Founded in 1860, the Guardian Life Insurance Company of America (hereinafter simply Guardian) is one of the largest mutual life insurance companies in the United States. As of December 31, 2009, Guardian and its subsidiaries had $30.9 billion in assets. With more than 80 agencies, 5,000 employees, and 3,000 financial representatives nationwide, Guardian and its subsidiaries protect individuals, businesses, and their employees with disability products.
Guardian Life prefers to issue long term disability policies to licensed professionals and executives such as doctors, lawyers, accountants, and corporate and government employees. In order to participate in most Guardian Life group plans, you must be a licensed:
- Mortgage Professional/Originator;
- Paralegal (or employed legal staff member);
- Optometrist; or
Guardian Life’s disability income insurance is sold through their affiliated company, Berkshire Life Insurance Company of America. Berkshire Life’s insurance products include both personal individual disability and business disability insurance plans.
Guardian both evaluates claims for benefits and pays benefits owed. Although Guardian Life is better than most other insurance companies in approving claims, there are still numerous claims every year that are wrongfully denied.
Who is Eligible to Apply for LTD Benefits?
If you have a Guardian Life LTD policy, you may apply for long term disability benefits under your plan if you meet the definition of “disability” under your policy.
The definition of disability is unique to each policy. Here is a typical definition in a Guardian Life policy:
Own Occupation Definition of Disability
This plan’s definition of disability is specific to your own occupation.
A member is considered disabled if he or she has physical, mental or emotional limits caused by a current sickness or injury and, due to these limits, he or she is: (a) not able to perform, on a full- time basis, the major duties of his or her own occupation: and (b) not able to earn more than this plan’s maximum allowed income earned during a period of disability. This own occupation definition remains in effect for your full benefit period.
For doctor’s (physician’s), own occupation means the medical specialty or subspecialty practiced by the doctor right before the start of disability, provided: (a) he or she is certified in such specialty or subspecialty by the American Board of Medical Specialties (ABMS); (b) he or she carries malpractice insurance covering the full range of duties performed in this specialty or sub-specialty; and (c) for the 24 months immediately prior to disability, at least 60% of his or her insured earnings was professional service fee income attributable to the practice of this specialty or sub-specialty.
Top Reasons Your Guardian Long Term Disability Claim Could Be Denied
There many, many reasons that your Guardian Life disability claim could be denied, but five most common are:
- Guardian Life hired a physician to review your medical records and the hired doctor issued a report stating that the claimant is not very limited and therefore is not disabled;
- Guardian Life hired a private investigator to conduct surveillance and follow you around with a camera or video recorder. Guardian Life then used the video footage as evidence that you can return to work;
- Guardian Life sent you to be examined by a doctor of its choosing for an “independent medical exam” (or an IME for short, which is really not so independent) or for a functional capacity exam (FCE) to evaluate your restrictions and limitations;
- A doctor or nurse hired by Guardian Life speaks with your treating doctor and your doctor states that you can return to work in some capacity; or
- The definition of disability under your policy changes from “own occupation” to “any occupation” after 12, 24, or 36 months, and Guardian hired a vocational expert to find jobs other than your own that you could presumably perform on a daily basis.
Most Guardian Disability Claims Are Governed By ERISA
Most long term disability policies Guardian Life sells are sold as group plans to employers. If a claimant is eligible for LTD coverage as an Employer-provided benefit, then any disputes over coverage by the policy are usually governed by the Employee Retirement Income Security Act (ERISA). ERISA is a set of pro-insurance company regulations that creates a very high burden for claimants to overcome in a lawsuit against the insurance company.
Mr. Ortiz is a disability attorney with experience in appealing and litigating ERISA claim denials throughout the state of Florida.
If your long term disability claim has been denied by Guardian Life it is important that you take immediate action. The time period to submit an internal appeal with the insurance company is usually 180 days. Once you have “exhausted” all of your appeals directly with the insurance company in an ERISA-governed claim, you may have a very limited period of time to file a lawsuit.
Mr. Ortiz is available to provide you with a free case evaluation to discuss your legal rights and options after a denial of disability benefits by Guardian.
Contingent Fee Lawyer To Fight Wrongfully-Denied Claims by Disability Insurance Companies
We know that you often do not have the funds to pay your ordinary bills when you are hurt, disabled, and unable to work, much less pay for a lawyer. Thus, in our disability insurance lawsuits, we typically represent our clients on a contingent fee basis. Our clients do not pay us anything “out-of-pocket”. The Ortiz Law Firm advances all costs on the case – like court filing fees, expert witnesses fees, court deposition fees, and electronic records subpoenas – and then we are paid an attorney’s fee entirely out of the recovery for the claimant.
We bring claims against all the major insurers like Guardian Life, including Aetna, CIGNA Life Insurance, Hartford Life and Accident Insurance, Liberty Life Assurance, Lincoln National, Metropolitan Life (“MetLife”), Prudential Insurance, and Unum Life Insurance. We handle claims involving all major disabling medical conditions, including:
- Claims where the insurer admits an injury but disputes the severity (such as spinal cord injuries and traumatic brain injuries);
- Claims where the insurance companies stubbornly refuse to admit a policyholder has a disease, like Crohn’s Disease, Degenerative Disc Disease, Lupus, and Multiple Sclerosis.
If your long term disability claim has been wrongfully denied or cut-off by your insurance company, contact The Ortiz Law Firm for a free, confidential consultation. Please call (888) 321-8131.
Request a Free Policy Evaluation
If you are considering purchasing a disability insurance policy or have recently purchased a policy, we will help you understand what you are entitled to and whether there are deficiencies in your coverage that could lead to a denied claim. It is easy for individual policyholders who are not trained to read insurance policies to misread or misunderstand the disability policy. As part of our evaluation, we will explain what everything means to you in your situation.
Some of the aspects of your policy we will review include:
- Total versus residual disability;
- Own occupation versus any gainful occupation;
- Mental and nervous disability benefit limitations; and
- Self-reported conditions benefit limitations.
Fill out the form below to submit your request, and please allow 5 business days to receive your free Policy Evaluation Report.