Guardian Life Insurance Denied Disability Lawsuits

Lawsuits filed against Guardian Life Insurance Company of America by its policyholders claim the insurer has wrongfully denied disability benefits by practicing bad faith insurance. If you had an insurance claim denied and think Guardian Life Insurance and their affiliated company, Berkshire Life Insurance Company of America, has conducted health insurance fraud, an insurance lawyer can help.

Guardian Denied Disability Benefits

Disability income protection insurance provides financial benefits to employees when they are unable to work due to a disability caused by a covered illness or injury, regardless of whether or not that illness or injury is work-related.

Guardian is a large company with more than 5,000 employees serving about five million customers. Guardian Life mainly issues long term disability policies to licensed professionals and executives such as doctors and dentists, lawyers, accountants, and corporate and government employees. A number of its policyholders have filed disability lawsuits—personal injury cases—against the insurance company claiming bad faith insurance and alleging the company denied their Guardian long term disability insurance. Although the company rates better than other insurers (it isn’t included in the “10 worst insurance companies ”) and it is known to be well-managed by experienced disability claim managers and examiners, numerous insurance lawsuits claiming wrongfully denied benefits are filed every year.

If you have had your claim denied, or if your claim was granted and then later terminated, you may be eligible for additional benefits.
 

Insurance Company Claim Denial Tactics

Guardian has a reputation for conducting business in good faith, but lawsuits and settlements reveal numerous denial tactics. Here are some common bad faith tactics:
 

• Insurer will send you to either be examined by a doctor of their choice (Independent Medical Examiner, or IME) who provides an IME Exam or a functional capacity exam (FCE) to evaluate your restrictions and limitations. The IME reports that you are not very limited and therefore not disabled.
• Insurer hires an IME to review your medical records—without seeing you--and their hired doctor reports that you are not disabled.
• Insurer hires a private investigator to video and photograph your daily “activities”. With photos and video surveillance footage it can argue that you can return to work.
• The definition of disability under your policy changes from “own occupation” to “any occupation” after 12, 24, or 36 months, and Insurer hires a vocational expert to find jobs other than your own that you could presumably perform on a daily basis.

As well, some claims are denied or underpaid due to the policy or claim itself, such as:
 

• The circumstances for which the claim was made are not covered by the policy because of an exclusion or because it is the wrong type of policy.
• The claim was poorly presented, so the insurance company wrongly decided that the claim was not covered
• An insurance adjuster failed to review the evidence in good faith; the adjuster had already decided to deny the policy
• The insurer wrongly decided not to extend important benefits that should have been provided by the policy, such as the duty to defend.

 

Guardian and ERISA

Guardian Life sells most long-term disability (LTD) policies as group plans to employers. If a claimant is eligible for LTD coverage as an Employer-provided benefit, any disputes over coverage by the policy are usually governed by the Employee Retirement Income Security Act (ERISA).

ERISA is a set of pro-insurance company regulations that tends to favor the insurance company rather than the claimant. However, ERISA insurance lawyers have experience in appealing and litigating ERISA claim denials.

If Guardian Life has denied your LTD, it is important that you take immediate action. The time period to submit an internal appeal with the insurance company is usually 180 days. After you have “exhausted” all of your appeals directly with the insurance company in an ERISA-governed claim, you may have limited time to file a lawsuit.
 

About Guardian

Guardian Life’s disability income insurance is sold through their affiliated company, Berkshire Life Insurance Company of America, which offers personal individual disability and business disability insurance plans. But Guardian both evaluates claims for benefits and pays benefits owed.

Guardian Life Insurance Company of America has been in the insurance business since 1860, and this Fortune 300 company is one of the largest mutual life insurance companies in the US. As of December 31, 2009, Guardian and its subsidiaries had $30.9 billion in assets. The company earned a net income of $271 million in 2013. There is speculation that some of these profits were made by denying LTD to its policy holders.
 

Guardian Denied Disability Lawsuits

Lawsuits filed against Guardian allege the company committed fraud and breach of contract. Many lawsuits stem from denial of legitimate Guardian long term disability insurance claims—where the insurance company allegedly unfairly and improperly fails to compensate the insured for a loss covered by their policy, or unreasonably delays making payments due under the policy.

In November 2016, Barry Weber filed a complaint against The Guardian Life Insurance Co. of America citing ERISA. According to the lawsuit, plaintiff alleges that he was denied LTD benefits by Guardian. The plaintiff believes that the defendant's decision to deny him of payment of benefits were highly influenced by its conflicting duties to him and its shareholders, despite his eligibility to receive benefits and being subjected to an unreasonable claims process by the defendant.

Randal M. was first diagnosed with an injury or illness to his spine in August 2009. He applied for and received short-term disability benefits from Guardian. Plaintiff then applied for LTD. In April 2010, Guardian denied Plaintiff LTD benefits, claiming plaintiff had a pre-existing condition that makes him ineligible for long-term disability benefits as defined by the Plan.

Randall M.applied for Social Security Benefits and received them beginning on June 1, 2010. Due to the fact that Guardian’s Long-Term Disability benefit is a greater amount than Plaintiff’s Social Security Disability benefit, Guardian is required to supplement the Social Security Benefit amount.

Plaintiff became totally disabled at age 51. Guardian’s LTD benefits policy covers the Plaintiff up to the age of 65. Because Plaintiff was never diagnosed or treated for a spinal injury or before August 2009, he did not have a pre-existing injury or illness. (In Randal M. Vs The Guardian Life Insurance Company Of America.)

If you or a loved one has suffered similar damages or injuries, please fill in our form and your complaint will be sent to a lawyer who may evaluate your claim at no cost or obligation.
Last updated on Oct-14-20