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

Did you find this helpful?
Unhelpful (0)

Resources to Help You Win Disability Benefits

Disability Benefit Denial Options
Submit a Strong Berkshire Appeal Package

We work with you, your doctors, and other experts to submit a very strong Berkshire appeal.

Learn more

Sue Berkshire

We have filed thousands of disability denial lawsuits in federal Courts nationwide against Berkshire.

Learn more

Protect Your Benefits
Get Your Berkshire Disability Application Approved
We help claimants throughout the entire application process.

Learn more

Prevent a Berkshire Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.

Learn more

Negotiate a Berkshire Lump-Sum Settlement

Our goal is to negotiate the highest possible buyout of your long-term disability policy.

Learn more

Berkshire Reviews
(642)

Policy Holder Rating

0 out of 5
0
Read 0 reviews
0would recommend
5
0%
4
0%
3
0%
2
0%
1
0%
Timely Payments
0.0out of 5
Handling Claim
0.0out of 5
Customer Service
0.0out of 5
Dependable
0.0out of 5
Value
0.0out of 5
Showing 8 of 642 Reviews
Sedgwick

AT&T Was Great and Sedgwick Horrible

Reviewed by From a great job to a complete nightmare on March 20th 2024   Verified Policyholder | March 2024 date of disability
My Physician recommended that I take some time from a toxic environment after several deaths in my family coupled with AT&T trying to run tenured employees out of the door... read more >
New York Life

Keeps claiming they will not approve claim for pre existing conditions but my illness is not preexisting

Reviewed by M.T. on February 15th 2024   Verified Policyholder | May 2023 date of disability
I have been appealing a claim for LTD for 8 months! New York Life keeps claiming they will not approve claim for pre existing conditions but my illness is not preexisting ... read more >
Reliance Standard

Staff Lie

Reviewed by Tanya on February 12th 2024   Verified Policyholder | August 2021 date of disability
I had my disability cut off the day I was scheduled to find out whether I should have surgery. The claims examiner was aware that I had an appointment on that date and sai... read more >
Reply
Sent on February 12th 2024 by Attorney Gregory Dell

I am sorry to hear about your experience. It’s crazy that Reliance Standard would deny your disability benefits when you are suffering so badly that you need surgery.... read more >

Hartford

Former Hartford employee has had life insurance and accidental death policy's revoked for one late premium payment

Reviewed by Becky H. THOMAS on February 12th 2024   Verified Policyholder | February 2024 date of disability
Dislike how they are constantly interrupting the lives of their disabled EE's whom are entitled to benefit which they paid into out of there pay check every pay period onl... read more >
Reply
Sent on February 12th 2024 by Attorney Gregory Dell

Thank you for your review of Hartford and we appreciate you sharing.  It’s sad they don’t take care of their own employees.

Lincoln Financial

Never received benefits my entire leave - or help with them

Reviewed by Anna on December 19th 2023   Verified Policyholder | November 2023 date of disability
I used my short term disability insurance for maternity leave and started the process beforehand knowing when I would be out (scheduled induction.) It took a little over a... read more >
Sun Life

Unscrupulous Tactics

Reviewed by Misseekayy on December 19th 2023   Verified Policyholder | May 2023 date of disability
Sunlife uses unscrupulous tactics in order to prevent payment of claims. They wait until it is close to the 30 day mark and then they ask for another form of information o... read more >
Sedgwick

Lame

Reviewed by Dennis T. on December 11th 2023   Verified Policyholder | March 2022 date of disability
My experience with Sedgwick and personell is as follows: Unhelpful, unprofessional and an overall unpleasant experience.
Unum

Low payments

Reviewed by Dorothy on November 30th 2023   Verified Policyholder | November 2023 date of disability
I was injured at work. I did house keeping in a hospital. I tore just about everything imaginable in my knee. I was let go from my job, because I was no longer able to do ... read more >
Answered Questions by Our Lawyers
(2)
Showing 2 of 2 Answered Questions

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?

Answered on March 7th 2018 by Attorney Gregory Dell
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?

Answered on March 25th 2014 by Attorney Stephen Jessup
A: Joe, From our experience, Guardian/Berkshire does not offer lump sum buyouts of uncontested disability claims.... Read More >
Helpful Videos
(896)
Showing 12 of 896 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips

Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?

When it comes to securing your long term disability benefits, it's vitally important that you... Read More >

Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak

If you're seeking long term disability benefits from an insurance company, you may be concern... Read More >

Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company

When you're seeking disability benefits under a long term disability policy, your medical rec... Read More >

Disability Benefit Denial Reason #3 - Video & Social Media Surveillance

One thing many long term disability claimants don't know about (or expect) from the claims re... Read More >

How Do You Fight a Long-Term Disability Denial?

Getting a denial letter from your disability insurance company is one of the ultimate insults... Read More >

Disability Denial Reason #2 - Change of Disability Definition & Vocational Review

One of the top reasons for terminating a claimant's long term disability benefits involves th... Read More >

Disability Denial Reason #1 – Paper Review & IME

At Dell Disability Lawyers, we've seen insurance companies give countless reasons to deny lon... Read More >

How to Apply for Reliance Standard Disability Benefits & Top 5 Reasons for a Claim Denial

At Dell & Schaefer we’ve handled hundreds of long term disability insurance claims against Reliance Standard, and have learned a few thi... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases

Berkshire Approves Application for Disability Benefits to Sales Manager

Our client, an accomplished outside salesman, had built a stellar reputation in his industry after building his company over a period of many ... Read More >

Berkshire and Liberty Mutual approve benefits to OB/GYN suffering from essential tremor

Our client, an OB/GYN purchased long term disability insurance policies from Berkshire and Liberty Mutual in hopes that he would never need to... Read More >

Berkshire approves total disability benefits for litigation attorney following surgery to remove a cancerous tumor and multi-level fusion of cervical spine

Our client was a litigator with his own successful practice. Early in 2009 he began to experience increasing pain in his upper back and neck. ... Read More >

Berkshire Life Insurance Company approves long-term disability benefits for a dentist suffering from lumbar disc disease

Our client, a general dentist, purchased a long-term disability policy from Berkshire Life Insurance Company of America. The policy defined "d... Read More >

Seven Surgeries and The Standard Still Denies Long Term Disability Benefits

Our client was employed with the State of Oregon as a Technical Support Representative. She s... Read More >

Sun Life Wrongfully Denies Disability After Paying For 23 Months

We represent a 57 year-old claimant who’s occupation was selling commercial vehicles for ma... Read More >
Disability Lawsuit Stories
(765)
Showing 8 of 765 Lawsuit Stories

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 negoti... Read More >

Pennsylvania Pharmacy Owner Learns The Hard Way That Accuracy Is Everything When Applying for Disability Insurance Benefits

On January 28, 2011, the United Sated District Court of the Eastern District of Pennsylvania granted Berkshire Life Insurance Company of Ameri... Read More >

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 plaintif... Read More >

Pizzeria owner suffering from Celiac disease filed lawsuit against Berkshire for breach of contract in refusing to pay disability benefits

Recently a lawsuit was filed against the Berkshire life Insurance company of America at the Circuit Court for the County of Wayne in Michigan ... Read More >

Reliance Standard Disability Denial Upheld Due to Claimant's Lack of Strong Medical Record Support

In the case of Amy Wright v. Reliance Standard Life Insurance Company (Reliance), Plaintiff was the vice-president of... Read More >

Unum Wrongfully Terminated Disabled Lawyer’s Disability Claim of Depression and Anxiety Despite Improvement in His Condition

This Unum lawsuit and appeal in federal court is a great victory for all Unum disability claimants. This ca... Read More >

Federal Court Overturns Aetna Denial Of Disability Benefits

In the recent case of Ferrin v. Aetna Life Ins. Co. a federal judge from the Northern District of Illinois determined that Aetna improperly te... Read More >

Court Finds Irregularities in Procter & Gamble Long Term Disability Benefit Denial

In ERISA cases filed in a district court asking for judicial review of a plan administrator's denial of benefits, the court is generally limit... Read More >

Reviews from Our Clients

Request a Free Consultation

Our Lawyers Respond Same Day

5 Ways We Help Get Your Benefits Paid

Get Your Disability Application Approved

Our goal is to get your application for disability income benefits approved. Applying for disability benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their "hired gun" doctor.

Through our experience of having helped thousands of disability insurance claimants, our lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.

Submit A Strong Appeal Package

If your disability insurance benefits have been wrongfully denied, then our lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.

Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of "disability". We encourage you to contact any of our lawyers for a free immediate review of your disability denial.

Sue Your Disability Company

98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability lawyers have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the "little guy" against the multi-billion dollar insurance company giants.

We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.

Prevent A Disability Benefit Denial

Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.

Our law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.

Negotiate a Lump-Sum Settlement

Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.

Questions About Hiring Us

Who are Dell Disability Lawyers?

We are disability insurance lawyers that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.

In more than 98% of our cases, our lawyers have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement. Our lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.

We welcome you to contact any of our attorneys for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 700 videos and regularly provide tips to help protect your disability benefits.

Who do you help?

Our lawyers help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.

Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.

A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, GoToMeeting sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.