ERISA Experience You Can Rely On.

What To Know About The Guardian Life Insurance Company

The Guardian Life Insurance Company of America is a major insurance company headquartered in New York, New York, which sells group insurance to employers. Berkshire Life Insurance Company of America is a wholly-owned subsidiary of The Guardian Life Insurance Company of America.

If you have a claim for benefits with The Guardian Life Insurance Company of America or its wholly-owned subsidiary, Berkshire Life Insurance Company of America, the ERISA Law Center can help you. We are familiar with The Guardian’s unfair claims practices, know what to expect from The Guardian, and know how to fight back. We will fight to get you the ERISA benefits that you deserve.

How Guardian Avoids Paying Claims

At the ERISA Law Center, we have found that sometimes The Guardian personnel seem to “take forever” to respond to communications, decide claims, or decide appeals of denied claims. Often, there is no explanation for the delays.

The Guardian’s claims and appeals handling and processing are very uneven in our experience. Often, claimants or their beneficiaries receive prompt, professional, and accurate handling of their claims. But sometimes, claims and appeal processing by The Guardian is slow and, in our opinion, unprofessional, incompetent and dishonest.

At the ERISA Law Center, we have found that sometimes claims or appeals personnel tell you or write to you that they have sent you documents or letters, include copies of those documents or letters in The Guardian’s claim files, but do not actually send the documents or letters to you. A benefit termination letter or an internal administrative appeal denial letter or a letter transmitting a medical review on appeal for your comment and review will be “in the file” as if it was sent to you, but it wasn’t. Therefore, when you have a claim or appeal pending with The Guardian, you should be careful to regularly ask – in writing – about the status of your claim or appeal.

Guardian’s History Of Handling Policies Inaccurately

We at the ERISA Law Center have found that The Guardian personnel often do not understand or properly apply policy terms to its long-term disability policies or, indeed, any other type of insurance policies.  Insurance policies are complex documents. It appears to us that The Guardian does not always properly train its employees so that they understand and properly interpret and apply policy terms. You need to understand your policy because if you have a claim with The Guardian Life Insurance Company of America, you cannot be confident that its employees understand the terms of your policy or apply it correctly.

Simplifying Guardian’s Complex Group Insurance Policies

The Guardian’s group policies are often very complicated, difficult to read, and difficult to understand. The Guardian often issues multi-coverage group policies which provide:

  • Life insurance
  • Short-term disability insurance
  • Long-term disability insurance
  • Accidental death and dismemberment benefits
  • Medical benefits
  • Dental benefits

It offers these and other benefits that are all part of the same master policy. Therefore, if you are covered by a group insurance policy issued by The Guardian Life Insurance Company of America, it is often difficult to understand exactly what benefits you have and what you need to do to get those benefits. If you are struggling with a Guardian Life Insurance denial or a Guardian Life/Berkshire Life disability benefit denial, you may need an insurance lawyer to review your policy with you.

Using Inaccurate Records To Skew Their Decisions

At the ERISA Law Center, we have found that even when The Guardian personnel collect all the relevant records, it appears that they are trained to minimize the cost of medical reviews by outside doctors and, therefore, do not provide all the records which they have to such outside doctors. This results in opinions by the outside doctors, which only reflect the records they are shown, but not the records that The Guardian personnel have collected – and therefore, the opinions are inconsistent with the known facts. When you bring this to The Guardian’s attention, that doesn’t matter: even though The Guardian knows it “sandbagged” its own doctors by not giving them all of your records, it is happy to rely upon the doctor’s opinion because that opinion supports denying or terminating your benefits.

Guardian Doesn’t Always Obey ERISA, Either

If your claim is subject to ERISA, as most employer-provided benefits are, The Guardian is required to provide a “full and fair review” of a denied claim for benefits. Part of that full and fair review is to provide you, in a timely fashion, an opportunity to respond to new medical or vocational evidence The Guardian develops during the appeal review. But it often doesn’t in our experience. During a recent ERISA-governed appeal process, The Guardian obtained a medical review and five revisions from one source, a medical review and an addendum from another source, and a vocational review. Only one medical review was shared during the appeal process, as required by law. Contrary to the law, all the rest were only made available after the appeal was denied.

Our California Disability Insurance Attorneys Take On Guardian Life Insurance

No one should have to struggle to recover the benefits to which they are entitled under their insurance policy. Let our team of ERISA lawyers stand up to Guardian to make it honor your policy. Please call us toll-free at 866-360-0983, call us locally in Fresno at 559-549-6490, or send us an email to schedule a consultation with our caring staff. Learn how we can help with Guardian Life/Berkshire Life disability benefit denial