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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Showing 8 of 653 Reviews
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New York Life is a joke!

Reviewed by Heather on October 3rd 2024   Verified Policyholder | August 2024 date of disability
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 ****

Reviewed by KM on October 3rd 2024   Verified Policyholder | August 2024 date of disability
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

Reviewed by RobRob on September 23rd 2024   Verified Policyholder | August 2024 date of disability
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 >
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MetLife for disability? Avoid the surgery unless it's life-threatening

Reviewed by Jeff on August 22nd 2024   Verified Policyholder | August 2024 date of disability
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

Reviewed by GaKRN on August 22nd 2024   Verified Policyholder | June 2024 date of disability
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 >
Unum

Unum Closed My Case Today

Reviewed by Scott C. on July 5th 2024   Verified Policyholder | March 2023 date of disability
Unum will keep you around, if they pay you 100 a month. But as soon as have to pay more than 2700 a month, they will drop you. We will be going to the attorneys office fir... read more >
Hartford

Ran me Around for Months

Reviewed by David on July 5th 2024   Verified Policyholder | January 2024 date of disability
Scammers. Immoral horrible people.
Reply
Sent on July 5th 2024 by Attorney Gregory Dell

David:

It’s horrible that Hartford did that to you.

Prudential

Denied but Not Denied but I am Denied

Reviewed by KDDK on July 5th 2024   Verified Policyholder | August 2022 date of disability
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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?

Answered on March 7th 2018 by Attorney Gregory Dell
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