Are Berkshire Life Disability Denials Common?
Disability insurance is intended to replace a percentage of your earned income when you are sick or injured and unable to work. Some people refer to disability insurance as “paycheck protection”. Having sufficient short-term and/or long-term disability insurance can help provide a sense of security that if you were to suffer serious injuries or a serious illness, you would still receive a regular income if you could no longer perform the duties of your job.
The Berkshire Life Insurance Company merged with Guardian Life Insurance Company of America in July 2001. Guardian Life Insurance Company maintained its normal operations, but a new Berkshire company was formed—Berkshire Life Insurance Company of America. Guardian Life, along with the Berkshire life Insurance Company of America, offers a wide variety of disability insurance policies.
Denied Claims for Berkshire Life Insurance Company of America Disability Insurance
Unfortunately, Berkshire Life Insurance Company of America, like many major insurance companies, does not always properly approve disability claims. Berkshire Life/Guardian has been known to deny the disability claims of professionals and business executives, including doctors, dentists, and lawyers, often citing that the claimant does not meet the definition of disability. Claim denials are surprising for many claimants, but claim denials are more common than the insurance companies will lead you to believe.
How Does Berkshire Life Deny Disability Income Claims?
Even though Berkshire Life’s/Guardian’s reputation has historically been excellent, there are also a growing number of legitimate, new disability insurance claims every year that Berkshire Life/Guardian will wrongfully deny. Sometimes, adverse claim decisions are grounded on nothing more than a medical record review of a remotely consultative physician without ever touching patients.
The Definition of Disability
A typical Berkshire Life policy may define “disability” as the inability to perform the substantial and material duties of one’s regular occupation or “own occupation”. An own occupation definition of disability refers to your specific occupation and your essential duties of that occupation. 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. You should look to the terms of the policy from Berkshire Life to see how the term “disability” is defined in your disability insurance policy. Not every disability insurance policy will use the same definition of disability.
An Own Occupation vs Any Occupation Disability Insurance Claim
Sometimes, an insurance carrier like Berkshire may claim that you have a dual occupation, which insurance companies often employ against health professionals who return to work in a different capacity. In such cases, providers of disability insurance such as Guardian/Berkshire may try to deny disability benefits based on the claimant’s ability to perform other work. This is where the definition of disability becomes especially important.
Let’s take the occupation of a heart surgeon, for example. A heart surgeon is not just a doctor; they are a surgeon with a specialty in cardiovascular surgery.
To be successful in the own occupation disability claim process and receive benefits, a heart surgeon must be unable to perform the material and substantial duties of their particular subspecialty to qualify for “total disability.” This doesn’t mean that the surgeon is completely helpless; they just cannot go back to work and perform surgery or perform the substantial duties of the same job as before – their regular occupation.
Let’s presume that the surgeon developed a tremor in their hands. As such, they can no longer hold a scalpel to perform delicate heart surgeries. However, they still have the ability to perform general consultations with heart patients. They may be able to work in another field such as general cardiology – and on a full-time basis, but they cannot perform heart surgeries.
If our heart surgeon in the example above had an “own occupation” insurance policy, the doctor would likely be deemed totally disabled and would qualify for disability benefits, even if gainfully employed as a cardiologist. If the heart surgeon only defined his or her “own occupation” as a “cardiologist”, then he or she may have a more difficult time qualifying for total disability benefits.
However, it is important to note that the heart surgeon would need more than a simple letter from their doctor stating that they are unable to perform heart surgery. In order to receive disability benefits from Berkshire or Guardian, the surgeon will need to submit medical records as proof that they are unable to work and meet the definition of disability as defined in the insurance policy.
Berkshire / Guardian Disability Insurance Claims Attorney
If Berkshire has sent you a disability denial letter or a cut-off letter terminating your disability insurance benefits, you need to understand your legal rights to challenge the disability denial under the applicable disability law. You should consult with an experienced long-term disability attorney to explore your legal options. Disability insurance lawyers can help you determine whether an appeal is appropriate in your individual disability claim. If an appeal is appropriate, an experienced disability lawyer will help you shape the medical evidence in your claim to maximize the chance of winning the appeal.
We Represent Disability Income Claimants Across the U.S. That 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 benefits which they are due 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 like doctors and business executives like high-level insurance salesmen.
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 an individual disability insurance claim cessation or termination of benefits;
- Appeal a group long term disability insurance claim cessation or termination of benefits;
- File a lawsuit in state court for the wrongful denial of an individual disability insurance claim;
- File a lawsuit in federal court for the wrongful cessation or termination of benefits of an ERISA-governed group policy.
Mr. Ortiz is an experienced disability insurance attorney, a Board-Certified Social Security Disability attorney, and offers a free consultation to those who have received a disability claim denial letter from Guardian/Berkshire (or any other major insurance companies like Berkshire). You won’t pay any fees upfront, and you will only have to pay an attorney’s fee if your disability claim is approved.
Our Berkshire/Guardian disability insurance lawyers provide prompt assistance following an individual and group disability insurance claim denial. Our disability insurance lawyers are experienced in having successfully handled individual and group disability benefits claims. We are here for support and will help you fight your disability denial so that you get the disability insurance benefits you deserve.
Request a Free Consultation to Discuss Your Berkshire/Guardian Claim
Do not let Berkshire deny you the disability income benefits that you are entitled to. If your claim has been denied and you would like information about how to appeal so that you can obtain benefits under your disability insurance claim, call the Ortiz Law Firm today at (866) 853-7210 to schedule a free consultation with a long-term disability insurance lawyer. You can also contact our law firm online to request your free consultation. Our attorneys would welcome the opportunity to call you to discuss the particular details of your claim.
We also offer a free policy analysis for people considering purchasing a disability policy for a lifetime.