Ambiguous Disability Policy Language is Construed in Favor of Disability Claimant with Berkshire Life Policy
Most purchasing a disability insurance policy may not negotiate specific language. Rather, insurance companies use stock forms, and the negotiation involves the tradeoff between the extent of coverage and the premium. The insurance company supplies the specific statutory provisions once the extent of coverage is determined.
When a dispute arises about specific terms, courts interpreting insurance policies use a time-honored legal principle that construes the language against the drafter. This means that if something in the policy is unclear and susceptible to two or more meanings, the court will favor the interpretation that is most beneficial to the policy holder because the insurance company had the ability to craft the policy in such a manner as to avoid the ambiguity.
Florida Supreme Court Rejects Berkshire Life Insurance Company’s Attempt to Limit Disability Benefits
In Berkshire Life Insurance Company v. Adelberg, the Florida Supreme Court decided when a disability policy fails to define the term “your occupation,” whether the claimant’s “own occupation” is subject to the insurance company’s determination or the claimant’s actual and specific occupation engaged in when the disability occurred. The claimant was employed as a yacht salesman when he injured his knee.
He had an own occupation disability policy with Berkshire Life Insurance Company, which defined “total disability” as the “inability to engage in your occupation, … after the first 120 months, the termtotal disability,’ will have this meaning: your inability to engage in any gainful occupation in which you might reasonably be expected to engage, with due regard for your education, training, experience, and prior economic status.” However, the policy did not define the term “your occupation.” Prior to injury, the claimant had worked as a jeweler, food-commodities salesman, and a yacht salesman. Subsequent to injury, he was employed as a freight-space salesman.
In court, the claimant argued his regular occupation when he was injured was that of a yacht salesman, an occupation which required him to walk and crawl though small spaces to inspect the product. Due to his previous and current employment being in sales, Berkshire Life contended his occupation was that of a general salesman and, because he had subsequently been employed in sales, he wasn’t totally disabled within the meaning of the policy and couldn’t recover disability benefits.
The Court held that Berkshire Life failed to define the term “your occupation,” and in doing so, the policy language would lead a reasonable person to conclude that during the first 120 months “your occupation” means the work in which a person is engaged at the time of disability. Therefore, the Court held, “the term ‘your occupation’ refers to the specific work done by the insured at the time of the injury, not work requiring similar skills and producing a comparable income.”
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Berkshire Reviews
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Sedgwick
Don't trust them, they like to play games
They suck the life out of people that need help. They falsely advertise for helping people that they care. Sorry to tell you it's all about money, they do not care for any... read more >
New York Life
Lyme Disease Disability Claim Denial
I have had repeat claims for genuine medical leave and they have repeatedly been denied by NY Life. I have even been diagnosed with Lyme and going through treatments and t... read more >
New York Life
Disappointed with NY Life Disability Excuses
I am beyond disappointed with NY Life Disability Insurance’s handling of my father’s claim. My father, a 66-year-old man who has suffered two strokes and continues to ... read more >
New York Life
New York Life is a joke!
This company sucks when it comes to disability claims. They are slow at processing stuff, then they always say they didn't recieve the doctors information. You spend your ... read more >
MetLife
They FULL OF ****
MetLife is what everyone on this review are saying. They don't contact you to let you know what's going on with your claim or to let know you need additional info. I had a... read more >
Sedgwick
Worst Company Ever
If something happens to you at work you better hope you die, my son is going through HELL because this company is handling his work comp. NO RETURN PHONE CALLS, TEXTS, EMA... read more >
MetLife
MetLife for disability? Avoid the surgery unless it's life-threatening
The worst company I ever dealt with, never received a call from my claim manager.
Reliance Standard
Short Term Disability Claim/Inconsistent to NO Communication
When I did call & reach a live person they were kind & helpful. The person assigned to my claim left one phone message & I have not spoken to her since. Information she re... read more >
Answered Questions by Our Lawyers
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Q: Are you familiar with the difference between Berkshire’s Enhanced and Basic residual contract language and how material the language difference could be at claim time?
A: Chris, thank you for asking this important question. Without actually seeing the exact policies that you are r... Read More >
Q: Does Berkshire offer lump sum buyouts of uncontested disability claims?
A: Joe, From our experience, Guardian/Berkshire does not offer lump sum buyouts of uncontested disability claims.... Read More >
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