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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 reputable names in the disability insurance industry.
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 (BLICOA). Guardian wholly owns BLICOA as a stock subsidiary.
Berkshire/Guardian Denies Long-Term Disability Claims
Many individuals depend on these companies to provide income protection in unforeseen circumstances. However, Berkshire/Guardian/BLICOA 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 come as a surprise for many claimants, prompting the need for a thorough appeal.
Assistance from Ortiz Law Firm
While Berkshire/Guardian is a renowned insurer with many satisfied customers, claim denials can and do happen. If you face a denied claim, remember to act swiftly, gather robust evidence, and consult an experienced attorney to ensure the best possible outcome. Our Berkshire Life Insurance Disability Denial Attorney Nick Ortiz represent policyholders anywhere in 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 initiating a claim with Berkshire/Guardian to avoid a denial:
- Notify Promptly: The policy likely has a stipulated period within which the policyholder must notify the insurer of their disability.
- 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 can include medical records, reports from specialists, 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 occupation or “own occupation.” An “own occupation” definition of disability refers to your specific occupation and essential 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. It would be best to look at the terms of the policy from Berkshire Life to see how “disability” is defined in your disability insurance policy. Not every disability insurance policy will use the same definition of disability.
Why Does Berkshire Life Deny Disability Insurance Claims?
Even though Berkshire/Guardian’s reputation has historically been excellent, there is also a growing number of legitimate disability insurance claims every year that Berkshire/Guardian will wrongfully deny.
RELATED POST: Guardian Denies LTD Benefits Because Claimant Was Not In Active Full-Time Service
Pre-Existing Conditions
Long-term disability claims can 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 that coverage. It is essential to review your policy carefully to understand what qualifies as a pre-existing condition and how it may impact your coverage.
Peer Review Reports
Long-term disability denials often stem from peer review reports that do not align 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, leading to 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 because of surveillance practices used by insurance companies. Surveillance footage is often a pivotal piece of evidence that insurers use to challenge disability claims. Claimants must be aware that their activities may be monitored, potentially leading to denials based on the perceived inconsistency between their reported limitations and observed actions. It is essential to seek guidance from legal experts familiar with disability claim procedures to navigate 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 employ against health professionals who return to work in a different capacity. In such cases, disability insurance providers, 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 especially important.
Let’s consider 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 perform the substantial duties of a cardiovascular surgeon – their regular occupation.
However, it is essential to note that the heart surgeon would need more than a simple letter from their doctor stating they cannot perform heart surgery. To receive disability benefits from Berkshire or Guardian, the surgeon must submit medical records as proof that they cannot work and meet the definition of disability as defined in 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 that case, you must understand your legal rights to challenge the disability denial under the applicable disability law. You should consult an experienced long-term disability attorney to explore your legal options. Disability insurance lawyers can help you determine whether an appeal is necessary to strengthen your 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. 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 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 like doctors and business executives like high-level 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 an individual disability insurance claim benefits;
- Appeal the cessation or termination of a group’s long-term disability insurance claim 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 long-term disability insurance attorney. He offers a free consultation to those who have received a disability claim denial letter from Guardian/Berkshire (or any other major insurance company like Berkshire). You won’t pay any fees upfront; 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 or group disability insurance claim denial. Our disability insurance lawyers are experienced in successfully handling individual and group disability benefits claims. We are here for support and will help you appeal your disability denial to recover 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 you are entitled to. If your claim has been denied and you would like information about how to appeal to obtain benefits under your disability insurance claim, call the Ortiz Law Firm today at (888) 321-8131 to schedule a free consultation with a long-term disability insurance lawyer. If you are considering purchasing a disability policy for a lifetime, we also offer a free policy analysis.