Guardian/Berkshire Long-Term Disability Insurance Denial

Did Guardian/Berkshire Insurance recently deny your long-term disability insurance claim?

Our office is receiving more than the usual number of calls regarding denials and terminations of claims from Guardian/Berkshire. If you are among the many whose disability claim has been denied or terminated, please call our office at 888-583-4959 so we can explain what your options are and provide insight into the process. If your disability insurance is part of your employee benefits package, there is a time element working against you, so we invite you to call today.

Why is Guardian/Berkshire denying so many claims?

It’s not because the company is doing poorly amid a continuing global pandemic. In fact, according to Guardian’s annual report website, the company is enjoying great success:

We had one of our best years financially in 2021, driven by our strong long-term investment focus, sound underwriting, prudent expense management, and earnings from complementary businesses. We achieved these results despite the uncertain economic environment and the adverse impact of COVID-19.

Operating income rose 10 percent to a record $1.9 billion, reflecting our robust investment returns and revenue growth. Guardian’s premiums increased sharply, driven by a 35 percent rise in renewals and life insurance sales due to increased customer outreach.

Our superior value to our customers depends on our strong financial foundation. We ended the year with $10.7 billion in capital, 13 percent more than in 2020 and an all-time record for Guardian.

What Can I Do to Protect My Disability Claim?

Start by locating your original disability policy. There may be a section on appealing a disability insurance claim that has been denied or terminated.

• If your policy is from your employer, your appeal will be governed by ERISA- laws used to regulate employee benefits. Your appeal will need to serve a dual purpose:
• It will need to provide as much evidence as possible about your disability, including medical reports, vocational evaluations, and every scrap of evidence you can gather about your disability and functional impairments. DO NOT simply re-submit the materials you included with your claim. Your appeal must be as robust as possible to overcome all of the rebuttals given by Guardian.
• The appeal will also serve as the record if a lawsuit is required, as courts will often limit consideration of materials to that which was part of the record developed during appeal.

Generally, your appeal will also be the ONLY evidence that the Court will consider if you lose your appeal and have to take Guardian to federal court.

Gathering the documents to support an appeal is not easy to accomplish on your own, when you don’t know exactly what Guardian claims adjusters are looking for.  This can be critical to the success of your appeal.  For example, if your doctor’s notes fail to include specific information on what tasks you can’t perform, this may be used to show that you can still work. Often, the for-hire medical professional engaged by the insurance company is only given a portion of your medical records, and they may come to the conclusion there’s not so much wrong with you and you can return to work. This is not an unusual occurrence where insurance companies hire doctors for paper only medical reviews.  Nor is this often a favorable situation for an insured claimant.

Further, claimants are not experienced disability attorneys and don’t know how to navigate the occupational records side of a disability insurance claim and the development of the appropriate support.  Often, Guardian examiners will rely on outdated vocational documents to determine whether or not a person can work full or part time or what might be required of the occupation.

Another way Guardian/Berkshire denies and terminates claims: by burdening a claimant with so many requests for information that the person becomes overwhelmed and gives up or burdening the treating physician and driving a wedge in the physician-patient relationship.

When you are so ill or injured you can’t work, the last thing you’re able to manage is a steady stream of requests for more and more information or challenges from your own doctor.  The relentless nature of the requests for information, the inability to get those documents in a timely manner to the insurance company and the frustration that only gets worse over time are deliberate tactics used with great success.

If you purchased your Guardian/Berkshire disability policy privately, from an insurance broker or directly from Guardian/Berkshire, (Non-ERISA) you will be able to take Guardian/Berkshire to court if your appeal fails, but don’t expect Guardian/Berkshire’s claims manager to treat you and your claim any differently than an ERISA claim with the use of the same tactics often employed.

Based on our years of experience, Guardian/Berkshire appears to have mounted an aggressive denial and termination of claim campaign in recent months and there is no way to know when this particular initiative will end.   One must be vigilant and prepared.

Contact our office if you have any questions about your Guardian/Berkshire disability insurance claim.