Guardian Disability Insurance Claim Lawyer

Although Guardian Life is better than most insurers at approving claims, they still wrongly deny long-term disability claims. Nick Ortiz is a national disability attorney with experience appealing and litigating Guardian disability denials. If Guardian has wrongly denied or terminated your claim, you can get 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 as defined in your specific policy.
• Guardian hired a physician to review your medical records and the physician determined that you are not eligible for disability benefits.
• Guardian hired a private investigator to conduct surveillance and follow you with a camera or video recorder. 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 returning to work in some capacity or another.
• Guardian hired a vocational expert to find jobs other than your own that you could perform on a daily basis.

If the Guardian has denied your claim, you must take action. You usually have 180 days to file an appeal. Once the appeals are 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 are very different from those for long-term disability benefits. Guardian may consider the SSA decision as evidence in your LTD case, but it does not guarantee approval.

Guardian will also consider how much time has passed since the SSA approved your claim. Guardian can argue that the SSA considered evidence that is no longer current or relevant to your long-term disability claim.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, accountants, and corporate executives. Because these are highly specialized occupations, most Guardian long-term disability insurance policies 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 after a certain period of time. This change in definition means that you must prove you cannot perform any kind of work. The definition usually changes from your occupation to any occupation after you have received benefits for 24-48 months. Here 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 Denied Guardian Disability Claim

If you have a group disability plan through your employer, 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 after 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. It should explain how the specific symptoms of your condition 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 have to file an appeal and you do not have the same restrictions on introducing new evidence. Another advantage of a non-ERISA policy is that claimants can bring a bad faith claim against Guardian. ERISA policies, on the other hand, 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 the Ortiz Law Firm to handle your appeal. We will obtain additional evidence to strengthen 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 understand that claimants who are unable to work and are fighting for benefits cannot afford to hire a Guardian disability attorney. We represent our clients on a contingency fee basis, with no out-of-pocket costs. Our contingency fee agreement means that you only pay an attorney’s fee if we successfully recover benefits. We will also advance the costs of your claim, including medical records costs and court filing fees.

Request a Free Case Evaluation with a Guardian Disability Insurance Attorney

It is 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 to you. Call us today at (888) 321-8131 for help getting the benefits you deserve.