Has Berkshire/Guardian Insurance Company Denied Your Disability Insurance Claim?
The Berkshire Life Insurance Company (Berkshire) merged with Guardian Life Insurance Company of America (Guardian), in July 2001. While Guardian maintained its normal operations, the old Berkshire Company was ended. In its place, a new Berkshire company formed—Berkshire Life Insurance Company of America (BLICOA). Now, Guardian wholly owns BLICOA as a stock subsidiary.
One thing has not changed: Guardian Life/BLICOA is in the insurance business to make money, earning a net income of $433 billion in 2015. While there is nothing wrong with running a successful business, some of these profits came at the expense of Guardian Life/BLICOA disability policyholders who were denied disability insurance benefits.
Over the years, many have fought Berkshire/Guardian/BLICOA in and out-of-court in the disability insurance claim process. A delayed or denied claim for individual or long-term disability benefits by Guardian Life, or its subsidiary BLICOA (Berkshire Life), means that you aren’t getting the financial assistance you deserve when you need it most. If BLICOA (Guardian) has denied your valid disability insurance benefit claim, our team of top-ranked, nationally recognized disability insurance attorneys and ERISA lawyers are here to help.
At DarrasLaw, our seasoned and highly experienced team of disability professionals are here to assist you in obtaining the disability insurance benefits you need and deserve, anywhere in the United States. We have recovered nearly $1 billion of insurance benefits on behalf of individuals just like you. When you are ready to tell Berkshire/Guardian enough is enough, we offer free policy and claim consultations to discuss your rights and remedies. Call DarrasLaw today at (800) 458-4577 or contact us online.
Filing a Disability Insurance Claim with Berkshire/Guardian
When policyholders fail to apply for disability insurance benefits correctly, insurance companies can delay or deny disability insurance benefits for otherwise legitimate claims. It is important that claimants understand Berkshire/Guardian’s claims and appeals process, in the event that you are ultimately denied disability insurance benefits.
When submitting a disability insurance claim with Berkshire/Guardian, you must respond to all application questions fully and accurately. Once you have thoroughly completed the applicable forms, send them to Guardian as soon as possible. Berkshire/Guardian expressly states that claimants should not wait to file a disability insurance claim until the elimination period—has passed. This suggests that waiting until the elimination period has passed could result in your inability or a serious delay collecting the disability insurance benefits you deserve.
Berkshire/Guardian’s standard disability insurance claims forms contain four sections:
I. Section 1: Claimant Statement— You (the disability insurance claimant) are to complete this section in full.
II. Section 2: Employer/Plan-holder Statement—Your company representative (likely the person authorized by your employer) should complete this section in full. If you are unsure who this person is, ask your supervisor or talk to an experienced disability insurance lawyer who can assist you.
III. Section 3: Attending Physician’s Statement—Give these statements to your treating physicians to fill out.
IV. Section 4: Direct Pay Enrollment and Authorization—In the event that Berkshire/Guardian grants your disability insurance benefits without the need for appeal, this section allows you to elect direct deposit of your disability insurance benefit payments into your bank account.
After completing the entirety of these four sections, Berkshire/Guardian allows disability insurance claimants to submit their documents in one of two ways: standard mail or email.
These addresses are found here.
Guardian’s Long-term Disability (LTD) package is found here.
Guardian provides the following helpful information regarding some group disability insurance plans:
Disability insurance benefits can be payable for any non-work related injury or illness (including disability due to pregnancy) beginning with the eighth consecutive day of disability. Disability insurance benefits can be payable for up to 26 weeks. Disability insurance benefit payments are generally based on your average weekly wages for the eight weeks immediately prior to your disability, and are subject to the maximum allowable by the law in effect on the initial day of disability.
To claim disability insurance benefits, you should file written notice and proof of disability (Claim Form DB-450) with your employer or the insurance carrier within 30 days from the first day of your disability, or all or part of your disability insurance claim may be rejected. Do not wait more than 26 weeks from that date to file a disability insurance claim. (See addresses and telephone numbers below.). Do not assume that your employer has filed a disability insurance claim on your behalf; claim filing is your responsibility.
This information—and more—is found here.
Stop the Delay, Denial, and Termination Games by Berkshire/Guardian
Berkshire/Guardian Life offers both group long-term disability insurance policies as well as individual policies through Berkshire Life Insurance Company of America. Guardian’s long-term disability insurance products typically target professionals—including accountants, lawyers, doctors, corporate employees and government workers.
Whether you’ve chosen the insurer on your own—as your individual disability insurance provider—or are with them through an employer-provided group policy, you still have the right to fair treatment and good faith dealings when making disability insurance benefit claims.
If you have had any of the following problems with your valid claim for disability insurance benefits on a policy held with Guardian or Berkshire, we can help:
- A false assertion that your disabling condition was pre-existing and does not qualify for disability insurance benefits under your policy
- A failure by the insurance company to follow the terms of its own plan when deciding your eligibility for disability insurance benefits; changing the interpretation of an “own occupation” policy to an “any occupation” policy, or using a vocational expert to find you work that you actually cannot do
- Repeated requests for duplicative documentation, only to be told that the documentation supplied is incomplete or unsatisfactory
- A refusal to give the right deference to Social Security Disability Insurance (SSDI) or SSA Findings
- A Berkshire/Guardian-hired doctor reviews your file and determines that you are not disabled by minimizing your physical and mental conditions
- You were followed by a private investigator who took video of you which Berkshire/Guardian claims is inconsistent with your restrictions of lifting, standing or sitting
If Berkshire/Guardian sends you to a functional capacity exam (FCE) or independent medical exam (IME), you should seek assistance from an experienced, top-rated disability insurance attorney or ERISA lawyer first before you say or do anything fatal to your claim.
Many long-term disability policies issued by Berkshire/Guardian are through a group or employer-sponsored plan and ERISA may govern your policy rights. You will surely face specific time limits on filing an ERISA appeal after a denial of LTD disability insurance benefits as well as deadlines for filing a lawsuit after an ERISA appeal denial is reaffirmed. Do not wait, call and speak to an ERISA insurance denial attorney if Guardian denied you disability insurance benefits to which you are entitled.
Berkshire/Guardian’s Long-Term Disability Appeal Process
Unlike some insurance companies, Berkshire/Guardian is not transparent about its long-term disability appeals process. The company provides little information to the public and long-term disability consumers regarding the ins and outs of properly appealing a Guardian disability insurance claim denial.
Don’t fret. After a little digging, here’s what we know: Guardian will send you the initial appeal information with the required notice of denial (likely by mail). If you choose to timely appeal and follow the requisite steps outlined for filing a disability insurance denial appeal, your file will reach an Adjudication & Procedural Specialist (APS). This person handles appeals for short-term disability and long-term disability insurance claims, among other things.
For more specific information related to your appeal options with the Guardian, please contact DarrasLaw. Our experienced ERISA disability insurance lawyers can review your policy and help explain and pursue any appeal options that exist for you.
Consider submitting any and all additional information that you want the insurer to consider. An experienced, disability insurance attorney can help you prepare your internal individual or group ERISA appeal.
Too Much Is Better Than Not Enough. Don’t Throw Disability Papers Away!
The disability insurance appeals process is often overwhelming. Sometimes, you need to jump through a lot of hoops and meet a lot of deadlines for submitting what can seem like endless amounts of paperwork. Don’t let that dissuade you. If Berkshire/Guardian denies your group disability insurance claim, fighting back is the only possibility you have for a different outcome.
Whenever possible, keep (or retrieve) copies of all correspondence between you and Berkshire/Guardian. Such documents can include, but are not limited to:
- Any documents providing additional information that your disability insurance company requested or that you voluntarily sent to your disability insurance company (like medical documents provided by your treating doctor that support your disability insurance claim).
- A copy of your request for appeal.
- If someone else filed an appeal for you, a copy of any form or letter you signed permitting that person to so do and explaining you couldn’t do the appeal yourself.
- Notes and dates from as many phone and email conversations as you had with Berkshire/Guardian—or any other relevant professional—relating to your delay, denial, or appeal. Always try to include things like the day, time, name, and title of the person you talked to, as well as any important information shared or discussed in the conversation.
Find what you can, make note of the documents you remember submitting but can’t locate, and save everything else moving forward.
If Berkshire/Guardian Said “No” To Your Valid Disability Insurance Claim You Have Options
For all employees, government workers, accountants, lawyers, doctors and other Berkshire/Guardian insureds that thought they had disability insurance coverage but the company denied, we are here for you. Our top-rated disability insurance lawyers and ERISA attorneys can help you fight back and overturn the wrongful denial of your claim for disability insurance benefits.
During your disability insurance benefits claims process, was your claim unreasonably delayed or denied by Berkshire/Guardian because of:
- Repeated, duplicative demands for the same claim information being requested?
- Assertions that Berkshire/Guardian never received medical records or other documentation needed to support your claim for disability insurance benefits?
- Berkshire/Guardian’s use of biased paper reviewers to repeatedly minimize, then deny your disability insurance claim?
- Undefined key terms in your policy that Berkshire/Guardian used against you, such as “own occupation” versus “any occupation” coverage?
- Retroactive cancellation of your disability insurance coverage, also called a rescission of your insurance policy?
- A refusal or failure to consider subjective and objective medical evidence that supports your claim for disability insurance benefits?
If you are a professional with disability insurance through Berkshire/Guardian, you need to present a full and complete picture of your situation in your initial claim for disability insurance benefits. For doctors, dentists, and lawyers that may include reporting your pre-disability coding or billing for the frequency of procedures or surgeries you performed, to accurately document your material and substantial duties of your occupation at the beginning of the claim. An experienced individual disability insurance lawyer can help you compile and present a thorough claim for Berkshire/Guardian individual disability insurance benefits.
A Cautionary Tale: Meet John Schwalm
In John Schwalm v. Guardian Life Insurance Company of America, the plaintiff—John Schwalm—argued that the Guardian’s decision to terminate his long-term disability insurance benefits was arbitrary and capricious.
The ultimate decision of the case is less telling than the facts. Schwalms’ claims Guardian once deemed legitimate; later resulted in denials.
Schwalm earned a base salary of $140,000 per year. He injured his back in July 1999, ultimately undergoing two surgeries, including a spinal fusion surgery.
For the first two years following his disability insurance claim submission in March 2003, Schwalm was covered under what Guardian called “the own occupation period.” This means that—during this period—Guardian considers the insured disabled if “physical, mental or emotional problems caused by a current sickness or injury” leave the insured person “not able to perform, on a full-time basis, the major duties of his own occupation.”
After March 13, 2005, however, Guardian applied a second definition of disability, for their disability insurance benefits to continue. This second definition said the insured is disabled if “not able to perform, on a full-time basis, the major duties of any gainful work.” The plan also defined the term “gainful work” as “work for which you are or may become qualified by: (a) training; (b) education; or (c) experience.”
Ultimately, Guardian terminated Schwalm’s disability insurance benefits based on this second definition. The case that Schwalm brought against Guardian allows the public to look at tactics that Guardian used in order to terminate long-term disability insurance benefits. Leading up to its decision to terminate disability insurance benefits, Guardian allegedly:
- Scheduled an independent medical exam (“IME”) for May 16, 2005.
- Guardian also arranged for surveillance of Schwalm’s activities for two days before and two days after the IME.
- On November 29, 2006, Schwalm underwent a functional capacity evaluation (FCE).
- On February 26, 2007, Guardian received a vocational assessment (“VA”), sometimes called an ability to work assessment.
After evaluating one or more of these “examinations,” Guardian determined that Schwalm was no longer “disabled.” Schwalm appealed, to no avail. Schwalm, then, sued.
This case is instructive and may open your eyes to the ways that Guardian built a case against its insured, then terminated his benefits.
At DarrasLaw, our team of top-rated disability insurance attorneys includes Frank N. Darras, widely considered America’s top disability lawyer. Our seasoned disability insurance lawyers and ERISA attorneys have the knowledge and the litigation experience to handle these cases and win!
What You Don’t Know Can Hurt You
Do not make the mistake of assuming that your denial was valid. Don’t give up when successful claim options may still exist.
Experienced disability insurance lawyers and ERISA attorneys find ways that often lead to favorable outcomes that the average person couldn’t imagine. The following are just a few hypothetical possibilities that experienced disability insurance lawyers may see that others could miss.
- Berkshire/Guardian could fail to comply with ERISA provisions
The Employee Retirement Income Security Act of 1974 (ERISA) is a wide-ranging federal statute that applies to U.S. employee disability insurance plans when those plans are provided by private employers or labor unions. Like other parts of an employee’s benefit package, disability insurance plans may fall under ERISA’s provisions. Pertinent requirements include:
- Providing accurate plan information to policyholders—what is and is not covered
- Standards of conduct for plan managers and other fiduciaries
- Enforcement provisions that help to shield plan funds so that qualifying beneficiaries receive the disability insurance benefits to which their plans entitle them.
- Providing policyholders with directions for how to file a disability insurance claim, in the event that the policyholder becomes disabled
- An outline of the appeals process, in the event that an insurance company denies a policyholder’s disability insurance claim
If an ERISA-protected disability insurance plan covers you, insurance companies are required to abide by the requirements that ERISA imposes. Failure to so do can result in myriad effects—some of which may benefit you. Berkshire/Guardian, as well as other insurers, can experience backlogs that could easily affect their ability to approve your disability insurance claim in fair and timely ways. In so doing, they could violate laws that may apply to you. Experienced disability ERISA lawyers will know what to look for.
- Berkshire/Guardian could misinform or misrepresent your disability insurance; or the policy provisions
Berkshire/Guardian has an obligation to keep you informed with the most up-to-date terms and limitations of your policy. If Berkshire/Guardian misinformed you or inadequately informed you about changes to your policy that ultimately affected your right to receive disability insurance benefits, you may have more options than you realize. Talk to your disability insurance lawyer or ERISA attorney if you have any questions or concerns about your claim.
How Do I Afford a Top-Rated Bad Faith Disability Insurance Lawyer or ERISA Attorney?
At DarrasLaw, we take all of the disability insurance claim denial cases that we choose to represent on a contingent fee basis. This means that you do not pay us up front. We do not collect fees, unless we get results.
We cover all up-front costs associated with your case—including medical evaluations and investigations. We hope to help as many disabled people from all across America as we can. This contingent fee arrangement helps us ensure more people who need an experienced disability insurance lawyer, or ERISA attorney, can get one.
Disability Insurance Help Is One Phone Call Away. Call Today for Immediate Assistance
We offer prompt help with individual and group disability insurance claims at DarrasLaw. We know that a disability can suddenly and unpredictably curtail your income—and we are here when you need us. Call (800) 458-4577 today to schedule a meeting with a nationally rated, top disability insurance lawyer from DarrasLaw.
Our nationwide disability insurance law firm has seen, evaluated, and resolved more individual and long-term disability cases than any other firm across the country. We are here to assist and help you fight for your disability insurance benefits. If, after making your valid claim, Berkshire/Guardian Life denied you disability insurance benefits, we can help you pursue the disability insurance benefits you deserve.
For a free policy or claim consultation, contact DarrasLaw online or call us at (800) 458-4577. We also offer free policy analysis for anyone considering purchasing an individual or long-term disability insurance policy.