With greater than $23 million in in-force premiums, Guardian Life Insurance coverage Firm (usually by means of its subsidiary Berkshire Life Insurance coverage Firm) is among the largest suppliers of group incapacity insurance coverage insurance policies in the US. Physicians and extremely educated professionals are particularly prone to have incapacity advantages by means of Guardian, because it is among the comparatively few incapacity insurance coverage firms to offer “true” own-occupation insurance policies.
Whereas Guardian does supply many long-term incapacity insurance coverage insurance policies with strong protection, that doesn’t imply they are going to deal with each incapacity declare precisely or pretty. Like all incapacity insurance coverage firms, they make their cash by denying claims—not paying them out. That always results in wrongful denial of advantages and, in some instances, even lawsuits and regulatory penalties.
In case your Guardian incapacity declare has been wrongfully denied, contact the long-term incapacity attorneys at Bryant Authorized Group at present. Incapacity insurance coverage appeals are complicated and high-risk, particularly in case your incapacity coverage is ruled by the Worker Retirement Revenue Safety Act of 1974 (ERISA). Preventable errors may completely hold 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 group may also help you combat again.
Breaking Down the Guardian Incapacity Declare Appeals Course of
In the event you disagree along 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 supplied an in depth declare denial letter outlining:
- Why they denied your incapacity declare, together with particulars in regards to the medical proof that they reviewed. Frequent claimed causes for Guardian incapacity denials embody inadequate medical proof, or physician opinions suggesting you’re able to working.
- Necessary deadlines to file your attraction.
Learn this letter rigorously. It is going to clue you in on essential data you’ll want to provide in your attraction, reminiscent of extra supporting medical proof.
Underneath 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 typically you solely get one shot to offer extra proof. You could begin instantly.
RELATED RESOURCE: ERISA Appeals – Bryant Authorized Group (bryantlg.com)
Step 2: Collect Proof for Your Administrative Attraction
Underneath ERISA, you’re not in a position to sue Guardian instantly after a declare denial. You should first undergo Guardian’s inside administrative attraction course of.
It’s extraordinarily essential 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 have the ability to add any new proof. The court docket can solely look at what’s already in your file.
As quickly as doable, request a duplicate of your declare file, which incorporates all of the information that Guardian has in your case. From there, you’ll want to collect, arrange, and supply as a lot extra proof as you may to assist your declare and present that Guardian made an incorrect conclusion about your eligibility for long-term incapacity advantages.
This proof may embody, however is actually not restricted to:
- Medical information
- Skilled experiences
- Vocational evaluations
- Useful 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
Upon getting all of your proof gathered, reviewed, and arranged, it’s time to file the attraction. Your attraction ought to embody an attraction letter containing:
- A concise (but persuasive) rationalization of why you’re interesting the choice
- Particular arguments (supplied 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: just a few paragraphs with imprecise statements on why you disagree is not going to lower it.
Once more, we can not stress sufficient—have an skilled incapacity legal professional in your aspect for this step. That is possible your solely shot at including new proof to your declare file. Failure to offer the required proof or sturdy sufficient arguments can value you your solely shot at getting your incapacity advantages permitted.
Step 4: What Occurs if Guardian Denials My Attraction?
Hopefully, your administrative attraction shall be profitable. If it isn’t, and you continue to imagine your advantages have been wrongly denied, you may usually file a lawsuit towards the insurance coverage firm. Nevertheless, test your incapacity coverage rigorously, as some insurance policies could require a second administrative overview.
RELATED POST: How Will the Courtroom Overview My Lengthy-Time period Incapacity Case? – Bryant Authorized Group (bryantlg.com)
Non-ERISA Appeals Course of
In the event you bought a person incapacity insurance coverage coverage by yourself (i.e., not by means of an employer), or your employer is a authorities company or church, your plan in all probability isn’t ruled by ERISA.
There are quite a few variations between ERISA and non-ERISA plans, and laws fluctuate by state. Nevertheless, in Illinois, the main variations when it comes to the attraction course of are:
- You don’t need to undergo Guardian’s administrative attraction course of should you don’t need to. You possibly can sue them immediately.
- In the event you do file a lawsuit, there’ll possible be a proper discovery course of, which is able to let you add new proof all through this part of litigation. You gained’t need to submit all the pieces unexpectedly in a single shot.
Contact Bryant Authorized Group for Assist With Your Guardian Incapacity Denial Immediately
In the event 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 hold you from acquiring the incapacity advantages you have to assist your self and your loved ones.
Bryant Authorized Group has earned a robust repute all through Illinois for dealing with Guardian incapacity claims truthfully, aggressively, and efficiently. To schedule your free session with considered one of our long-term incapacity attorneys, name us at present at (312) 561-3010 or full our on-line kind.
The content material supplied right here is for informational functions solely and shouldn’t be construed as authorized recommendation on any topic.
