Disabled South Carolina doctor sues Berkshire Life for disability benefits
A disability attorney recently filed a federal lawsuit in South Carolina against the Berkshire Life Insurance Company of America. The plaintiff, a physician, paid for disability policies that were underwritten and insured by Berkshire. When the doctor applied for disability benefit, Berkshire refused to pay.
The Plaintiff, through his disability Lawyer, filed a disability lawsuit due to Berkshire’s breach of insurance contract and bad faith to recover long-term disability benefits that were wrongfully withheld by Berkshire.
The Facts of the Case Against Berkshire Insurance Company of America
On August 1, 2004, Berkshire issued a policy to the Plaintiff, insuring him against disability as defined in the “original policy.” This original policy allowed the Plaintiff to add additional coverage from Berkshire at a later time.
The Plaintiff exercised his rights to additional coverage on several occasions. Berkshire issued an additional policy on September 22, 2010. This policy called for the Plaintiff to receive $2,500.00 per month in the event he became injured. It would not pay anything to the Plaintiff if the disability was caused by a pre-existing condition except under certain circumstances.
According to this policy, “Pre-existing Condition” meant the following:
- That was misrepresented or not disclosed on the Participant’s application; and either
- For that which the Participant received professional medical advice, diagnosis, or treatment within 2 years before the effective date of the policy; or
- For that which caused symptoms within 1 year before the effective date of the policy for which a prudent person would usually seek professional medical advice, diagnosis, or treatment
Plaintiff also purchased an additional policy from Berkshire, with an effective “policy date” of August 1, 2010. Berkshire collected premiums from the Plaintiff for coverage from that date. This policy called for a monthly disability payment to the Plaintiff of $2,500.00 a month in the event of a “disability” as defined by that policy.
On August 16, 2010, Plaintiff became disabled according to the definitions in all three policies.
Denial of Berkshire Disability Benefits Claims
Berkshire paid the Plaintiff according to the terms of the original policy, but denied the Plaintiff’s claim under last purchased policy under the presumed condition that the Plaintiff was disabled when he purchased the policy. Plaintiff’s claim under the 2nd purchased policy was also denied based on the presumed condition that the Plaintiff’s disability was due to a pre-existing condition as it is defined in that policy. The denial letter was sent to Plaintiff on January 25, 2011.
Lawyer Files Lawsuit Against Berkshire
According to the lawsuit, the Plaintiff alleged that Berkshire failed:
- To provide the disability benefits that are due to the Plaintiff under the terms of the referenced policies mentioned above, which is a breach of the insurance policies to which the Plaintiff and Berkshire had agreed to; and
- To honor the specific language of its policies, including the definition of “pre-existing condition” in the 2nd and 3rd policies.
Plaintiff also claims Berkshire committed the following wrongful acts:
- Unlawful and erroneous denial of disability benefits
- Denying Plaintiff’s disability benefits was either due to misunderstanding its own terms, bad faith, or both
- Denying Plaintiff’s disability benefits was a breach of Berkshire’s duties in failing to meet its fiduciary responsibilities to the Plaintiff’s
Relief Sought By The Plaintiff In The Berkshire Lawsuit
Due to Berkshire’s actions, the Plaintiff requests the following relief from the Court:
- Benefits and all pre-judgment interest due to the Plaintiff under the policies mentioned
- Award of attorney’s fees and costs as stated according to the Law of South Carolina
- Actual, compensatory, and punitive damages
- All other and further relief that the Court decides to be just and proper
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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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