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Attorneys for Guardian Life Disability Claims


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Guardian Disability Claims, Appeals And Lawsuits

Guardian Life Insurance Company of America has been in the insurance business since 1860. While Guardian has been around longer than our law firm, we have been helping claimants with Guardian disability insurance claims since the mid 1980s.

Through the representation of numerous disability claimants in ERISA Appeals, lawsuits and the application for benefits, we have gained an invaluable understanding as to how Guardian evaluates every disability claim.

Unlike most other disability insurance companies, you are lucky to have a Guardian disability policy. Guardian is a large company with more than 5,000 employees and over 5 million customers, but they are managed very well by experienced disability claim managers and examiners.

However, despite Guardian’s efforts to conduct business in good faith, there are still numerous claims every year that are wrongfully denied.

Top Five Reasons Your Guardian Disability Claim Could Be Denied

There are dozens of reasons that could result in a Guardian disability denial, but five most common are:

  1. Guardian hires a physician to review your medical records and the hired doctor drafts a report stating that the claimant is not disabled.
  2. Guardian hires a private investigator to follow you around with a video camera. Guardian then uses the video surveillance footage to argue that you can return to work.
  3. Guardian will send you to either be examined by a doctor of their choice (IME Exam) or to a functional capacity exam (FCE) to evaluate your restrictions and limitations.
  4. A Guardian hired doctor or nurse speaks with your treating doctor and receives information that you can return to work.
  5. Your definition of disability changes from “own occupation” to “any occupation” and Guardian hires a vocational expert to find jobs that you probably cannot perform on a daily basis.

Most Guardian Disability Denials Are Governed By ERISA

The majority of the disability Policies sold by Guardian are sold to Employers. If a claimant receives their disability coverage as an Employer provided benefit, then the policy is usually governed by ERISA.

We encourage you to watch any of our videos discussing ERISA. ERISA is a pro-insurance company law that creates a very high burden for claimants to overcome if a lawsuit needs to be filed.

Our disability attorneys litigate and Appeal ERISA claim denials on a daily basis throughout the USA.

If your claim has been denied by Guardian it is important that you take immediate action. The time period to submit an ERISA appeal is usually 180 days and following an ERISA denial you may have a very limited period of time to file a lawsuit.

Our lawyers are available to provide you with a free consultation to discuss your options regarding a denial of disability benefits by Guardian.

There are 27 opinions so far. Add your comment or complaint now.

Gloria Walton:

Great site!

Robert Bantom:

I was protected for disability loss of income by Guardian. In addition, I purchased a separate excess policy for additional monthly limits through Unum.

I had 2 occurrences affecting my health. The first was November, 1995, a heart irregular rhythm. I was out of work for over 6 months, and not able to do any full time type work for over 18 months. After negotiations, I reached a settlement with both Guardian and Unum. All seemed well until January, 1998 when I had a stroke at work. Again, I was in the hospital for about a week and needed almost 6 months of rehab, and rest. I tried again to return to full time but found the medications and conditions caused me to cut back. I filed with both carriers for partial disability and settled the claim with Unum. Guardian rejected the claim as I was not working a 30 hour work week. I explained and sent them information of applying to Social Security Disability. After SSDI review, my case was approved for payment in 2006.

So, Unum agreed to settle, and Social Security agreed to settle. Only Guardian gave this very lame reason for not settling. The delays of going back and forth with Guardian allowed them to bring in the ERISA laws and not the time to reach a settlement.

Now we are almost into 2012, and I had to sell my investments to live and to pay for medications, until the SSDI started. I still believe Guardian should offer a settlement on my case, and I was really willing to work this out with them, but they just plain refused. As in my case with Unum, they terminated my partial disability claim, but when the “class action suit” and verdict came down on them, they had to re-open my case and we eventually settled. I needed an ERISA lawyer, disability lawyer, and my health did not allow me to continue under those stresses.

Today I thought I should get an opinion, and to see if many others have had the same experience I have had with Guardian.

Again, Unum tried to cancel off paying disabled people and I can only assume Guardian tried the same plan. Please let me know.

Many thanks,
Robert Bantom

Ardi:

Am I obligated to provide my Tax returns to Guardian for my LTD Disability? I just received a letter from Guardian asking for “complete tax return with all schedules and attachments … Please note, pursuant to provisions in your Group Long-Term Disability plan, copies of an insured’s complete tax returns with all schedules and attachments are required as acceptable proof of earnings for the ongoing adjudication of your claim.” My policy documents do not mention anything about “tax returns”.

I have been receiving LTD from Guardian for many years. The payments are offset by the SSDI I also receive. My tax returns are filed jointly with my wife. The tax return lists my occupation as “disabled”. I do receive income from dividends and interest from banks and brokerages.

My wife is very uncomfortable with the idea of sending out our tax return (with her information) to Guardian. Any opinion/suggestions?

Many Thanks!
Ardi

Attorney Greg Dell:

Ardi,

You can blackout any information that is related to your wife or anyone else. You should send in the return as you have nothing to lose by submitting it. Cross out anything related to your wife.

Ryan Philip:

Thank you for all the info!

You have listed Guardian and NWM as among the top 3 DI companies. Would you recommend Guardian or NWM for disability insurance for a Cardiologist?

Thanks!

Attorney Greg Dell:

Ryan,

They are both good companies, but they both offer very different definitions of disability.

Northwestern Mutual recently started selling a policy with their own special definition of own occupation which they argue is better.

I have published an article discussing the Northwestern Mutual “medical occupation” definition of disability which you can read here.

Guardian offer a true own occupation definition of disability.

Stephen:

I was denied a claim based on a pre-existing condition. I appealed and Guardian hired the services of an outside vendor “BMI” to get a doctor to talk to my doctors in a peer-to-peer review.

It seems as though the system is designed to get the claims denied rather than approved.

Attorney Stephen Jessup:

Tyrone,

Depending on what Guardian determines the physical demand level of your former occupation is based upon the Department of Labor description, and the results of the FCE, you could very well expect a denial of continued benefits. If it is determined your job was “light duty” in nature and the results of the exam indicate you maintain the residual physical ability to work at that level, then definitely expect a denial. However, if the FCE results come back that you cannot perform at the required level, expect Guardian to continue to pay at this point. Please feel free to contact our office if you have any additional questions.

Tyrone Holloman:

I was sent by Guardian to take an FCE exam. I was a “Maintenance Tech”, I was T-boned in a car accident and it screwed up my back. MRI says minimal facet arthropathy throughout the lumbosacral spine and minimal chronic anterior wedging is also present at T12 with slight reversal of lordosis of the cervical region. Now to Guardian these things may be nothing but for me I no longer can lift, bend, twist, sit, walk, or even sleep the same since the accident. I’ve participated with Guardian and done everything they’ve asked of me from Vocational Rehab to now taking this FCE exam. The Exam had me in pain the entire time but the examiner didn’t seem to care at all. I took this exam a week ago today, so I called Guardian to get some insight on the exam and I was told the results of the exam had not come back as of yet but my benefits are approved through early September. What can I expect from Guardian once the results of the exam come back?

Bill Bergovoy:

Hello,

How often can the Guardian request medical evaluations? I was asked for an attending physician’s statement in January, and then again in May. That seems a bit too frequent? Does the Guardian need to pay for those evaluations?

Also, if the Guardian issues a denial of claim, for not submitting the tax forms “in a timely manner”, then once they receive those tax forms, then keep suspending the benefits for another reason? IE the new medical evaluation that they just asked for (after the tax forms were turned in).

Seems to me that they should reinstated the benefits, as I submitted the tax forms, and then be given an opportunity to comply with the medical evaluations?

Thanks.

Attorney Stephen Jessup:

Bill,

It seems like you have multiple issues with your claim that a short response is not going to answer adequately. Failure to provide requested information can certainly result in a denial of benefits. However, once that information is received it is not uncommon for the carrier to at least pay benefits under a reservation of rights. With respect to requesting IMEs – it doesn’t appear that the number they have requested is egregious, but it does appear that they are setting up your claim for a potential denial. Please feel free to contact us if you would like to discuss how we may assist you with your claim.

LIsa P.:

I had a policy for several years for LTD provided by my employer (I was a teacher) as part of a benefit package. After over six years of faithfully paying premiums (even when they increased), when it was it was time for Guardian to come through and honor the plan, I was denied benefits.

I went through the appeal process, and once again I was denied benefits. As informed consumers, we are all aware of the claims and legal departments and their mandate to DENY, DENY, DENY! Guardian was provided documents regarding my neck and back surgery from the neurosurgeon, a list of all the medications that were required prior to and after surgery from my pharmacy, and my primary doctor also responded. Physical therapy notes were also included. This doesn’t include records from the psychiatrist. (THANK YOU Guardian for adding to my stress and anxiety levels.)

It is important to note that my state Department of Education office has all of this information, which by the way they had their own separate medical board review, and they have classified me as permanently disabled. Still Guardian does not come through. By the way, records regarding my recent shoulder surgery and therapy haven’t even been submitted yet.

I would warn anyone considering enrolling for a LTD policy ( or any policy for that matter) with Guardian to be very cautious. RUN WHILE YOU CAN! After having no income for 11 months (that doesn’t even include the 91 day elimination period), all I have from Guardian is a copy of a Benefit Plan catalog, check stubs with monthly payments deducted for Guardian, a letter of denial, and another letter denying my appeal.

With over several billions of dollars collected by Guardian annually for premiums from the paychecks of hardworking subscribers, and thanks to their company mandate to deny claims as well as appeals, and their attempt to intimidate anyone who seeks recourse from their highly staffed and paid legal department, Guardian still generates billions in profits.

Now you tell me, does such actions by a company who you have placed your trust in and paid them to safeguard that trust seem ethical let alone morally correct?

Even with a post-graduate college degree, I was scammed. I considered myself to be an educated person and an informed consumer. I cannot say that anymore thanks to Guardian. I suggest the company name be changed because they sure did not guard my policy or provide aid to sustain me when needed. A guardian-hah! The joke is on the policy holder who only receives pieces of paper. If I had a fireplace, I guess I could burn the benefit catalog, etc. for heat to save on the power bill. Unfortunately, I do not have a fireplace.

P.S. I welcome a response from Guardian because I certainly did not receive assistance with my claim. From past actions, I will assume my comments will be MODERATED or even not posted. Let’s see what happens.

Attorney Stephen Jessup:

Lisa,

I am sorry to hear about your experience. From reading your story, with specific attention to your “P.S.”- please note that we are not representatives of Guardian, or any insurance company for that matter. We are a law office focused on securing disability insurance benefits for people such as yourself. Please feel free to contact our office should you wish to explore your options from a legal standpoint.

Robert Bantom:

I was checking your web site, and found a message I sent to your firm. I also found several other messages from others, and all were replied to by your lawyer’s. My message had no reply or response to my knowledge. Please look into my claim denial and advise as quickly as possible. Thank you, Robert Bantom.

Attorney Stephen Jessup:

Robert,

I reviewed your previous comment from Christmas 2011. Based on the fact pattern as presented, it would seem your claim for benefits with Guardian was denied in 2006. If your policy was in fact an ERISA based policy as you have indicated there stands a greater than likely chance that any applicable statute of limitations may have run. Typically, ERISA governed disability policies provide a three year statute of limitations to file a lawsuit. If that is the case with the policy you had, then that time frame may have expired some time in 2009. In that event there would have most likely be nothing any attorney could have done in 2011 or today.

Mike Jones:

I have recently had to start the disability process, my plan calls for 9 weeks of STD and then LTD until Social Security age (I worked for a great company who setup a good plan). I have a rare condition les than 200 people in the world have been diagnosed with. I took the time to provide Guardian with 200+ pages of documentation from every doctor/hospital I have seen (world renown), 8 CD’s od MRI’s, MRV’s etc. Guardian acknowledged receipt but chooses not to use the information for the purpose to approve my claim. They approved my STD for 2 weeks the first time, then ask my Dr. to fill out the exact same paperwork and have now bumped it up to 5 weeks but with all the information at their finger tips they still refuse to extend it for the full 9 weeks. I have a friend who works for another STD/LTD company and he has told me word for word what they would say and do. When you talk to an agent, you feel like your talking to a robot or corpse. They cannot answer the basic questions related to terminology definitions in the policy, own occupation, part time work, rehabilitation clauses etc. I am dreading when the LTD portion begins, I can only imagine how hard they are going to try and get out of paying even though I have Drs. that are the top in their field that have already written letter’s stating I can’t be cured, my condition will only progress etc. I can’t imagine people having jobs and being so heartless when others are at their weakest moment. Good luck to everyone.

Attorney Stephen Jessup:

Mike,

Has Guardian approved the STD claim at this point? Have they begun the LTD process? Please feel free to contact our office should you have any questions.

Katina:

I have been receiving LTD from Guardian for almost a year now. Finally being released to work June 13th. I have had really no problems with Guardian other than having to secure alot of the paperwork for them. I’ve actually been quite surprised and because of Guardian have been able to keep my home, cars… etc. Even though I have a Doctor’s note saying I can return to work I foumd out yesterday that they will continue to pay untill I secure appropriate employment. Worse problem I have been up against is the Doctors being so scared to fill out the paperwork. None will say exactly why that is but I wonder how much they are intimidated by Guardian and why.

Attorney Stephen Jessup:

Katina,

Guardian is one of the most reputable insurance carriers, so your treatment is not necessarily surprising. Many doctors are just hesitant to complete forms as they are concerned that they may one day be pulled into some legal action.

Carolina:

Guardian will only state that I have not established “proof of loss.” What does that lingo mean?

Attorney Stephen Jessup:

Carolina,

It is a fancy way of saying there is not enough evidence to support that your medical condition would prevent you from working.

Joseph P. Czarnecki:

Yes, I was also getting 66% of my pay from Guardian; also getting NYS Comp. Guardian forced me to apply for SS disability. When I got payment of $29000 from SSD they forced me to give it to them. It was their or they would stop payment. NYS Comp. settled with me and I am 75% disabled. Guardian dropped me saying I can work full time and I can make in my field of work min. $18.00 an hour. So far no one will hire me, not even Walmart.

Attorney Stephen Jessup:

Joseph,

Please feel free to contact our office to discuss your rights under ERISA as it relates to filing an administrative appeal of the denial of your benefits.

RSDS2014:

I have RSD from carpel tunnel surgery in March of 2010. The surgeon sent me to a pain Dr 3 weeks after surgery not telling me why. He had to send all my info to the pain Dr. before I could get an appt. I met my pain Dr on my bday, April in 2010 with the diagnosis of RSD. It was managed with pain meds and some other meds at first. My hand, 4 years later, is still swollen, numb and is in constant burning pain – but always getting worse. Now my fingers barely move. I was on FMLA for a year before I went out completely. I had the same job for 15 years, so they were always aware of my condition progressing. Now I am on pain Patches and Morphine. I can not even think clearly much less move my hand. It’s pretty horrible. At any rate, my Dr wrote me off work at the end of April, 2014. My employer filled in their section and sent it off to Guardian. STD is 70% for 6 months and LTD is 60% til retirement age. I have sent more than 2 times all of my Dr’s reports – from my monthly pain Dr’s info to my PCP who signed the paperwork. I also now live in London (my husband is British) and even had my current Dr fill out paperwork and signed that I am disabled and evaluating my pain and hand, etc. It has now been over 3 months and I have not received anything besides “they are still working on it” and “I just need this one more piece of info” and “please be patient” and no check yet. I estimate the first check should be about $7k by now (my waiting period is only 7 days). Any suggestions? Do I need a lawyer? Shouldn’t they have to have done something by now? It’s very frustrating. It’s a huge financial strain.

Attorney Stephen Jessup:

RSDS2014,

Please feel free to contact our office to discuss your claim. Guardian is typically very prompt in their claim review, and 3 months to make a determination under a short term disability policy is excessive.

Bill:

I have a privately purchased “own occupation” disability policy with Guardian. I suffer from depression and significant anxiety. I am an employee of a financial advisory firm. My job is to perform investment management duties and manage client relationships. My depression and anxiety have caused me to be very uncomfortable in relating to clients. In meetings I often, as if paralyzed, begin shaking uncontrollably. (fortunately it’s not always apparent to others but it certainly renders me “not all there”) On phone calls I often am so overwhelmed with anxiety I am unable to clearly think and reason. I’ve grown more and more afraid to answer phone calls. I typically let phone calls go to voicemail and only reply if I absolutely must. When I speak with clients I am nervous and it shows in the tone of my voice and lack of confidence. All of this further adds to my depression and feelings of lack of self-worth. Clients have been leaving and I fear my inability to perform my role effectively will find me jobless before long. I fret at what I would do as an encore career because I don’t feel qualified to do anything. I am looking for guidance as to whether my situation would be considered a disability that could be claimed? If so, am I best having an attorney handle the initial claim and what’s the likelihood of winning a depression/anxiety claim?

Attorney Stephen Jessup:

Bill,

The application for benefits under a private disability insurance policy is without a doubt the most important piece of information in a disability claim as it sets the tone for the claim to come. Please feel free to contact our office for a free consultation and review of your disability policy so we can best advise you as to your rights under your policy.

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