When you are disabled due to an injury or illness, long-term disability insurance benefits are supposed to help support you.  Unfortunately, many find that insurance providers wrongfully deny their claim.  If you applied for a long-term disability with Guardian or Berkshire Life, you may be wondering why your claim was denied.

If your long-term disability policy is through an employer-sponsored group plan, it is likely governed by a law known as ERISA (Employee Retirement Income Security Act).  Many aspects of this law benefit insurance companies. As a result, you need to consult with our attorney experienced in handling ERISA long-term disability appeals and litigation after a denial.  There are strict and short deadlines that apply to these cases, and the failure to follow the precise rules and procedures can damage your appeal and reinstating your benefits.

Whether you’ve been receiving disability benefits and were denied or recently applied and were denied, you shouldn’t give up!  Our long-term disability attorney is trained in the law governing these types of claims and can help you appeal a wrongful denial, and get the benefits you deserve.  We know the rules and the best strategy to fight back to get your benefits reinstated. Call our office today at 816-203-0143 or through our website email or chat to get the help you need.  We’re on your side! 

 

How Our Attorney Can Help With Guardian or Berkshire Disability Denial

  1. If Guardian or Berkshire Life has denied your long-term disability insurance, please fax/email/mail us the denial letter as soon as you can. We will review it free of charge and give you a detailed strategy for moving forward. Please note that you must act promptly after a denial. The insurance company only gives you a limited time to appeal or you will lose your right to appeal.
  2. If you are thinking about applying for disability, it’s a good idea to contact us and schedule a call with our long-term disability attorney before you quit working. During our paid consultation, we will review your disability policy, talk about your medical issues and any difficulties with performing your job. After our call, you’ll have a plan of action on what to do next.
  3. If you are still gathering information, check out our free online resources, including our attorney’s free disability guide, which you can download instantly. You can also browse our library of helpful articles, FAQs and videos.  It's free information, and our goal is to answer every question you may have.

About Guardian or Berkshire Life Long-Term Disability Insurance

Guardian or Berkshire Life insurance company is a major provider of disability insurance in the US. It provides both individual disability income policies and group policies covered by ERISA. Guardian or Berkshire positions itself as a premium insurer offering pricey insurance policies to salaried executives, doctors, lawyers, and other high-income professionals. 

Numerous long-term disability insurance options are available from Guardian Life and its subsidiary Berkshire Life Insurance Company of America. The insurance plans are designed to cover you if you become ill or injured and cannot carry out the duties of your "occupation," a term of art with various connotations depending on the situation.

Beginning in early 2020, there’s been a substantial increase in Guardian/Berkshire disability claim denials and benefit terminations.  Guardian used to be one of the better insurance firms for giving its claimants the benefit of doubt, but it now seems this is shifting.  This trend appears to be occurring more frequently with claims for high-wage earners like doctors, lawyers, and dentists.  

Frequently, the adverse claim decisions are based only on a medical records review by a remote medical specialist who has never met the patient.  A cottage industry of medical consultants regularly reviews patient data for disability insurers, frequently disputing attending physicians who have experience treating the patient.

Before assuming responsibility for paying new claims, Guardian/Berkshire conducts a forensic review of their claims.  For claimants, the claims procedure is intentionally complex and may become overly frustrating so you give up, resulting in many claimants being denied the benefits they deserve. 

Our experienced long-term disability attorney can assist in appealing and reversing Guardian/Berkshire Life long-term disability claim denials and benefit terminations.  Our LTD attorney has years of experience taking on insurance providers who wrongfully deny to provide coverage to their clients and beneficiaries. If Guardian or Berkshire Life has denied your claim, call us today to schedule your free consultation. We’re here to help, and on your side.

Reasons for Getting Your Guardian or Berkshire Long-term Disability Claim Denied

There are various reasons why your long-term disability claim may have been denied. These might include:

  • Guardian's Medical Consultant Argues You Aren't Disabled

red letters stamped claim deniedGuardian/Berkshire often employs physicians to provide medical reviews, frequently hired through third-party contractors that only work in the disability insurance sector. Due to this hiring practice, there is reason to be concerned about the objectivity of their opinions and whether they have access to the appropriate comprehensive information.

Occasionally, frequently used consulting doctors make decisions regarding illnesses outside the scope of their training and expertise.  Many times these doctors will cherry-pick the medical records to review, pointing out issues with a portion of a patient's record, while ignoring the parts supporting the disability claim.  Without meeting you, the insurance consultants cannot understand how your condition truly affects your life and ability to work.

  • Arguing Your Job Was Less Demanding than it Actually Was

Most Guardian or Berkshire policies are ‘own occupation,’ yet not for the duration of any claim.  This means that typically after the first 24 months, the policy definition changes from your own occupation to ‘any occupation’.  Essentially, if you were an engineer, the insurance company might say you can now perform any job, rather than that of an engineer, which would lessen the long-term benefits you received. 

To offset this, Guardian then offers an even higher and more costly coverage plan for physicians, dentists, and lawyers to practice in their "own specialty." These plans are designed to pay out if you cannot work in your chosen specialty, even if you can perform alternative, less demanding tasks within your trade.  However, Guardian or Berkshire Life may still argue that your job not as demanding or that you did not practice within your specialty and deny your claim.

  • Own Occupation/Any Occupation Claims

While the majority of individual policies define "disability" as the inability to engage in your usual occupation or area of expertise, other policies, such as group coverage provided to company employees, redefine "disability" after a set period of typically 24 months of benefits have been paid.

For instance, your policy can stop paying benefits after 24 months unless you can demonstrate you are no longer able to conduct any work. Guardian or Berkshire may have one of its occupational experts identify careers that require less mental or physical effort to argue you could work in those occupations. This is why having our experienced long-term disability attorney on your side and fighting for your rights is a must.

Is Your Guardian or Berkshire Life Claim Being Delayed?

Delays could happen when the insurance provider keeps asking for more information. These requests might be for good reason, like requesting medical records and other data Guardian/Berkshire hasn't received.  However, in other instances, Guardian/Berkshire might engage in stalling tactics, where they shuttle you back and forth between your doctor and the claims manager.  This creates a situation where it can seem as though no one will never get on the same page. When this occurs, it’s likely they’re attempting to delay and deny your claim.

Our long-term disability attorney can help you recognize these tactics and move the process along. To stop this back and forth stalling tactic requires our experienced disability attorney to implicitly (or overtly) threaten litigation, and thus forcing a claim decision or reinstatement.

Appealing a Denial of Long-Term Disability by Guardian or Berkshire Life

When you receive a denial of your long-term disability benefits, Guardian/Berkshire will send you the required notice of denial with the initial appeal information.  If you hire our firm to appeal it, we will timely file it within the required deadline. The appeal file will then be sent to the person charged with handling the appeal.

The appeals process for long-term disability is intentionally very complicated.  There is a voluminous amount of documentation required, making you jump through hoops and meet many deadlines. Don't let this discourage you!  As a rule of thumb, keep or request copies of any correspondence between you and Guardian/Berkshire Life. These may include:

  • Any document providing additional information to Guardian/Berkshire (like medical records provided by your attending physician that support your long-term disability insurance claim).
  • A duplicate of your appeal request.
  • A copy of your insurance policy

Our Long-Term Disability Attorney Can Help With Denials from Guardian or Berkshire Life

When your long-term disability claim is denied, our experienced long-term disability attorney provides you with the best chance of getting your benefits reinstated.  Our attorney and legal team is ready to help you fight back and reverse the unfair denial of your long-term disability benefits.

Call our office today at 816-203-0143 or contact us through our website email or chat to schedule a free review of your denial letter.  You can also download our free guide for long-term disability appeals right now.  We’re here to help, and on your side!

 

Kevin J. McManus
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Kevin McManus is an accident injury lawyer and long-term disability attorney in Kansas City, MO.