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Berkshire Life Insurance Company of America, commonly known as Berkshire, and its parent company, Guardian Life Insurance Company of America (Guardian), are respected names in the disability insurance industry.
The Berkshire Life Insurance Company merged with Guardian in July 2001. Guardian continued its normal operations, but a new Berkshire company was formed—Berkshire Life Insurance Company of America (BLICOA). Guardian wholly owns BLICOA as a stock subsidiary.
Berkshire/Guardian Denies Long-Term Disability Claims
Many individuals rely on these companies to provide income protection in the event of an unforeseen circumstance. However, Berkshire/Guardian/BLICOA has been known to deny the disability claims of professionals and business executives, including doctors, dentists, and lawyers, often claiming that the claimant does not meet the definition of disability.
Assistance from the Ortiz Law Firm
While Berkshire/Guardian is a reputable insurer with many satisfied customers, claim denials can and do happen. If you are faced with a denied claim, remember to act quickly, gather evidence, and consult with an experienced attorney to ensure the best possible outcome. Our Berkshire Life Insurance Disability Denial attorneys represent policyholders throughout the United States. We understand the complexities of the long-term disability appeal process and will protect your rights as we guide you through it.
Filing a Claim with Berkshire/Guardian
There are steps you can take when filing a claim with Berkshire/Guardian to avoid a denial:
- Notify Berkshire Promptly: The policy will likely have a time limit within which the policyholder must notify the insurance company.
- Complete Documentation: Obtain and complete all required forms. This often includes a claimant’s statement, an attending physician’s statement, and employment verification.
- Provide Medical Evidence: This may include medical records, specialist reports, diagnostic test results, and other relevant documentation that demonstrates the extent and nature of the disability.
RELATED POST: How to Apply for Long-Term Disability
Understanding Berkshire’s Long-Term Disability Policies
A typical Berkshire Life policy may define “disability” as the inability to perform the substantial and material duties of one’s regular or “own occupation.” An “own occupation” definition of disability refers to your specific occupation and material duties. Other policies may have a dual definition of disability, meaning that the definition changes after a certain period of time.
For example, many disability policies with a dual definition of disability will change from “own occupation” to “any occupation” after 24 months. It would be best to look at the terms of your Berkshire Life policy to see how “disability” is defined in your disability insurance policy. Not every disability insurance policy uses the same definition of disability.
Why Does Berkshire Life Deny Disability Claims?
While Berkshire/Guardian’s reputation has historically been excellent, there is also a growing number of legitimate disability insurance claims each year that Berkshire/Guardian wrongfully denies. Below are some of the most common reasons Berkshire Life denies long-term disability claims.
WATCH: Reasons Why Guardian Denies Long-Term Disability Insurance Claims
Pre-Existing Conditions
Long-term disability claims may be denied due to pre-existing conditions. If you have a medical condition that existed before your disability policy went into effect, the insurance company may use it as a reason to deny your claim. This can be frustrating and stressful, especially if you rely on this coverage. It is important to review your policy carefully to understand what is considered a pre-existing condition and how it may affect your coverage.
Peer Review Reports
Long-term disability denials often stem from peer review reports that are inconsistent with a claimant’s medical history and documented limitations. These file reviews, conducted by medical professionals hired by insurance companies, can sometimes downplay the severity of an individual’s condition, resulting in denied claims. Claimants must challenge these denials by providing comprehensive medical evidence. Understanding the nuances of these peer review processes and being prepared to respond are essential steps in navigating your claim
Surveillance
Many individuals experience long-term disability denials due to surveillance practices used by insurance companies. Surveillance footage is often a key piece of evidence that insurers use to challenge disability claims. Claimants need to be aware that their activities may be monitored, potentially leading to denials based on perceived inconsistencies between their reported limitations and observed actions. It is essential to seek the advice of legal experts familiar with disability claims procedures to navigate the potential challenges associated with surveillance evidence.
Own Occupation vs. Any Occupation
Sometimes, an insurance carrier like Berkshire may claim that you have a dual occupation, which insurance companies often use against medical professionals who return to work in a different capacity. In such cases, disability insurers like Berkshire/Guardian, may try to deny disability benefits based on the claimant’s ability to perform other work. This is where the definition of disability becomes particularly important.
Let’s take a heart surgeon as an example. A heart surgeon is more than just a doctor; they are a highly specialized cardiovascular surgeon.
For a successful “own occupation” disability claim, the surgeon must prove that they cannot perform the material and substantial duties of a cardiovascular surgeon to qualify as “totally disabled.” The surgeon is not helpless, but they cannot return to performing the material duties of a cardiovascular surgeon – their regular occupation.
It is important to note, however, that the heart surgeon would need more than a simple letter from their doctor stating they cannot perform heart surgery. In order to receive disability benefits from Berkshire or Guardian, the surgeon must submit medical records to prove that they are unable to work and meets the definition of disability as defined by the insurance policy.
RELATED POST: Own Occupation vs. Any Occupation in Disability Insurance Claims
Berkshire/Guardian Disability Insurance Claims Attorney
Suppose Berkshire has sent you a disability denial letter or a cut-off letter terminating your disability insurance benefits. In this case, you need to understand your legal rights to appeal the denial under the applicable disability law. You should consult with an experienced long-term disability attorney to explore your legal options.
Disability attorneys can help you determine whether an appeal is necessary to strengthen your claim. If an appeal is appropriate, an experienced disability attorney will help you frame the medical evidence in your claim to maximize your chances of winning the appeal.
We Represent Disability Income Claimants Across the U.S. Who Have Been Denied
Nick Ortiz and his experienced legal team have extensive knowledge of Berkshire disability insurance claims and disability law. Nick Ortiz and the Ortiz Law Firm have helped hundreds of people from across the United States win the benefits they are entitled to and deserve. He has handled hundreds of long-term disability claims against major insurance companies, including Berkshire Life and Guardian. His past clients include professionals such as doctors and business executives such as high-ranking insurance sales associates.
The Ortiz Law Firm can help you:
- Appeal the denial of an individual disability insurance claim;
- Appeal the denial of a group long-term disability insurance claim governed by ERISA;
- Appeal the cessation or termination of benefits under an individual disability insurance claim;
- Appeal the cessation or termination of benefits under a group long-term disability insurance claim benefits;
- File suit in state court for the wrongful denial of an individual disability insurance claim;
- Filing a lawsuit in federal court for the wrongful cessation or termination of benefits under an ERISA-governed group policy.
Mr. Ortiz is an experienced long-term disability insurance attorney. He offers a free case evaluation to anyone who has received a disability claim denial letter from Guardian/Berkshire (or any other major insurance company like Berkshire). You don’t pay any fees up front; you will only have to pay an attorney’s fee if your disability claim is approved.
Our Berkshire/Guardian disability insurance attorneys provide prompt assistance following an individual or group disability insurance claim denial. Our disability attorneys are experienced in successfully handling individual and group disability benefits claims. We are here to support you and help you appeal your disability denial to get the disability insurance benefits you deserve.
Request a Free Case Evaluation to Discuss Your Berkshire/Guardian Claim
Do not let Berkshire deny you the disability income benefits you deserve. If your claim has been denied and you would like information on how to appeal to obtain benefits, call the Ortiz Law Firm today at (888) 321-8131 to schedule a free case evaluation with a long-term disability insurance attorney.
