Guardian Disability Insurance Claim Lawyer

Although Guardian Life is better than most insurers at approving claims, they still wrongly deny disability claims. Nick Ortiz is an experienced national long-term disability attorney who has successfully appealed and litigated Guardian disability denials. If the Guardian has wrongly denied or terminated your claim, you can receive a free case review. Call (888) 321-8131 or click the button below to get started.

Why Was My Guardian Disability Insurance Claim Denied?

There are many, many reasons why Guardian denies disability claims. The most common reasons for a Guardian’s long-term disability denial are detailed below.

• Guardian has determined that you do not meet the definition of disability in your policy.
• Guardian hired a physician to review your medical records, who determined that you are not eligible for disability benefits.
• Guardian hired a private investigator to follow you and record your activities. Guardian then used the video footage as evidence that you could return to work.
• Guardian sent you for an independent medical examination to evaluate your restrictions and limitations.
• Your doctor stated that your medical condition does not prevent you from working in some capacity.
• Guardian hired a vocational expert to identify other jobs that you could perform.

If the Guardian has denied your claim, you need to act fast. You usually only have 180 days to file an appeal. Once the appeals process is exhausted, claimants only have a limited time to sue their disability insurance companies.

Social Security Approved My Claim, So Why Did Guardian Deny It?

The requirements to qualify for Social Security disability benefits are very different from those for long-term disability benefits. Although Guardian may consider the SSA’s decision as evidence in your LTD case, it does not guarantee approval.

Guardian will also consider how much time has passed since the SSA approved your claim. They can argue that the SSA considered evidence that is no longer current or relevant to your long-term disability claim.

Own Occupation vs. Any Occupation Policies

Guardian often issues disability insurance policies to licensed professionals and executives, such as doctors, lawyers, and accountants. Because these are highly specialized occupations, most of these policies issued by the Guardian use an “own occupation” disability definition.

Here is an example from an “own occupation” policy:

“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:

1. Not able to perform, on a full-time basis, the major duties of his or her own occupation and
2. 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 physicians, own occupation means the medical specialty or subspecialty practiced by the doctor right before the start of disability, provided:

1. He or she is certified in such specialty or subspecialty by the American Board of Medical Specialties (ABMS);
2. He or she carries malpractice insurance covering the full range of duties performed in this specialty or sub-specialty and
3. 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.”

However, it is common for long-term disability plans to use a definition of disability that changes over time. This means that, after the initial period, you must prove that you cannot perform any kind of work.

Usually, the definition changes from your specific occupation to any occupation after you have received benefits for 24 to 48 months. Below is an example of an “any occupation” definition of disability:

“Disability or Disabled: These terms mean that a current sickness or injury causes physical or mental impairment to such a degree that the covered person is:

(1) During the elimination period and the own occupation period, not able to perform, on a full-time basis, the major duties of his or her own occupation.

(2) After the end of the own occupation period, not able to perform, on a full-time basis, the major duties of any gainful work.

The covered person is not disabled if he or she earns, or is able to earn, more than this plan’s maximum allowed disability earnings.

The covered person may be required, on average, to work more than 40 hours per week. In this case, he or she is not disabled if he or she is able to work for 40 hours per week.

Neither: (a) loss of a professional or occupational license; or (b) receipt of or entitlement to Social Security disability benefits; in and of themselves constitute disability under this plan.”

How to Appeal a Guardian Disability Denial

If you have a group disability plan through your employer, the Employee Retirement Income Security Act (ERISA) governs your claim. ERISA is a set of pro-insurance company regulations. ERISA law requires claimants to go through the administrative appeals process before filing a lawsuit.

Under ERISA, you cannot submit additional evidence once you have exhausted your appeals. Steps you can take to strengthen weak areas of your claim include:

• Gather Additional Medical Evidence: Your medical records alone may not be enough to bridge the gap between diagnosis and impairment. Ask your doctor to complete a residual functional capacity form or write a statement supporting your claim. The form should explain how your specific symptoms have disabled you.
• Work with a Vocational Expert: A vocational expert evaluates a claimant’s ability to perform a particular job. Vocational experts are useful when you need to prove that you cannot perform a job.
• Get Statements from Family, Friends, and Coworkers: You can get a statement from anyone who has witnessed how your condition affects your abilities. Most claimants have at least one person who has witnessed their disability. Additional testimony about your limitations can strengthen your claim.

If you have an individual disability insurance plan, your disability insurance claim is exempt from ERISA regulations. You may not need to file an appeal, and there are fewer restrictions on introducing new evidence. Another advantage of a non-ERISA policy is that claimants can file a bad faith claim against Guardian. ERISA policies do not allow for bad faith claims.

The Ortiz Law Firm Can Help with Your Claim

If Guardian has denied or terminated your claim, contact us to handle your appeal. We will gather additional evidence to support your claim during the appeal process. If Guardian denies your appeal, we can help you in file a lawsuit to recover your disability income insurance benefits.

We represent our clients on a contingency fee basis, so there are no out-of-pocket costs. This means that you only pay an attorney’s fee if we successfully recover benefits. We also advance the costs of claims, including the cost of obtaining medical records and court filing fees.

Request a Free Case Evaluation with a Guardian Disability Attorney

It’s easy for untrained claimants to misread or misunderstand a disability policy. We will review your policy and the details of your case. As part of our evaluation, we will explain what everything in your claim means. Call us today at (888) 321-8131 to get the benefits you deserve.