With greater than $23 million in in-force premiums, Guardian Life Insurance coverage Firm (typically via its subsidiary Berkshire Life Insurance coverage Firm) is without doubt one of the largest suppliers of group incapacity insurance coverage insurance policies in the US. Physicians and extremely educated professionals are particularly more likely to have incapacity advantages via Guardian, because it is without doubt one of the comparatively few incapacity insurance coverage corporations to offer “true” own-occupation insurance policies.
Whereas Guardian does supply many long-term incapacity insurance coverage insurance policies with sturdy protection, that doesn’t imply they may deal with each incapacity declare precisely or pretty. Like all incapacity insurance coverage corporations, they make their cash by denying claims—not paying them out. That always results in wrongful denial of advantages and, in some circumstances, even lawsuits and regulatory penalties.
In case your Guardian incapacity declare has been wrongfully denied, contact the long-term disability attorneys at Bryant Authorized Group right now. Incapacity insurance coverage appeals are complicated and high-risk, particularly in case your incapacity coverage is ruled by the Worker Retirement Earnings Safety Act of 1974 (ERISA). Preventable errors might completely maintain you from acquiring the incapacity advantages you paid for (and deserve). Working with an skilled incapacity legal professional is strongly inspired. You aren’t alone, and our crew may also help you struggle again.
Breaking Down the Guardian Incapacity Declare Appeals Course of
When you disagree together with your long-term incapacity declare denial, you’ll must fille an attraction. Step one is determining whether or not your plan is ruled by ERISA.
In case you have employer-provided long-term incapacity insurance coverage and a public sector, non-church job, you virtually actually have an ERISA plan. We’ll define the appeals course of for ERISA plans first.
Guardian ERISA Appeals Course of
Step 1: Overview Your Declare Denial Letter
When Guardian denied your declare, they need to have offered an in depth declare denial letter outlining:
- Why they denied your incapacity declare, together with particulars concerning the medical proof that they reviewed. Frequent claimed causes for Guardian incapacity denials embrace inadequate medical proof, or physician opinions suggesting you’re able to working.
- Essential deadlines to file your attraction.
Learn this letter rigorously. It’s going to clue you in on vital info you’ll want to provide in your attraction, similar to extra supporting medical proof.
Beneath ERISA, you usually solely have 180 days to file an attraction after Guardian denies your preliminary software. In case your coverage isn’t ruled by ERISA, Guardian could ask that any new proof be submitted in simply 30 days. That isn’t a lot time, and usually you solely get one shot to offer extra proof. You might want to begin instantly.
RELATED RESOURCE: ERISA Appeals – Bryant Legal Group (bryantlg.com)
Step 2: Collect Proof for Your Administrative Attraction
Beneath ERISA, you’re not capable of sue Guardian instantly after a declare denial. You should first undergo Guardian’s inside administrative attraction course of.
It’s extraordinarily vital to incorporate all related proof and current the absolute best case at this stage. When you do have the choice to file a lawsuit if Guardian denies your attraction, you gained’t be capable of add any new proof. The court docket can solely study what’s already in your file.
As quickly as attainable, request a duplicate of your declare file, which incorporates all of the data that Guardian has in your case. From there, you’ll want to collect, arrange, and supply as a lot extra proof as you’ll be able to to assist your declare and present that Guardian made an incorrect conclusion about your eligibility for long-term incapacity advantages.
This proof would possibly embrace, however is actually not restricted to:
- Medical data
- Professional studies
- Vocational evaluations
- Purposeful evaluations
- Letters of assist from physicians
- Private testimony from colleagues and members of the family
- Copies of paperwork in your declare file
- Pictures and video proof
- Ache journals
Step 3: File the Attraction
After getting all of your proof gathered, reviewed, and arranged, it’s time to file the attraction. Your attraction ought to embrace an attraction letter containing:
- A concise (but persuasive) clarification of why you’re interesting the choice
- Particular arguments (offered within the denial letter) that you simply’re contesting
- A abstract of the documentary proof you’re offering
- Any relevant citations to your plan paperwork or earlier case legislation
In brief: a couple of paragraphs with obscure statements on why you disagree is not going to minimize it.
Once more, we can’t stress sufficient—have an skilled incapacity legal professional in your aspect for this step. That is seemingly your solely shot at including new proof to your declare file. Failure to offer the mandatory proof or robust sufficient arguments can price you your solely shot at getting your incapacity advantages authorised.
Step 4: What Occurs if Guardian Denials My Attraction?
Hopefully, your administrative attraction will probably be profitable. If it isn’t, and you continue to consider your advantages have been wrongly denied, you’ll be able to usually file a lawsuit towards the insurance coverage firm. Nonetheless, verify your incapacity coverage rigorously, as some insurance policies could require a second administrative assessment.
RELATED POST: How Will the Court Review My Long-Term Disability Case? – Bryant Legal Group (bryantlg.com)
Non-ERISA Appeals Course of
When you bought a person incapacity insurance coverage coverage by yourself (i.e., not via an employer), or your employer is a authorities company or church, your plan most likely isn’t ruled by ERISA.
There are quite a few variations between ERISA and non-ERISA plans, and rules fluctuate by state. Nonetheless, in Illinois, the most important variations by way of the attraction course of are:
- You don’t need to undergo Guardian’s administrative attraction course of if you happen to don’t wish to. You possibly can sue them instantly.
- When you do file a lawsuit, there’ll seemingly be a proper discovery course of, which is able to help you add new proof all through this part of litigation. You gained’t need to submit every part unexpectedly in a single shot.
Contact Bryant Authorized Group for Assist With Your Guardian Incapacity Denial Right now
When you’ve made it this far, we shouldn’t need to remind you the way essential a very good legal professional might be all through the Guardian appeals course of. Don’t let preventable errors or unfamiliarity with the method maintain you from acquiring the incapacity advantages you’ll want to assist your self and your loved ones.
Bryant Authorized Group has earned a robust status all through Illinois for dealing with Guardian incapacity claims truthfully, aggressively, and efficiently. To schedule your free session with one among our long-term incapacity legal professionals, name us right now at (312) 561-3010 or full our online form.
The content material offered right here is for informational functions solely and shouldn’t be construed as authorized recommendation on any topic.
