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The Berkshire Life Insurance Company of America, commonly known as Berkshire, and its parent company, the Guardian Life Insurance Company of America (Guardian), are well-respected names in the disability insurance industry. Berkshire merged with Guardian in July 2001. Guardian continued its normal operations, and a new company, the Berkshire Life Insurance Company of America (BLICOA), was formed.
Many individuals rely on Berkshire for income protection in the event of unforeseen circumstances. Although Berkshire is a reputable insurer with many satisfied customers, claim denials can and do happen. The company often claims that the claimant does not meet the definition of disability. If your claim is denied, act quickly. Gather evidence and consult with an experienced long-term disability attorney to ensure the best possible outcome.
Our Berkshire disability attorney represents policyholders throughout the United States. We can help you understand the complexities of the long-term disability appeal process and represent claimants nationwide. We will protect your rights as we guide you through the administrative appeal process and, if necessary, taking your claim to court.
Understanding the Definition of Disability
A typical Berkshire Life policy defines “disability” as the inability to perform the substantial and material duties of one’s “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.
For example, many disability policies with a dual definition of disability will change from “own occupation” to “any occupation” after 24 months. 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.
RELATED POST: Own Occupation v. Any Occupation In LTD Claims
Tips to Avoid a Disability Claim Denial
There are steps you can take when filing a long-term disability claim with Berkshire to avoid 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 demonstrating the extent and nature of the disability.
However, even the most well-supported LTD claim can be denied. Insurance companies like Berkshire will use various tricks and tactics to delay or deny your claim.
Why Does Berkshire Life Deny Disability Claims?
Although Berkshire has historically had an excellent reputation, the number of legitimate disability insurance claims that Berkshire wrongfully denieseach year is growing. The following are some of the most common reasons Berkshire Life denies long-term disability claims.
Pre-Existing Conditions
Long-term disability claims may be denied due to pre-existing conditions. If you had a medical condition before your policy took effect, the insurance company may use it as grounds to deny your claim. This can be frustrating and stressful, especially if you rely on this coverage. Therefore, it is important to review your policy carefully to understand what constitutes 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 should be aware that their activities may be monitored and that denials may be based on perceived inconsistencies between their reported limitations and their observed actions. Therefore, it is crucial to consult a legal expert who is familiar with disability claims procedures. A long-term disability attorney can navigate the potential challenges associated with surveillance evidence.
RELATED POST: Social Media Accounts Are Used to Deny Long-Term Disability Claims
Own Occupation vs. Any Occupation
Sometimes, Berkshire may claim that you have a dual occupation. This claim is often used against medical professionals who return to work in a different capacity. In such cases, Berkshire may deny disability benefits based on the claimant’s ability to perform other work. This is why the definition of disability is particularly important. For example, let’s consider a heart surgeon.
A heart surgeon is more than just a doctor; they are a highly specialized cardiovascular surgeon. To qualify for benefits under an “own occupation” disability policy, the surgeon must prove that they cannot perform the material and substantial duties of a cardiovascular surgeon. While the surgeon is not helpless, they cannot return to performing the material duties of their regular occupation as a cardiovascular surgeon.
However, it’s important to note that a heart surgeon would need more than a simple letter from their doctor stating that they can’no’t perform heart surgery. They must submit medical records proving their inability to work and demonstrating that they meet the policy’s definition of disability.
Working with a Berkshire Disability Attorney
Suppose Berkshire sent you a letter denying your disability claim or terminating your disability insurance benefits. In this case, it is important to understand your legal rights and how to appeal the denial under the applicable disability laws. Consult an experienced long-term disability attorney to explore your legal options.
Attorneys specializing in disability law can help you determine whether an administrative appeal is necessary to strengthen your claim. If so, an experienced disability attorney will help you present the medical evidence in your claim to maximize your chances of winning the appeal.
How Ortiz Law Firm Can Help with Your LTD Denial
Nick Ortiz and his experienced legal team have extensive knowledge of Berkshire disability insurance claims and disability law. Mr. Ortiz and the his firm have helped hundreds of people from across the United States win the benefits they deserve. He has handled hundreds of long-term disability claims against major insurance companies. His clients have included professionals such as doctors and dentists 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 offers a free case evaluation to anyone who has received a disability claim denial letter from Berkshire. You don’t pay any fees up front if you decide to work with us; you only pay an attorney’s fee if your disability claim is approved. We are here to support you and help you get the disability insurance benefits you deserve.
Request a Free Case Evaluation to Discuss Your Berkshire Disability 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 your LTD denial, call (888) 321-8131 to schedule a free case evaluation today.
