HomeDisability InsuranceHow to Appeal a Guardian Long-Term Disability Denial

How to Appeal a Guardian Long-Term Disability Denial

With more than $23 million in in-force premiums, Guardian Life Insurance Company (often through its subsidiary Berkshire Life Insurance Company) is one of the largest providers of group disability insurance policies in the United States. Physicians and highly educated professionals are especially likely to have disability benefits through Guardian, as it is one of the relatively few disability insurance companies to provide “true” own-occupation policies.

While Guardian does offer many long-term disability insurance policies with robust coverage, that does not mean they will handle every disability claim accurately or fairly. Like all disability insurance companies, they make their money by denying claims—not paying them out. That often leads to wrongful denial of benefits and, in some cases, even lawsuits and regulatory penalties.

If your Guardian disability claim has been wrongfully denied, contact the long-term disability attorneys at Bryant Legal Group today. Disability insurance appeals are complex and high-risk, especially if your disability policy is governed by the Employee Retirement Income Security Act of 1974 (ERISA). Preventable mistakes could permanently keep you from obtaining the disability benefits you paid for (and deserve). Working with an experienced disability attorney is strongly encouraged. You are not alone, and our team can help you fight back.

Breaking Down the Guardian Disability Claim Appeals Process

If you disagree with your long-term disability claim denial, you’ll need to fille an appeal. The first step is figuring out whether your plan is governed by ERISA.

If you have employer-provided long-term disability insurance and a public sector, non-church job, you almost certainly have an ERISA plan. We’ll outline the appeals process for ERISA plans first.

Guardian ERISA Appeals Process

Step 1: Review Your Claim Denial Letter

When Guardian denied your claim, they should have provided a detailed claim denial letter outlining:

  • Why they denied your disability claim, including details about the medical evidence that they reviewed. Common claimed reasons for Guardian disability denials include insufficient medical evidence, or doctor opinions suggesting you are capable of working.
  • Important deadlines to file your appeal.

Read this letter carefully. It will clue you in on important information you’ll need to supply in your appeal, such as additional supporting medical evidence.

Under ERISA, you typically only have 180 days to file an appeal after Guardian denies your initial application. If your policy is not governed by ERISA, Guardian may ask that any new evidence be submitted in just 30 days. That isn’t much time, and in most cases you only get one shot to provide additional evidence. You need to start right away.

RELATED RESOURCE: ERISA Appeals – Bryant Legal Group (bryantlg.com)

Step 2: Gather Evidence for Your Administrative Appeal

Under ERISA, you’re not able to sue Guardian right away after a claim denial. You must first go through Guardian’s internal administrative appeal process.

It’s extremely important to include all relevant evidence and present the best possible case at this stage. While you do have the option to file a lawsuit if Guardian denies your appeal, you won’t be able to add any new evidence. The court can only examine what’s already in your file.

As soon as possible, request a copy of your claim file, which includes all the records that Guardian has on your case. From there, you’ll need to gather, organize, and provide as much additional evidence as you can to support your claim and show that Guardian made an incorrect conclusion about your eligibility for long-term disability benefits.

This evidence might include, but is certainly not limited to:

  • Medical records
  • Expert reports
  • Vocational evaluations
  • Functional evaluations
  • Letters of support from physicians
  • Personal testimony from colleagues and family members
  • Copies of documents in your claim file
  • Photos and video evidence
  • Pain journals

Step 3: File the Appeal

Once you have all your evidence gathered, reviewed, and organized, it’s time to file the appeal. Your appeal should include an appeal letter containing:

  • A concise (yet persuasive) explanation of why you’re appealing the decision
  • Specific arguments (provided in the denial letter) that you’re contesting
  • A summary of the documentary evidence you’re providing
  • Any applicable citations to your plan documents or previous case law

In short: a few paragraphs with vague statements on why you disagree will not cut it.

Again, we cannot stress enough—have an experienced disability attorney on your side for this step. This is likely your only shot at adding new evidence to your claim file. Failure to provide the necessary evidence or strong enough arguments can cost you your only shot at getting your disability benefits approved.

Step 4: What Happens if Guardian Denials My Appeal?

Hopefully, your administrative appeal will be successful. If it isn’t, and you still believe your benefits were wrongly denied, you can typically file a lawsuit against the insurance company. However, check your disability policy carefully, as some policies may require a second administrative review.

RELATED POST: How Will the Court Review My Long-Term Disability Case? – Bryant Legal Group (bryantlg.com)

Non-ERISA Appeals Process

If you purchased an individual disability insurance policy on your own (i.e., not through an employer), or your employer is a government agency or church, your plan probably isn’t governed by ERISA.

There are numerous differences between ERISA and non-ERISA plans, and regulations vary by state. However, in Illinois, the major differences in terms of the appeal process are:

  • You don’t have to go through Guardian’s administrative appeal process if you don’t want to. You can sue them directly.
  • If you do file a lawsuit, there will likely be a formal discovery process, which will allow you to add new evidence throughout this phase of litigation. You won’t have to submit everything all at once in a single shot.

Contact Bryant Legal Group for Help With Your Guardian Disability Denial Today

If you’ve made it this far, we shouldn’t have to remind you how crucial a good attorney can be throughout the Guardian appeals process. Don’t let preventable mistakes or unfamiliarity with the process keep you from obtaining the disability benefits you need to support yourself and your family.

Bryant Legal Group has earned a strong reputation throughout Illinois for handling Guardian disability claims honestly, aggressively, and successfully. To schedule your free consultation with one of our long-term disability lawyers, call us today at (312) 561-3010 or complete our online form.

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.