described as "sedentary", despite the fact that I have informed her multiple times that I work as a Sex Offender Treatment Specialist, that I work inside of a medium security state prison, and that I cannot return to work until my doctor has cleared me to do so as I work in a potentially hazardous setting where I am required to be alone in a room with violent sexual predators as one of my primary job duties, and that I need to be able to defend myself against inmate assaults as a primary job requirement.

Desired Settlement: I believe the insurance company needs to review this decision, and that they should pay out on this claim from the date I was taken off work by the attending physician, and not the date I finally had surgery for the injury.

Business Response: Initial Business Response /* (1000, 7, 2014/10/20) */ October 17, 2014 Better Business Bureau Serving Alaska, Oregon & Western Washington Complaint Department 1000 Station Drive Ste 222 DuPont, WA 98327 Re: BBB Case Number: ******** Complainant:************ Group Policy: State of Washington Policy Number: ****** Claim Number: ********* Complaint Department: We are writing in response to the Complaint Activity Report received October 8, 2014, in which you indicate Mr.************ has filed a complaint with your company concerning the decision on his Long Term Disability (LTD) claim with Standard Insurance Company (The Standard). As a Manager in the Employee Benefits Division responsible for the administration of claims under the State of Washington Group LTD Policy, your inquiry was referred to me for response. ************ claim for LTD benefits has been under review in order to determine if he meets the provisions of his group policy, including its Definition of Disability. We did not receive an authorization to release information from ***********, therefore I am unable to comment on any of the medical information contained in his claim file. However, as he has expressed his disagreement with our determination to pay his claim, but using a later date of disability than he requested, we are forwarding his file to our Administrative Review Unit for an appeal of this determination. We will continue to keep him informed of the progress of our review and will provide a full explanation of our decision when it has been reached. I will notify your office when the Administrative Review Unit has complete its review. In the interim, I can be reached via contact number and email below if you have any additional questions. Sincerely, ******** ****, Manager Employee Benefits Department

9/15/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: on the 12 june I received some paper from the standard about my social security records and education noe I fill out that paper last year for my education and I was told I will fill it out every 24 months. they send me anoher one just a year after the 24 months.I was also told on theletter that in 45 day that I will keep getting my check.they didn,t send me any paper to find out that I,m still under a doctor care for remator arttritciand still taking infusion,my doctor name is *********** and I been under his care since may when we move.i we move so I can be close to family did not have family in charlotte,knees kelp giving out.also in the letter it,s said that I will keep getting my check until they investogat and I found out that my claime was closed with no explanation and no letter. if they was to send me the right paper I would took them to my new doctor for him to fill out.I feel like this company robbed me because in there document it stated that when you have a claim that your benetfit,will go until you are 65 years old and I,m not 65 they lied. I fill they was trying to close my claim for a long time,and they cheaped.i don't know why *************** and *****************,that closed my claim without finding or send me paper for my new doctor to fill out,no they closed the claim without finding out.all they had to do,is do things right. noletter and no explanation.that,s not good business like that.if this don,t help me than.i have no reason than to go talk to a lawyer, with all my paper works I have I do have a case.

Desired Settlement: DesiredSettlementID: Other (requires explanation) open my claim back and send me paper for the doctor like they suppose to do, I hope this does,nt happen to you, like the old saying says what go around come around. do the right thing you too.

Business Response: Initial Business Response /* (1000, 9, 2014/08/20) */ Better Business Bureau Serving Alaska, Oregon & Washington Electronic Acknowledgement RE: DEPARTMENT 0F INSURANCE FILE # Complainant: ****************** Insured: same as above Group Name: ***************************** NAIC No: ***** Dear Better Business Bureau; On behalf of Standard Insurance Company (The Standard) I am responding to ************ complaint to the Better Business Bureau. If, after reviewing this response, you have any questions, please address them to me. ************ Complaint ********* states that his claim has been closed. In his complaint he asserts that because he is continuing under the care of a physician, he is owed benefits until he turns 65 years old. He further alleges that The Standard failed to communicate with him and violated the terms of its own "document". He asks that his claim be reopened and that he be forwarded a form for his physician to complete. Explanation of Policy and Coverage ********* was insured under a Long Term Disability (LTD) Policy purchased by his employer, ***************************** (Group Policy). This policy provides a LTD Benefit so long as the Member meets the Definition of Disability or until the Maximum. Benefit Period of age 65. For the first 24 months of LTD Benefits, the Member is Disabled if he is unable to perform the Material Duties of his Own Occupation. After 24 months of LTD Benefits have been paid, the Definition of Disability changes to the inability to perform Any Occupation the Member is able to perform, whether due to education, training or experience, which is available in one or more locations in the national economy and in which the Member can he expected to earn at least 60% of Indexed Predisability Earnings within 12 months following return to work, regardless of whether he is working in that or any other occupation. Moreover, ********* does have an obligation under the policy to provide written Proof of Loss and Documentation in support of his claim Administration of ********* Claim and Response to his Complaint *********'s complaint reveals a misunderstanding of his benefits under the Group Policy. *********'s LTD claim was initially approved, because be was Disabled from working in his Own Occupation. However, his policy provided him LTD Benefits until he turned age 65 only if he remained Disabled as defined. Significantly, an important change to the Definition of Disability occurred after 24 months of LTD Benefits were paid. Instead of receiving benefits for the inability to perform his Own Occupation, he now was eligible to receive LTD Benefits because he was unable to perform Any Occupation and earn 60% of his Predisability Earnings. The Standard recognizes that this is an important event in the claim and that claimants deserve to be informed of this change. Indeed, ********* was informed of the change in a letter dated November 27, 2012 and then again in a letter dated May 14, 2014. Finally, he was provided with a full explanation of the decision in a letter dated July 23, 2014, the date of the closure. The record does not support his claim that The Standard failed to accurately inform him of its administration of the Group Policy and did not provide an explanation of its decision. Another part of ************ complaint concerns his apparent understanding that to continue LTD Benefits he must simply have his physician complete a form. While we will carefully consider any information he chooses to submit, we have made a decision based on an evaluation of all the information in the claim file, including his own statements, medical records, reviews by consulting physician(s), and forms submitted. It is the entirety of the record and not simply one document that determines the decision. Because ********* is receiving Social Security Disability Benefits, before closing his claim The Standard did forward to him requests on June 12, 2014 and June 17, 2014 for the Social Security record. He was informed he could provide the record or that The Standard would submit the request if he provided an authorization for release of these materials to it. These letters explain that a decision will be made 45 days following the June 12, 2014 letter with the information available to us. While ********* states in a telephone call on June 16, 2014 that this file contains no new information, he ultimately signed the form and The Standard forwarded a request with the authorization and a fee to Social Security for the information. We did not receive the information within the 45 days, so a decision was made based on the information in the claim file. This is consistent with the Documentation provision of the Group Policy. Settlement of *********'s Claim ********* has asked for his claim to be reopened while he completes a form. We cannot agree to this course. ************ LTD claim has closed; because when the Definition of Disability changed it was determined he is no longer Disabled. This decision was based on a careful evaluation of substantial medical and vocational information. It cannot be overturned without significant documentation establishing he cannot perform Any Occupation. As indicated in our July 23, 2014 letter he does have the opportunity to present such information to The Standard, and another reviewer and alternate physician or other expert will reevaluate his claim. If he continues to disagree with the decision to close his claim after he reviews The Standard's correspondence, I would encourage him to request a review. Thank you for the opportunity to respond to *********'s concerns. Again, should you have any questions or wish to further discuss this matter, please contact me. Sincerely, ***************** ***SUPPORTING DOCUMENTS REDACTED BY BBB*** Initial Consumer Rebuttal /* (3000, 11, 2014/08/23) */ (The consumer indicated he/she DID NOT accept the response from the business.) for onething the doctor you are talking about ********** I have not seen this doctor in two years allmore and I don,t remembering talking to anyone one the phone about my heath,also I sign the paper for the social serity when I call about the paper and not my heath.******* transfer me to ************** in may 2014. ********* I stop seeing him in 2012 because he act like he was afraid to touch me and I needed help and in pain I amm still doing my infusion every month and still, having problem with my hands,my feets,my lower part of my back,my hip, I am going to see ******** next month and if you want paper to be fill out,than send them to me to get fill out. I am trying to play with my heath at all.and the paper that they send me I did not under stand what they mean I have a 10th grade education. Final Business Response /* (4000, 13, 2014/09/08) */ September 3, 2014 Better Business Bureau Serving Alaska, Oregon & Washington Electronic Acknowledgement RE: DEPARTMENT OF INSURANCE FILE #: Complainant: ****************** Insured: same as above Group Name: ***************************** NAIC No: ***** Dear Better Business Bureau; On behalf of Standard Insurance Company (The Standard) I am again responding to *********** complaint to the Better Business Bureau. *********** Complaint ********* has responded to my letter of August 12, 2014 with additional comments. To summarize he believes he remains Disabled, is now seeing a new doctor and does not understand the process for submitting additional information. Follow-up and next steps I called ********* on September 3, 2014 in order to discuss how he might avail himself of the review process since he disagrees with The Standard's decision. In that regard I provided ********* with my e-mail address and coached him on how to request a review. I encouraged him to tell us in his own words why he is unable to work in any occupation. I also assured ********* that I had noted his concerns regarding consideration of the medical record of his new physician. Furthermore, I noted his assertion that the occupations identified require a high school diploma. Finally, I provided him with my telephone number and encouraged him to call me should he have any questions. Assuming that ********* submits a request for review, his claim will be referred to the Administrative Review Unit. There, a reviewer who has not had any role in the claim decision will evaluate his claim. Any pertinent information necessary for a full review will be requested and a medical review by a physician will be initiated as will a review by a vocational case manager. Neither of these individuals will have had any role in the prior claim determination. Upon completion of the evaluation ********* will be provided with a full explanation of the reviewer's decision. By requesting a review ********* can have his concerns addressed and he has been provided with the resources necessary to do so. As such, I believe his complaint has been addressed. Again, should you have any questions or wish to further discuss this matter, please contact me. Sincerely, **************** Manager, Disability Benefits Standard Insurance Company ******************* Portland, OR 97204 Telephone ************* cc:*******************, Vice President External Affairs & Associate Counsel, Standard Insurance Company Final Consumer Response /* (4200, 15, 2014/09/10) */ (The consumer indicated he/she DID NOT accept the response from the business.) have not learn to email anyone yet my son will show me how. soon when he does I will email mr. ************** soon as possible. or I will write a letter, but I am still not satisfy with it. thanks

6/26/2014 Problems with Product/Service
5/6/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: Detail of Complaint I have submitted the requested documentations to ***** within days of her request. When documents are received, there would be subject to 7-10 review before a discussion was made. Pay is issued weekly & I have only received 6 payments within 19 weeks of disability. I believe my claim is closed immediately after payment is issued to avoid showing up on the company's opened, pending, etc tracking system & provides her an opportunity to process the claim at her leisure rather than on a professional level. The consistent claim denial, payment inconsistency and financial hardship have a direct impact to recovery. On 11/26 my claim was approved from 11/1 to 11/20 & future payments would depend on the findings of a board certified medical examiner. She said my review was rushed & I would know prior to the next payout date, 12/4. There was no response from ***** so I contacted her & I still await correspondence, please see the attached. This consistent behavior took a toll on my health & has an adverse impact on my treatment. I feel these actions/behaviors are a retaliatory in nature. My physician & therapist have provided treatment summarization & diagnosis which such be sufficient to substantiate my disability claim. I have attempted to work with her direct supervisor, ******* ***** and his superior, **** ***** regarding this matter. ***SUPPORTING DOCUMENTS REDACTED BY BBB***

Desired Settlement: 1)Back payment for loss of wages due to disability 2)Complete copy of file communications (emails, phone calls, im's, faxes, etc) Previously requested information by my attorney office requested: A) curriculum vitae of medical examiner and other individuals who have made determinations regarding my claim B) e-mails, call logs (including notes) and other recorded communication requests & submissions sent to and received by ******************** ******** and still await information at this time request has remained unfulfilled. All i.m. communication(s) regarding my claim 3)Reimbursement for nsf and late fees

Business Response: Initial Business Response /* (1000, 8, 2014/03/07) */ Dear Better Business Bureau: We are writing in response to the complaint filed by ********** regarding his Short Term Disability (STD) claim with Standard Insurance Company (The Standard). I have reviewed the complaint and the information in the claim and we wish to respond. Mr. ********** has previously filed a complaint with the ******************************* which is very similar to this complaint. This original complaint record is identical to the complaint made with the *******************************. As such we are including a letter written on January 7, 2014 in response to that complaint. The letter covers much of what is discussed in the current claim with your Bureau. With regard to the Mr. **********'s current desired resolutions not covered in the previous letter we submit the following. ************** asks for a complete copy of file communications which he previously requested through his attorney. This information was previously forwarded to the ******************************* and we will send a copy of what was requested to his attorney as requested immediately. At the time that ********** attorney had initially requested some of this material on October 16, 2013 his claim was being paid and release of these materials is not indicated in situations where claims are being paid fully. ************** asked how a fair and equitable decision was reached by ***************** on February 5, 2014. ***************** is the Benefits Review Specialist in the Administrative Review Unit who is conducting the independent review of **************s claim. As is outlined in the letter on February 5th by ************* he is requesting medical records for the period from October 1, 20l3 to present. He has further explained what those records might contain to provide ************** with some direction in terms of what kind of information might help in completing the independent review. Further, ************* notified Mr. ********** that if the documentation was not received by March 23, 2014 they would proceed with their review at that time. Lastly, **** ********** requests reimbursement for a fee for documentation he was charged by *** ***** office for a form he had completed. This is not something under the purview of the contract. We do acknowledge that we often request medical records on behalf of claimants and pay for those records; however, we do not have a contractual basis to respond to Mr. **********'s request for reimbursement of a fee he was charged by his treating physician's office. As the claim is currently with our Administrative Review Unit we would respectfully request an extension in order to complete that independent review. I send written updates every 14 days in order to update your office with the progress of the review. Should you have further questions please feel free to contact me at the number or email address below. Sincerely, ************ Supervisor, Disability Benefits ************ ************@standard.com ***SUPPORTING DOCUMENTS REDACTED BY BBB*** Initial Consumer Rebuttal /* (3000, 16, 2014/03/27) */ March 24, 2014 Better Business Bureau, BBB 4004 SW Kruse Way Pl Ste 375 Lake Oswego, OR 97035 RE: CASE NO: ******** DEFENDANT: THE STANDARD GROUP NAME: STATE OF GEORGIA POLICY NO. ****** CLAIM NO. ********** Dear BBB: I have supplied The Standard with additional medical documents, records, etc. which were not considered. The Standards, has centered it's determination around medical notes from my therapist and refuses to review the medical facts that were supplied after 24 November 2013. I provided psychotherapy notes from my psychiatrist, treatment plans, summary of diagnosis, treatment frequencies, etc. without any consideration from claim adjuster or ARU, ********************. I was referred for psychiatric service by several medical professionals and followed through with all medical recommendations including leave from work. Consequently, I cannot return to work for a release from my psychiatrist is required. My medical providers do not professionally or medically recommend my return to work. However, The Standard has not considered the supplemental medical records but feel that I do not meet the definition of disabled as covered in the policy. "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, Pregnancy or Mental Disorder: l. You are unable to perform with reasonable continuity the Material Duties of your Own Occupation; and 2. You suffer a loss of at least 20% in your Benefit Salary (Predisability Earnings) when working in your Own Occupation" (The Standard. Revised 3/2011, 642967-A). ********* and other medical professional have stated that I am not able to return to work due to my present mental state and additional medical concerns. I have suffered a loss of benefit salary which is greater than 20%. Therefore, I meet The Standards policy definition of Disabled. Additional, my employer classified me as a disabled employee and placed me on a medical leave from work duties. Why has The Standard not classified me as Disabled? I am not able to perform my Own Occupation duties as I work 30-40 adolescence's where I am required and held accountable not only my actions rather theirs as well. If I am not able to manage my mental behavior, should I be driven or subjected to the behavior of unpredictable adolescents? Is it not more reasonable to believe The Standard should consider the same options? "... Under federal regulations implementing HIPAA, a patient has certain rights with respect to inspecting and copying their health records when they make a specific request to do so in writing. Those regulations also make clear, among other thing, that the provider does not have to give the patient a copy of the "psychotherapy notes," which are defined as the notes recorded in any medium by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual's medical (includes mental health) record." The following link describes and defines the difference between psychotherapy notes and records, *************************************************. According to ************, "We discussed that he doesn't want to provide the treatment notes from his provider-this is personal information. I understood, and said that in lieu of these notes, we could accepts progress notes, treatment summaries or anything else the provider would like to send that explains why he remains unable to return to work" (November 20, 2013 @ 12:23). The Federal Government felt a necessary to clarify the difference between psycho "notes" and psycho records. Based on The Standard's request, it appears this is only an attempt to throw around legal terms in a lose manner to avoid contractual obligations. Furthermore, should I be required or subjected to violating my protected constitutional rights to satisfy their voyage. Medical records from certificated medical provider support my medical disability and prevent me from returning to work. Therefore, I would like to request mediation or elect to have both of our physicians select an arbitrary physician to consult over the medical documents and claim file. This would help resolve my concerns in a timely fashion as the lack of income has a direct correlation on my ability to focus on my recovery. I am consistently losing sleep, worried, confused, frustrated, lack to ability to make reasonably decision and most importantly lost my health care coverage which could prohibit my rehabilitation. My medical disabilities make it extremely difficult to maintain logical thinking process and it increases my anxiety level. Consequently, I would like to just mediate these conditions to avoid stress factors. Additionally, I would like for ************* to review past payment on my claim because I was not paid at my accurate rate of pay. I have attached a copy of the employer statement which was faxed directly to The Standard from my employer. My accurate pay rate is $34.90 based on a 40 hour work schedule yielding $1,396 per week. The Standard compensates for 60% of my weekly earnings, $837.60 per week. I was previously compensated at $599.26 per week which results in a -$238.34 weekly shortage. My claim was previously approved August 08, 2013 to November 24, 2013 resulting a 15 week and 4 days of pay shortage totaling $3,711.29= (($238.34*15)+($238.34/7)*4). I do believe this was an oversight on ************ behave and would like to be compensated immediately (3 business days) with standard banking interest calculated to be included. Attached is a copy of my original request for clarification of some ambiguous concerns with The Standard. Could you please provide details, facts, etc. to support your reasoning to the previously submitted questions? I am held and evaluated on Standards which are designed to National measurements for teachers. In order for me to receive an acceptable and favorable job performance review, I must meet those standards. I have included a copy of the questions originally sent to you and a revised copy. After I reviewed the questions sent to you for clarification, I noticed grammatical errors. My present mental state does not allow time for me to process things in an immediate manner. Therefore, I revised the questions and hope this is a clear demonstration of why my medical providers' feel I am disabled. Would you want an unstable and confused teacher placed before your child(ren)? Please understand I would like to concrete on my recovery and hope to return to work soon. Please, oh please allow my the time to deal with my medical concerns and get back to my passion, teaching! As well, I have included the following literature to support my claim not to release psycho notes to The Standard. Again I would like to request the following: 1. Immediate compensation, 3 business days, with standard banking interest for rate of pay shortage 2. Mediation to determinate possible scams of "Disabled" employee or selection of physician consultant to be determined by both of our physicians 3. Answers to previously submitted questions, see attached revised copy Sincerely, ********************* Enclosure ***SUPPORTING DOCUMENTS REDACTED BY BBB*** Final Business Response /* (4000, 28, 2014/04/24) */ April 16, 2014 ****** ****** *** *** **** *** ** **** * Atlanta, GA 30312 Re: State of Georgia Group Policy XXXXXX Claim No. ******** Dear *** ****** **** We are writing in regard to the review of the decision made by Standard Insurance Company (The Standard) to close your Short Term Disability (STD) claim. The Administrative Review Unit has completed the review of this decision. This was an independent review, conducted separately from the individuals who made the original claim determination. After carefully considering all the information in your claim file, including additional medical information, which has been gathered during the review process, we find it is reasonable to reopen your claim for payment through the STD Maximum Benefit Period, which is January 27, 2014. Additionally, in a letter dated March 24, 2014 that you wrote to the Better Business Bureau, you explained that you felt your STD Benefits had been incorrectly calculated as your hourly rate was 34.90 and based on a 40 hour work week you had a weekly income of $1396. According to the State of Georgia Group Policy's Benefit Salary provision (copy enclosed), your Benefit Salary will be based on the earnings shown on your Employer's Option Statement in effect immediately preceding your Disability and is effective for the entire Plan Year. The information from your Employer states your annual salary is $51,936. To determine the weekly equivalent, the amount of $51,936 was divided by 52, which equals $998.77. We find that your claim was calculated correctly based on a weekly Benefit Salary of $998.77, which equaled a gross weekly STD Benefit of $599.26. Your file will now be returned to Disability Benefits Specialist, ***** ******* so that STD benefits can be issued to you through January 27, 2014. *** ****** can be reached at (XXX) XXX-XXXX ext. **** if you have any questions about your claim or payment of benefits. This concludes the review of your claim by the Administrative Review Unit of The Standard. We are pleased to be of assistance to you regarding your claim for STD benefits. Sincerely, ******* ********* Benefits Review Specialist Administrative Review Unit Enclosure: Benefit Salary Policy Provision Final Consumer Response /* (4200, 23, 2014/04/16) */ Please refer to the documents which follow to see how The Standard is playing games and refusing to make a determination. 1. The Standard_April 7 Emails 2. The Standard_April 9 Physician Consultant Referral Letter 3. The Standard_January 7 2014 Denial Letter Envelope 4. 1_7_14 Standard Denial Letter These documents demonstrate *** ********* original attempts to delay making a decision until May 7, 2014. Originally a determination was pending medical records. On February 5, 2014 my psychiatrist faxed information directly to *** ********* . A decision was made the very same day by *** ********* without consulting a physician. Regardless of the information; records; or documents provide to The Standard, they are going to utilize stall tactics to prevent making a fair review. I have provided them with medical documents to excuse me from by more one certified medical physician. I have asked on numerous occasions for a third party physician to consult. The Standard's physician and my psychiatrist could collectively decide on a consulting physician to avoid any bias motivated results. Most importantly, the April 7 emails and the The Standard_April 9 Physician Consultant Referral Letter are not in agreement. "The waiting review, additional medical documents/records, pending a physician consultant," lines are always used to avoid providing me with a concrete determination. Additionally, items 3 & 4 are to demonstrate how I was told by a claim adjustor that ***** ****** was working on my letter and would return my call on January 13, 2014. Consequently, the letter was dated January 7, 2014 and US Postal stamp confirms shipping date of January 13, 2014. I believe this is due to 45 day time limit that is specified in my policy. This is the only correspondence with conflicting dates, Why? PLEASE, PLEASE, PLEASE, HELP ME. I have waited very patiently and continue to receive excuse after excuse as to why a decision is not able to be reached or will not be reached until the very last hour. Distraught, *** ****** ******, *** ************ ****please view attached documents online****

5/6/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: I became ill in january 2014. I used my vacation, personal, and sick time to cover this. I officially took my medical leave in february 2014. I saw my doctor and filed my claim. The agent told me that the tim. I took off in january would not be included because I did not see my doctor until february. The agent said I would be approved from the date of my doctor's visit to the time my doctor said I could return. When the letter and check arrived the time I took off in january was included up to march 15,2014. The check was for one day for sixty dollars. I called the representative and asked why was it back dated to january when my official leave didn't start until february which we agreed. My doctor has sent forms stating my conditions and the company is still requesting more info stating my doctor was vague. In the forms my doctor is very clear about my condition. My doctor has even faxed a statement to the company stating there is some privacy between a parient and doctor. I cannot afford to see any other specialist because my insurance will not cover it. I feel at this point I am being giving the run around which is not helping my health. This company clearly does not want to pay. I have spoken ti managers with no help.

Desired Settlement: I want what I am owed so that I can get better. I officially took my leave in february and that is when I saw my doctor. I was approved based on my doctor statement and to get out of paying me for february to now, they back dated my claim from january to february instead of being dated from february to may. The same doctor statement that was approved is now being stated as too vague. I want what I am owed from march to may 1, 2014

Business Response: Initial Business Response /* (1000, 7, 2014/04/21) */ Better Business Bureau Serving Alaska, Oregon & Western Washington Electronic Response Letter Re: Case No: ******** Complainant: *************** Group Name: **************************** Policy No. ****** Claim No. ******** Dear Better Business Bureau: We are writing in response to the complaint filed by *************** regarding her Short Term Disability (STD) claim with Standard Insurance Company (The Standard). I have reviewed the complaint and the information in the claim file and we wish to respond. The claimant stated the first medical information in the claim file indicated that treatment first commenced on February 27, 2014. The Group Policy explains that in order for Benefits to be payable a claimant must be under the care of a physician as follows: A. Care Of A Physician You must be under the ongoing care of a Physician in the appropriate specialty as determined by us during the Benefit Waiting Period. No STD Benefits will be paid for any period of Disability when you are not under the ongoing care of a Physician in the appropriate specialty as determined by us. Further, the Group Policy also defines when Benefits are payable as follows: INSURING CLAUSE If you become Disabled while insured under the Group Policy, we will pay STD Benefits according to the terms of the Group Policy after we receive Proof Of Loss satisfactory to us. C. Proof Of Loss Proof Of Loss means written proof that you are Disabled and entitled to STD Benefits. Proof Of Loss must be provided at your expense. For claims of Disability due to conditions other than Mental Disorders, we may require proof of physical impairment that results from anatomical or physiological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques. Once the Attending Physician Statement was provided, showing treatment the Examiner was able to approve the claim based on the recommended expected duration of impairment in the Medical Disability Advisor for an individual performing in her Occupation. This was found to be 56 days. This 56 day period was applied from the date the claimant began her FMLA leave according to her Employer’s. This date was January 18, 2014 and allowed for approval through March 14, 2014. The claimant had a 15 day waiting period so Benefits were only payable for one day. The approval took place on March 27, 2014. The Attending Physician’s Statement provided to us contained a limited amount of information regarding ************ condition and treatment going forward. This prompted the Examiner to request medical records from the treating Physician on the claimant’s behalf. The medical records were received on April 2, 2014. The medical records consisted of one note handwritten on about a quarter of a letter sized page and did not provide any further insight into ************ condition. On April 9, 2014 the claimant’s treating Physician wrote a four sentence letter explaining that her medical information was privileged and stated ********** told him her problem was secondary to personal and family issues. On April 10, 2014, in an attempt to gain further clarity regarding the claimant’s condition we faxed a medical questionnaire to the treating physician’s office. That questionnaire has been received today, completed, and will be reviewed to better understand the claimants condition. Once this medical review is completed we should be able to make a decision on whether Benefits are due beyond March 14, 2014. To the claimants complaint that Benefits are owed to her prior to February 27, 2014, unless medical records or some other documentation can be provided which established Proof of Loss prior to February 27, 2014 STD Benefits are not payable for that period. As the claim is currently being reviewed we would respectfully request an extension in order to complete that review. I will send written updates every 14 days in order to update your office with the progress of the review. Should you have further questions please feel free to contact me at the number or email address below. Sincerely, ************* Supervisor, Disability Benefits ************ Cc: **************, Vice President & Associate Counsel

3/25/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: RE: Claim # ****** Dates and information is to the best of my memory, some dates may be incorrect. * November 14, 2013, my doctor sent in statement and records that I would need to be off until January 5, 2014. * November 19, 2013 I sent in additional records I had received from doctors. * November 22, 2013 Called into check status was told it was with a nurse rep * November 24, 2013 Called in an attempt to find out status of claim was told that it had been denied on November 22, due to lack of supporting information. * November 25, 2013 Attempted to reach my rep ***** ******** she was on vacation, I spoke to ***** and ***** I was told that I had been denied my extension for the same illness that I had been receiving benefits for. I could not get ahold of **** until ***** had told me I was denied my extension. Reps would tell me they were on the line and transfer me then I would go to voicemail. * December 2, 2013 finally got my rep ***** ******** on the phone said that it was denied by the nurse rep. I could not get a straight answer from anyone that I had spoken to this entire time. I have spoken with multiple customer service reps through this process one of which even told me that they weren't sure if they wanted to continue pay my disability of $420 per week. I have been told at one point that I would have to have surgery to get my benefits even though my blood sugars are too high, which I have sent in records of. I plan on having surgery as soon as blood sugars are low enough. It would put my healing and well being in jeopardy to have surgery with high blood sugars. Forcing me to have surgery is literally putting my life in danger. I have been told that I am not disabled, when my records are reviewed you will see that I am. Typing cannot be done because of arthritis in my wrists, fingers as well as EVERY joint in my body. This is just one of many reasons. * December 2, 2013 ***** tells me they need docs from pain management to make a decision. * December 3, 2013 I fax the documents she calls me back and says she has put a rush review on them. * December 4, 2013 she tells me the nurse has looked at them and needs to ask the doctor one question. * December 5, 2013 I am filing this complaint. I have provided multiple records on every doctor I have seen and everything I have done and all of my symptoms. My disability has not improved it has worsened I have 2 slipped discs at T2-T4. I have herniated disc, pinched sciatic nerve. I am on medications that make it impossible for me to deal with customers. I cannot walk or stand longer than 3 minutes. I believe I have gotten the run around because my rep was on vacation. I faxed additional docs on November 26, 2013. When I called on December 2, no one seemed to know what was going on with them kept telling me they were in review. I spoke with ***** she knew nothing of them, she also told me that I was not disabled since 8.20.13 and that they just kept sending me checks that I would have to pay back. I was given two extensions during that time. I have also been told that additional records were requested from *** ****** I was told that your company did not request any docs ever that I had to provide them all. I HAVE DONE NOTHING WRONG, I AM DISABLED, I AM ILL AND I WANT THE EXTENSION APPROVED THERE IS NO REASON FOR ME TO HAVE BEEN PUT THROUGH ALL OF THIS. This situation has had me so stressed that my blood sugars are sky high and for the first time that I have been a diabetic sugar at a +3 is spilling over into my urine. I am taking massive amounts of insulin just to keep it under control. I take clizonapam in an attempt to control this stress. I have attempted to talk to people while on my meds and it is not good. I have tried to drive while on my medication and damaged my car twice. I am currently disabled. I feel that my file should be reviewed and a decision made today. All documentation I have sent since my disability began and all notes made in the system. I would like a copy of the notes in the system made by all reps mailed to me. ***** ****** Cc: Insurance Commissioner and Better Business Bureau

Desired Settlement: I want my claim extended, I am disabled, documentation has been provided.

Business Response: Initial Business Response /* (1000, 9, 2013/12/23) */ December 18, 2013 Better Business Bureau Serving Alaska, Oregon & Western Washington Electronic Acknowlegement Re: Complainant: ***** ****** Insured: same as above Group name: ******* *********** Policy No,: ****** Claim No.,: ******** NAIC No., ***** Dear Better Business Bureau: We are writing in response to the complaint filed by *** **** ****** regarding her Short Term Disability (STD) claim with Standard Insurance Company (The Standard). Please see attached copies of our letters to ** ***** dated December 11, 2013 as well as our follow up letter of December 13, 2013. One of the December 11th letters is a response to her December 5th letter. The other December 11th letter which was enclosed with our December 13th letter explained the decision on her claim. Barring further communication from you office, we will assume we have adequately addressed all issues in this complaint and will consider the complaint as closed. If you have any additional questions regarding the administration of this claim, please contact me at the number indicated below. Sincerely, ***** ****** Supervisor, Disability Benefits ***********, x**** ***SUPPORTING DOCUMENTS REDACTED BY BBB*** Final Consumer Response /* (4200, 16, 2014/01/16) */ (The consumer indicated he/she DID NOT accept the response from the business.) No, it has not been addressed. I have submitted additional correspondence to The Standard review department. My claim was denied out of spite by **************. Both of my rotator cuffs are torn, carpal tunnel right wrist. Arthritis both wrists. Pinched ulnar nerve left elbow. Unable to sit or stand for extended periods. They had the majority of this information. They disclosed private medical information to my employer for no reason they told them that I was on narcotics. I will not settle for anything less than my claim being reopened and paid. I will submit docs. Final Business Response /* (4000, 14, 2014/01/07) */ January 7, 2014 Better Business Bureau Serving Alaska, Oregon & Western Washington Electronic Acknowledgement RE: Complainant: ***** ***** Insured: same as above Group Name: ********* ********** Policy No.: ****** Claim No,: ******** NAIC No.: ***** Dear Better Business Bureau: We are writing in response to the complaint filed by *** **** ***** regarding her Short Term Disability (STD) claim with Standard Insurance Company (The Standard). We received *** ******* rebuttal dated December 31, 2013 in which she noted that she does not accept our response. As explained in our December 18, 2013 letter and attachments, we have reviewed all of the information in the file. The information did not support that *** ***** continued to meet the Definition of Disability under the ********* *********** Group Policy beyond November 17, 2013. Her claim has been referred to the Administrative Review Unit (ARU) for an independent review. This Unit was specifically formed to assure that each claim receives a fair and objective review. As explained in previous correspondence, *** ***** has the right to submit any additional information for review. The ARU will include any additional information in their evaluation. *** ***** has previously contacted us to see where she could fax additional information to the ARU. Regarding her statement that Standard disclosed private health information to her employer, I am unaware of any information being released. Barring further communication from your office, we will assume we have adequately addressed all issues in this complaint and will consider the complaint as closed. If you have any additional questions regarding the administration of this claim, please contact me at *********** x****. Sincerely, **** ****** Supervisor, Disability Benefits

2/25/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: We filed a disability claim due to my wife's auto accident in April. All paperwork was received by June 26th. To date, we have received numerous letters stating they are unable to make a decision and verify that my wife's injuries meet the definition of disability. We received copies of all 40 pages of medical and psychological records they have received. These records state repeatedly the medical issues my wife is having. Her work has accepted the documentation of disability, the other insurance companies have accepted the documentation of disability and her 457b (who we had to make a hardship withdrawal from due to no disability payments)has accepted the documentation of disability. Why the delay in decision?

Desired Settlement: We are seeking an approval or decline of her claim. With approval they will owe us back payments from June 1, 2013. With a decline we can at least appeal the descision as one has finally been made.

Business Response: Initial Business Response /* (1000, 5, 2013/10/16) */ October 15, 2013 Electronic Upload **** ***** Life & Health Complaint Analyst North Carolina Department of Insurance **** **** ******* ****** Raleigh, NC 27699-1201 Re: DEPARTMENT OF INSURANCE FILE NO.:XXXX-XX-XXXXX Complainant: ****** ** ****** Insured: same as above Group ******* ******* ******** NAIC No:XXXXX Dear *** ****** We are in receipt of your correspondence regarding the above captioned complaint. The inquiry has been sent to our Employee Benefits Division disability manager, who is now reviewing it and will respond. I appreciate your calling this matter to our attention. Please feel free to contact me if you need anything further. Sincerely, ****** ******* Vice President, External Affairs & Associate Counsel Standard Insurance Company (XXX) XXX-XXXX ****** Standard Insurance Final Consumer Response /* (4200, 37, 2014/01/21) */ According to the response from *** ******* the only authorization they have is the original authorization completed on May 29, 2013 specifically for ******** ********** and ******** **** ****** ****** ****** with an effective date of April 30, 2013. If this is so, why do all the copies of the records requests we received request information from January 1, 2013? Is this not a direct violation of the authorization? In a prior communication with The Standard, we had requested where in the policy to locate specific descriptive verbiage for a condition we did not have clear understanding. In response, we received concise to the point directions. It is apparent that upon continuing to try to clearly understand our disability policy the customer service went from accommodating those that do not speak Insuranc-ese to here is your policy - figure it out. *** ****** did provide the copy of the policy - we were just unable to locate where in the policy it directly stated we were required to release protected information and as yet have been unable to find this. Pertinent records would also be the physical therapy and cognitive therapy records that were never requested by The Standard. When we requested copies of the records received by The Standard in order to better understand their inability to make a decision we reviewed the file. It was at that time that we found the references to the incorrect doctor for the psychological exam. As having my wife seen by a neurologist had not been a common occurrence prior to this accident we were unaware that the medical records reflected referrals to doctors that we never received. We assumed that The Standard was doing due diligence and that the doctors mentioned were involved in reviewing records and completed each and every authorization request they sent to us in good faith. We also contacted the person sending us the requests via email and had phone conversations with her confirming these were received and that we had contacted *** ****** ****** to expedite the sending of the requested records. Again, had we known they were not going to bother contacting ******** ********** ************** we would have requested the information and sent it on to The Standard ourselves. When we received the denial letter it stated that an uninvolved team would be reviewing the file if we requested an appeal review. We requested that review. Due to *** ********* statement to *****'s employer that The Standard was declining the file due to unclear information on *****'s limits and restrictions, we sent medical information from *****'s primary care physician clearly outlining her limits and restrictions. We also sent documentation from the cognitive therapist at ******** ********** with even more detailed information on her limits and restrictions. The next letter received by The Standard stated that they would review our file but that the file was still lacking the report they wanted and that is the information that would be required to get anything approved. If it is a new team reviewing the file, how can the old teams put restrictions on our appeal? Yesterday, we received a letter from The Standard. They stated that the file was being reviewed by someone board certified in neurology. If this was available, why did they not do this right away? All information we gave about the injury was that this was a brain injury. The information we gave our representative last June about the therapy was that ***** was being seen by the concussion team at ******** ********** for a brain injury and the issues related to that injury. ***** was unable to walk correctly unassisted; ***** was unable to speak correctly; ***** was not able to think clearly. Yet The Standard says she is not disabled. Wouldn't it be beneficial for the nurse reviewing the file to have some knowledge about brain injury? Final Business Response /* (4000, 49, 2014/02/13) */ February 11, 2014 Better Business Bureau Serving Alaska, Oregon & Western Washington Complaint Department Re: Case # ********: *************** Complainant: *************** Insured: Same as above Group Name: County of Clackamas NAIC No: ***** Dear Better Business Bureau: Thank you for forwarding the additional follow up response by**************, dated January 21, 2014. In this updated response,************** asserts it was a violation of the authorization to request medical records that pre-date the signing of the authorization. Such requests are not uncommon, since one element of a claim investigation involves evaluating a claimant’s medical status up to the date of an injury. This helps develop a baseline for normal functioning, and clarifies limitations and restrictions resulting from a particular incident. The second complaint listed in the updated response is centered on the policy language. It appears************** is looking for “where in the policy it directly stated we were required to release protected information”. We’ve attempted to clarify this point on multiple occasions, and directed************** to the applicable provisions that apply to this situation. The bigger issue at hand seems to be our differing viewpoint on what he defines as “protected information”. We pursue records that can help establish limitations and restrictions. The policy establishes the framework in which that documentation is requested, and permits an adverse decision if the documentation isn’t provided in support of a claim. Regarding the third paragraph, I don’t believe************** and I disagree over the issues we encountered in tracking down the correct doctor who performed the evaluation. We attempted to communicate the status of our record requests via mailed correspondence, and proceeded with new requests when we learned a particular doctor had not performed the evaluation in question. This particular issue was addressed in my prior response, when************** stated our office had not notified them of our pursuit of such records, which we in fact did. Moving on to the fourth paragraph,**************’s new complaint has to do with a letter received by the Benefit Review Specialist handling the appeal of his wife’s claim. I’ve reviewed the letter, and believe he’s referencing the following paragraphs: “You have also stated you are at a loss as to what documentation is still needed to approve this claim, and remain confused as to why The Standard has requested you provide the neuropsychological evaluation in support of your claim. You also asked whether the professional reviewing your claim should be able to review the file as it stands and without additional information. Our initial review of the documentation in your claim file finds you have been notified on multiple occasions what additional medical and psychological documentation was being requested to properly evaluate your LTD claim. As it appears that you are asking for your claim to be reviewed with the documentation that is currently in your claim file and you do not intend to submit additional information, we will conduct our independent review with what has been currently made available to us for review. Please note that following our initial review, The Administrative Review Unit would have requested additional information as well in order to obtain a complete understanding of the medical conditions you are claiming disability for. As part of our review, we would have required the complete neuropsychological evaluation and any follow-up visits (to document the evaluation and presence of the cognitive deficits you are claiming), all vision evaluation and vision therapy notes, all treatment records from the *********************************, including the occupational therapy, physical therapy if present but especially all speech therapy chart notes, and updated medical records from *********, ************ and ************. However as noted, we will complete our independent review with the documentation that is currently in your claim file as per your request, although we find it to be incomplete.” Each claimant is allowed one independent review under the terms of the Group Policy, so this language is provided in order to make it clear that the Benefit Review Specialist would have pursued additional information in order to ensure a full and fair review. I don’t agree with**************’s assertion that a “restriction” was placed on the appeal. Finally, we have**************’s complaint that a board certified Neurologist was not consulted for a medical review prior to the involvement of the Administrative Review Unit. When a claim is initially investigated in our Benefits Department, we pursue all information deemed necessary to establish limitations and restrictions. A medical review was conducted by a Nurse Case Manager on September 12, 2013, who reviewed the information we’d obtained up to that point, and felt we needed the neuropsychological evaluation before referring the medical documentation to a Physician Consultant. Based on what we had at that time, we couldn’t establish duration of impairment. At this point, *************** claim has been approved through March 9, 2014, which correlates with a gradual return to work plan outlined by her doctor. I hope you find this letter helpful in evaluating the complaints raised by**************. If you have any questions about this letter, please write or call me. Sincerely, ************* Supervisor, Disability Benefits ************************ Fax: **************

1/28/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: Standard always gives me excuse after excuse a different answer...They received my medical records on on Dec 7th and since then they have passed my file around and ended up thru the cracks. Every time I call I get a different response from every person. This has been going on since the beginning of November. I now have another lady named ***** who is extremely rude...knowing I have no food, an eviction notice, widowed, 3 brain aneurysms and dementia. I am going to contact channel 12 news, governor advocacy, senator, American Disability act, HUD and the CEO of Standard until I get my ltd money and food in my house with my rent paid. ***** ******** is her name and my doctors office would like to file a complaint along with mine. Thank you ***** ******* XXX-XXX-XXXX

Desired Settlement: They owe me long term disability money since mid November. They sent me a letter back then stating they were working on it and I should hear in about a week. I have no income, no food, etc

Business Response: Initial Business Response /* (1000, 5, 2014/01/09) */ Dear Better Business Bureau: We are in receipt of your correspondence regarding the above captioned complaint. The inquiry has been sent to our Employee Benefits Division disability manager, who is now reviewing it and will respond. I appreciate your calling this matter to our attention. Please feel free to contact me if you need anything further. Sincerely, ***** ****** Final Business Response /* (1000, 8, 2014/01/15) */ January 14, 2014 Better Business Bureau Serving Alaska, Oregon & Western Washington Complaint Department 1000 Station Drive Ste 222 DuPont, WA 98327 Re: BBB Case Number: XXXXXXXX Complainant: ***** ******* Group Policy: State of Oregon Policy Number: XXXXXX Claim Number: ******** Complaint Department: We are writing in response to the Complaint Activity Report received January 9, 2014, in which you indicate *** ***** ******* has filed a complaint with your company concerning the status of her Long Term Disability (LTD) claim with Standard Insurance Company (The Standard). As a Supervisor in the Employee Benefits Division responsible for the administration of claims under the State of Oregon Group LTD Policy, your inquiry was referred to me for response. *** *******'s claim for LTD benefits is under review in order to determine if she meets the provisions of her group policy, including its Definition of Disability. We did not receive an authorization to release information from *** *******, therefore I am unable to comment on any of the medical information contained in her claim file. However, we are expediting our efforts to complete our review of her eligibility for benefits and have issued her a one-time payment by exception in consideration of her financial circumstances. We will continue to keep her informed of the progress of our review and will provide a full explanation of our decision when it has been reached. I will notify your office when we have reached a decision on *** *******'s claim. In the interim, I can be reached via contact number and email below if you have any additional questions. January 14, 2014 Page 2 Sincerely, ******* ****, Supervisor Employee Benefits Department XXX-XXX-XXXX *********@Standard.com cc: ****** *******, Vice President & Assistant General Counsel, Standard Insurance Company

1/14/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: I filed a disability claim through this provider in July of 2013. It has been nearly six months and they still have yet to complete their investigation of my claim or pay on the insurance policy. I've provided them with requested information NUMEROUS times, and they continue to say they have not received it.

Desired Settlement: completion of investigation and payment as specified in the insurance contract.

Business Response: Initial Business Response /* (1000, 8, 2013/12/20) */ December 18, 2013 Better Business Bureau Serving Alaska, Oregon & Western Washington Electronic Acknowledgement Re: Case ********************** Complainant: *********** Insured: Same as above: Group Name: ************************* NAIC No. ***** Dear Better Business Bureau: We are writing in response to your inquiry regarding the above captioned complaint filed by**** ****** ********* asserts that he has provided Standard insurance Company (The Standard) with the information we have requested numerous times. We acknowledge that ********* provided a partial response to our request for information in October 2013 (the undated letter is postmarked October 29, 2013). We do not have documentation of repeated responses or communications from *********. In his response he advised he did not have access to all documentation requested and directed The Standard to other sources to obtain information he could not provide. Pursuant to his suggestion The Standard requested from the alternate source and received the information he indicated he did not have access to. However, because the medical providers on file did not provide documentation of treatment during the period ********* is requesting benefits we are attempting tocontact ********* to obtain the names of any other medical providers he may have seen. Thus, although ********* did respond to our initial request for information additional information is required to conclude our review. Please be assured that The Standard will continue our investigation and pay any disability benefits payable under the Group Policy. Should there be specific issues that I have not addressed, please contact me and I will be happy to do so. Barring further communication from your office we will consider this issue resolved. Sincerely, ***********, FLHC, FLMI Disability Claim Supervisor Employee Benefits Division *********************

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