Berkshire/Guardian Insurance: Understanding Disability Insurance Claims and Appeals

Has Berkshire/Guardian Insurance denied your disability insurance claim? Understanding the process and your rights is crucial when dealing with insurance companies. In this article, we will delve into the merger between Berkshire Life Insurance Company and Guardian Life Insurance Company of America and explore the potential challenges faced by policyholders in obtaining disability insurance benefits. We will also provide guidance on filing a disability insurance claim, the appeals process, and the importance of seeking legal assistance from experienced disability insurance attorneys. Let’s navigate the world of Berkshire/Guardian Insurance and ensure you receive the benefits you deserve.

For an example of our work convincing Guardian to pay on a disputed claim, see this article:  Robinson Warncke achieves confidential settlement against Guardian, salvaging the termination of $2M+ in ERISA disability benefits for a disabled attorney.

The Merger and Berkshire Life Insurance Company of America (BLICOA):

In July 2001, the merger between Berkshire Life Insurance Company and Guardian Life Insurance Company of America took place. As a result, the old Berkshire Company ceased to exist, and a new entity, Berkshire Life Insurance Company of America (BLICOA), was formed. Currently, Guardian wholly owns BLICOA as a stock subsidiary.

The Profit Motive and Disability Insurance Claims:

Guardian Life/BLICOA, like any business, aims to generate profits. In 2015 alone, the company earned a substantial net income of $433 billion. However, concerns have been raised about whether these profits were attained at the expense of disability policyholders who were wrongfully denied their insurance benefits.

The Fight for Disability Insurance Claims:

Over the years, numerous individuals have faced difficulties in their disability insurance claim process with Berkshire/Guardian/BLICOA. When a claim for individual or long-term disability benefits is delayed or denied, it means that policyholders are left without the much-needed financial assistance during challenging times. If your valid disability insurance claim has been denied by BLICOA (Guardian), it is crucial to seek assistance from top-ranked disability insurance attorneys and ERISA lawyers.

Assistance from Robinson Warncke:

At Robinson Warncke, our highly experienced team of Berkshire Life Insurance Disability Denial Attorneys is dedicated to helping policyholders across the United States obtain the disability insurance benefits they rightfully deserve. We understand the complexities of the insurance industry and are here to guide you through the process, ensuring that your rights are protected.

Filing a Disability Insurance Claim with Berkshire/Guardian:

To avoid potential delays or denials, it is essential to understand Berkshire/Guardian’s claims and appeals process. When submitting a disability insurance claim, it is crucial to provide thorough and accurate responses to all application questions.

Berkshire/Guardian’s disability insurance claims forms consist of four sections:

  1. Claimant Statement: As the claimant, it is your responsibility to complete this section fully.
  2. Employer/Plan-holder Statement: Your company representative, typically authorized by your employer, should complete this section. If you’re unsure who this person is, seek assistance from an experienced disability insurance lawyer.
  3. Attending Physician’s Statement: Provide these statements to your treating physicians for completion.  These forms can be confusing even to your doctors.  Sometimes the forms are not a good fit for explaining how and why your disability prevents you from working. A specialty law firm should know how to assist your doctors in completing the forms to maximize your chance of recovering the benefits you paid for.
  4. Direct Pay Enrollment and Authorization: This section allows you to choose direct deposit of your disability insurance benefit payments into your bank account if your claim is approved.

Once you have completed all four sections, you can submit your documents to Berkshire/Guardian via standard mail or email. Relevant addresses can be found on their official website.

Understanding Guardian’s Long-Term Disability (LTD) Package:

Guardian offers long-term disability (LTD) insurance packages that cover nearly every kind of disability, whether from injuries or illnesses, including those related to pregnancy. Short term benefits can be payable for up to 26 weeks, based on your average weekly wages during the eight weeks prior to your disability. Long term benefits often pay to age 65 or beyond. It is crucial to file timely written notice and proof of your disability to avoid claim rejection.

Challenges Faced: False Assertions and Unfair Practices:

Policyholders have encountered various challenges when dealing with Berkshire/Guardian insurance claims. Some common issues include:

Assertion of pre-existing conditions: Claimants sometimes face the wrongful denial of disability insurance benefits under the mistaken assertion of a pre-existing condition.

Deviation from plan terms: Insurers sometimes fail to follow their own plan terms when determining eligibility, for instance altering an “own occupation” policy to an “any occupation” policy.

Demanding duplicative documentation: Policyholders may experience repeated requests for the same information, only to be told that the documentation provided is incomplete or unsatisfactory.

Ignoring Social Security Disability Insurance (SSDI) or SSA findings: Insurers sometimes fail to give appropriate consideration to SSDI or SSA findings, resulting in claim denials.

Minimizing medical conditions: Insurance-hired doctors may downplay the severity of physical and mental conditions, deeming claimants ineligible for benefits.

Surveillance and video evidence: Private investigators hired by Berkshire/Guardian may gather video evidence purportedly contradicting a claimant’s limitations, potentially leading to denial.  Sometimes this evidence is being taken out of context and can be explained through additional evidence.

Navigating the Appeals Process and Seeking Legal Assistance:

Understanding the appeals process is crucial when facing a denial from Berkshire/Guardian. The appeals process is the most critical phase of every claim.  This is where experienced disability insurance attorneys, such as those at Robinson Warncke, can have the most positive impact on your claim. It is almost always a mistake to try to handle your own appeal.  We have been contacted by many people with legitimate disabilities who did serious damage to their claims by mishandling their own appeals. The value of the claim can be seriously compromised, if not completely destroyed, without the involvement of a specialty law firm.

Keeping a Record of Correspondence and Documents:

Throughout the claims process, it is essential to retain copies of all correspondence with Berkshire/Guardian. This includes additional information requested by the insurance company, appeal requests, and any relevant phone or email conversations. Detailed records help substantiate your case and protect your rights.

Your Options When Berkshire/Guardian Denies Your Claim:

If your valid disability insurance claim has been wrongfully denied by Berkshire/Guardian, it is crucial to explore your options. Our top-rated disability insurance lawyers and ERISA attorneys are ready to fight for your rights and challenge the denial, ensuring you receive the benefits you are entitled to.

When to Seek Assistance from a Berkshire Life Insurance Disability Denial Attorney:

Navigating the disability claim process can be overwhelming, particularly when facing a denial from Berkshire Life Insurance. Seeking assistance from a knowledgeable disability lawyer can be beneficial in the following situations:

  • Denial of your claim: A denial is not the end of the road. Skilled attorneys can help you appeal the decision and present a compelling case to overturn the denial.
  • Feeling overwhelmed: Dealing with a disabling condition is challenging enough, and understanding complex insurance policies can add to the stress. Disability insurance lawyers can guide you through the process and alleviate your burden.
  • Lack of progress: If your claim seems to be going nowhere, and you encounter difficulties in obtaining information from Berkshire Life Insurance, legal intervention can help move your claim forward efficiently.
  • Pressure from the insurer: Berkshire Life Insurance adjusters may employ tactics that put pressure on claimants to accept inadequate benefits or make statements detrimental to their case. Seeking legal counsel can protect your interests.

When facing a denial or challenges in obtaining disability insurance benefits from Berkshire/Guardian Insurance, it is essential to be aware of your rights and seek legal assistance from experienced disability insurance attorneys. Robinson Warncke’s team is dedicated to fighting for policyholders’ rights and ensuring they receive the benefits they deserve. Don’t navigate the complexities of the claims process alone—reach out for expert guidance and protect your interests today.