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2021-131407 20231231 Information provided by: the New Mexico Aging & Long-Term Services Department Berkshire Life Insurance provides life insurance, disability insurance, dental insurance, and other benefits that help protect people and inspire their well-being. LanguagesOther Topics That May Be UsefulAll comments are subject to review. If it's decided that a comment is inappropriate then it will be deleted from the site. User ReviewsThere are no reviews for this agency yet. Record last updated: Jun 16 2022 8:07AM Has Berkshire/Guardian Insurance Company Denied Your Disability Insurance Claim?The Berkshire Life Insurance Company (Berkshire) merged with Guardian Life Insurance Company of America (Guardian), in July 2001. While Guardian maintained its normal operations, the old Berkshire Company was ended. In its place, a new Berkshire company formed—Berkshire Life Insurance Company of America (BLICOA). Now, Guardian wholly owns BLICOA as a stock subsidiary. One thing has not changed: Guardian Life/BLICOA is in the insurance business to make money, earning a net income of $433 billion in 2015. While there is nothing wrong with running a successful business, some argue these profits came at the expense of Guardian Life/BLICOA disability policyholders who were wrongfully denied disability insurance benefits. Over the years, many have fought Berkshire/Guardian/BLICOA in and out-of-court in the disability insurance claim process. A delayed or denied claim for individual or long-term disability benefits by Guardian Life, or its subsidiary BLICOA (Berkshire Life), means that you aren’t getting the financial assistance you deserve when you need it most. If BLICOA (Guardian) has denied your valid disability insurance benefit claim, our team of top-ranked, nationally recognized disability insurance attorneys and ERISA lawyers are here to help. At DarrasLaw, our seasoned and highly experienced team of Berkshire Life Insurance Disability Denial Attorneys are here to assist you in obtaining the disability insurance benefits you need and deserve, anywhere in the United States. Our founding partner Frank N. Darras and his firms have recovered nearly $1 billion of insurance benefits on behalf of individuals just like you. When you are ready to tell Berkshire/Guardian enough is too much, we offer free policy and claim consultations to discuss your rights and legal remedies. Call DarrasLaw today at (866) 276-3054 or contact us online. Filing a Disability Insurance Claim with Berkshire/GuardianWhen submitting a disability insurance claim with Berkshire/Guardian, you must respond to all application questions fully and accurately. Once you have thoroughly completed the applicable forms, send them to Guardian as soon as possible. Berkshire/Guardian expressly states that claimants should not wait to file a disability insurance claim until the elimination period—has passed. This suggests that waiting until the elimination period has passed could result in your inability or a serious delay collecting the disability insurance benefits you deserve. Berkshire/Guardian’s standard disability insurance claims forms contain four sections:
After completing the entirety of these four sections, Berkshire/Guardian allows disability insurance claimants to submit their documents in one of two ways: standard mail or email. These addresses are found here. Guardian’s Long-term Disability (LTD) package is found here. Guardian provides the following helpful information regarding some group disability insurance plans: Disability insurance benefits can be payable for any non-work related injury or illness (including disability due to pregnancy) beginning with the eighth consecutive day of disability. Disability insurance benefits can be payable for up to 26 weeks. Disability insurance benefit payments are generally based on your average weekly wages for the eight weeks immediately prior to your disability, and are subject to the maximum allowable by the law in effect on the initial day of disability. To claim disability insurance benefits, you should file written notice and proof of disability (Claim Form DB-450) with your employer or the insurance carrier within 30 days from the first day of your disability, or all or part of your disability insurance claim may be rejected. Do not wait more than 26 weeks from that date to file a disability insurance claim. (See addresses and telephone numbers below). Do not assume that your employer has filed a disability insurance claim on your behalf; timely claim filing is your responsibility. This information—and more—is found here. Stop the Delay, Denial, and Termination Games by Berkshire/GuardianBerkshire/Guardian Life offers both group long-term disability insurance policies as well as individual policies through Berkshire Life Insurance Company of America. Guardian’s long-term disability insurance products typically target professionals—including accountants, lawyers, doctors, corporate employees and government workers. Whether you’ve chosen the insurer on your own—as your individual disability insurance provider—or are with them through an employer-provided group policy, you still have the right to fair treatment and good faith dealings when making disability insurance benefit claims. If you have had any of the following problems with your valid claim for disability insurance benefits on a policy held with Guardian or Berkshire, we can help:
If Berkshire/Guardian sends you to a functional capacity exam (FCE) or independent medical exam (IME), you should seek assistance from an experienced, top-rated disability insurance attorney or ERISA lawyer first before you say or do anything fatal to your claim. Many long-term disability policies issued by Berkshire/Guardian are through a group or employer-sponsored plan and ERISA may govern your policy rights. You will surely face specific time limits on filing an ERISA appeal after a denial of LTD disability insurance benefits as well as deadlines for filing a lawsuit after an ERISA appeal denial is reaffirmed. Do not wait, call and speak to an ERISA insurance denial attorney if Guardian denied you disability insurance benefits to which you are entitled. Berkshire/Guardian’s Long-Term Disability Appeal Process
Don’t fret. After a little digging, here’s what we know: Guardian will send you the initial appeal information with the required notice of denial (likely by mail). If you choose to timely appeal and follow the requisite steps outlined for filing a disability insurance denial appeal, your file will reach an Adjudication & Procedural Specialist (APS). This person handles appeals for short-term disability and long-term disability insurance claims, among other things. For more specific information related to your appeal options with the Guardian, please contact DarrasLaw. Our experienced and award winning ERISA disability insurance lawyers can review your policy and help explain and pursue any appeal options that exist for you. Consider submitting any and all additional information that you want the insurer to consider. An experienced, disability insurance attorney can help you prepare your internal individual or group ERISA appeal. Too Much Is Better Than Not Enough. Don’t Throw Disability Papers Away!The disability insurance appeals process is often overwhelming. Sometimes, you need to jump through a lot of hoops and meet a lot of deadlines for submitting what can seem like endless amounts of paperwork. Don’t let that dissuade you. If Berkshire/Guardian denies your individual or group disability insurance claim, fighting back is the only possibility you have for a different outcome. Whenever possible, keep (or retrieve) copies of all correspondence between you and Berkshire/Guardian. Such documents can include, but are not limited to:
Find what you can, make note of the documents you remember submitting but can’t locate, and save everything else moving forward. If Berkshire/Guardian Said “No” To Your Valid Disability Insurance Claim You Have OptionsFor all employees, government workers, accountants, lawyers, doctors and other Berkshire/Guardian insureds that thought they had disability insurance coverage but the company denied, we are here for you. Our top-rated disability insurance lawyers and ERISA attorneys can help you fight back and overturn the wrongful denial of your claim for disability insurance benefits. During your disability insurance benefits claims process, was your claim unreasonably delayed or denied by Berkshire/Guardian because of:
If you are a professional with disability insurance through Berkshire/Guardian, you need to present a full and complete picture of your duties preclaim based on time spent and money earned in your initial claim for disability insurance benefits. For doctors, dentists, and lawyers that may include reporting your pre-disability coding or billing for the frequency of procedures or surgeries you performed, to accurately document your material and substantial duties of your occupation at the beginning of the claim. An experienced individual disability insurance lawyer can help you compile and present a thorough, comprehensive claim for Berkshire/Guardian individual disability insurance benefits. When is it Time to Seek Help from a Berkshire Life Insurance Disability Denial Attorney?
Like many people in this situation, you might file your long-term disability claim with Berkshire Life Insurance and wait for a check to arrive, but it never comes. Instead, you run into countless obstacles, delays, or even complete claim denials, which means you must live without the benefits you need and deserve. Many people who encounter difficulties with the process benefit from the help of a stellar disability lawyer who regularly deals with this company and its antics. The following are some situations in which you should consider contacting our legal team. You received a denial.A denial is the last thing you want, but it is not the worst situation, as you have options to appeal and/or litigate. However, challenging a denial by BLICOA (Guardian) can be an uphill battle if you do not know what you are doing or how this company works. Never give up, but instead, contact our disability attorneys, who can help you build and present your case to overturn the denial and grant you the benefits you richly deserve under your policy. You are overwhelmed.Dealing with a disabling condition and the associated physical, mental, and financial stress is difficult enough. When you add in complicated insurance policies with confusing language and ambiguous terms, the situation can quickly become overwhelming. The process of filing a claim and gathering all the necessary information can leave you feeling helpless, but there is help available. Even if you have not yet filed a claim, you should feel free to contact a Berkshire Life Insurance disability denial attorney for help. You feel like your claim is getting nowhere.Companies like BLICOA (Guardian) often tell claimants that they never received certain documents or information when you know you sent them. They might never return emails or calls or force you to wait on hold repeatedly when you try to get any information about your claim status. If you are getting a runaround from Berkshire Life Insurance, the intervention of a knowledgeable attorney can help your claim get back on track and proceed without unnecessary delays. You are getting pressure from the insurer.Sometimes, adjusters from BLICOA (Guardian) will pressure claimants into giving recorded statements, accepting inadequate benefits, signing rehab agreements, and take other steps to decrease or deny your claim and damage your future. You may not know what is in your best interest, and you should not hesitate to seek competent legal counsel. Whether you are considering filing a claim, already have a claim in process, or received a denial, the time to contact a long-term disability insurance lawyer is now. A Cautionary Tale: Meet John SchwalmIn John Schwalm v. Guardian Life Insurance Company of America, the plaintiff—John Schwalm—argued that the Guardian’s decision to terminate his long-term disability insurance benefits was arbitrary and capricious. The ultimate decision of the case is less telling than the facts. Schwalms’ claims Guardian once deemed legitimate; later resulted in denials. Schwalm earned a base salary of $140,000 per year. He injured his back in July 1999, ultimately undergoing two surgeries, including a spinal fusion surgery. For the first two years following his disability insurance claim submission in March 2003, Schwalm was covered under what Guardian called “the own occupation period.” This means that—during this period—Guardian considers the insured disabled if “physical, mental or emotional problems caused by a current sickness or injury” leave the insured person “not able to perform, on a full-time basis, the major duties of his own occupation.” After March 13, 2005, however, Guardian applied a second definition of disability, for their disability insurance benefits to continue. This second definition said the insured is disabled if “not able to perform, on a full-time basis, the major duties of any gainful work.” The plan also defined the term “gainful work” as “work for which you are or may become qualified by: (a) training; (b) education; or (c) experience.” Ultimately, Guardian terminated Schwalm’s disability insurance benefits based on this second definition. The case that Schwalm brought against Guardian allows the public to look at tactics that Guardian used in order to terminate long-term disability insurance benefits. Leading up to its decision to terminate disability insurance benefits, Guardian allegedly:
After evaluating one or more of these “examinations,” Guardian determined that Schwalm was no longer “disabled.” Schwalm appealed, to no avail. Schwalm, then, sued. This case is instructive and may open your eyes to the ways that Guardian built a case against its insured, then terminated his benefits. At DarrasLaw, our team of top-rated disability insurance attorneys includes Frank N. Darras, widely considered America’s top disability lawyer. Our seasoned disability insurance lawyers and ERISA attorneys have the knowledge and the litigation experience to handle these cases and win! What You Don’t Know Can Hurt YouDo not make the mistake of assuming that your denial was valid. Don’t give up when successful claim options may still exist. Experienced disability insurance lawyers and ERISA attorneys find ways that often lead to favorable outcomes that the average person couldn’t imagine. The following are just a few hypothetical possibilities that experienced disability insurance lawyers may see that others could miss.
The Employee Retirement Income Security Act of 1974 (ERISA) is a wide-ranging federal statute that applies to U.S. employee disability insurance plans when those plans are provided by private employers or labor unions. Like other parts of an employee’s benefit package, disability insurance plans may fall under ERISA’s provisions. Pertinent requirements include:
If an ERISA-protected disability insurance plan covers you, insurance companies are required to abide by the requirements that ERISA imposes. Failure to so do can result in myriad effects—some of which may benefit you. Berkshire/Guardian, as well as other insurers, can experience backlogs that could easily affect their ability to approve your disability insurance claim in fair and timely ways. In so doing, they could violate laws that may apply to you. Experienced disability ERISA lawyers will know what to look for.
Berkshire/Guardian has an obligation to keep you informed with the most up-to-date terms and limitations of your policy. If Berkshire/Guardian misinformed you or inadequately informed you about changes to your policy that ultimately affected your right to receive disability insurance benefits, you may have more options than you realize. Talk to your disability insurance lawyer or ERISA attorney if you have any questions or concerns about your claim. How Do I Afford a Top-Rated Bad Faith Disability Insurance Lawyer or ERISA Attorney?At DarrasLaw, we take all of the disability insurance claim denial cases that we choose to represent on a contingent fee basis. This means that you do not pay us up front. We do not collect fees, unless we get results. We cover all up-front costs associated with your case—including medical evaluations and investigations. We hope to help as many disabled people from all across America as we can. This contingent fee arrangement helps us ensure more people who need an experienced disability insurance lawyer, or ERISA attorney, can get one. Disability Insurance Help Is One Phone Call Away. Call Today for Immediate AssistanceWe offer prompt help with individual and group disability insurance claims at DarrasLaw. We know that a disability can suddenly and unpredictably curtail your income—and we are here when you need us. Call (866) 276-3054 today to schedule a meeting with a nationally rated, top disability insurance lawyer from DarrasLaw. Our nationwide disability insurance law firm has seen, evaluated, and resolved more individual and long-term disability cases than any other firm across the country. We are here to assist and help you fight for your disability insurance benefits. If, after making your valid claim, Berkshire/Guardian Life denied you disability insurance benefits, we can help you pursue the disability insurance benefits you deserve. For a free policy or claim consultation, contact DarrasLaw online or call us at (866) 276-3054. We also offer free policy analysis for anyone considering purchasing an individual or long-term disability insurance policy. Who is the largest insurer of longFormed in 1845, New York Life Insurance Company currently operates as the largest mutual life insurance firm in the United States. The firm offers traditional long-term care insurance and plans with a combination of long-term care and life insurance benefits.
Who pays the most for longMedicaid is by far the largest payer of Long-Term Care costs in the US today. Most people find out quickly when they need care that the government is not going to pay their way until they have spent most of their assets.
How long has longLong-term care insurance was first offered in the early 1980s, and the market grew rapidly for two decades.
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