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Attorneys for Berkshire Disability Claims


Guardian Life Disability And What To Expect When Seeking Disability Benefits
Guardian & Berskhire Life Long Term Disabilit Insurance Claims (Ep. 9)

Our firm has handled and currently represents numerous claimants seeking disability benefits with Berkshire Life Insurance Company. In our opinion, Berkshire is one of the most highly respected and trustworthy disability insurance companies. The majority of our Berkshire disability claim clients are business professionals, doctors, dentists and lawyers. Most Berkshire disability policies contain an “own occupation” definition of total disability as well as a “residual disability” provision.

The older Berkshire policies contained a complicated residual disability definition which requires a 6 month averaging of income while a disabled claimant continues to work in a limited capacity. The Berkshire policies issued in the past few years contain a traditional residual disability definition which pays a percentage of the monthly benefit that is proportionate to the claimant’s loss of pre-disability income. The Berkshire policies usually define “total disability” as the inability to perform the material duties of your occupation.

What Are The Pros And Cons Of Being A Berkshire Life Disability Insurance Policy Holder?

Berkshire is one of the few long term disability insurance companies that actually wants to make the right decision on a claim. They don’t always get it right but they will give more effort and attention to your claim than any other disability company.

Our law firm’s opinions about Berkshire come from our experience of representing numerous Berkshire claimants from the initial application for benefits through the filing of a lawsuit. Contact us for assistance at any stage of your claim for benefits with Berkshire.

There are Pro and Cons that a claimant must be aware of when seeking disability benefits from Berkshire.

The Pros

The Pros are that Berkshire will give a claimant the benefit of the doubt when evaluating a claim. Most companies will cease any opportunity to deny a claim, but Berkshire does not behave this way. They will be very detailed in their request for information and they will give a claimant every opportunity to support their claim for disability.

Another pro is that the disability claim examiner assigned to your case will be well educated and have multiple years of experience in handling disability claims.

Berkshire will always give a claimant a reasonable time period to provide whatever information is requested.

The Cons

The Cons are that if you present a sloppy or incomplete claim to Berkshire, then you significantly reduce your chances of receiving benefits. If you are not organized with your business and financial records then you may not be able to comply with Berkshire’s request for information.

For example, if you are a physician or dentist and you cannot provide monthly production data (CPT or ADA Code reports) to support your pre-disability activities, then Berkshire will challenge your material duties. Berkshire and their medical team will scrutinize your medical records, therefore it is important that your treating physicians understand how to document your restrictions and limitations.

Berkshire Claim Resources And Information

Berkshire Life Insurance Company is a subsidiary of The Guardian Life Insurance Company of America.

We welcome you to watch our Berkshire / Guardian disability video, read some of our Berkshire resolved case summaries, and review information about Berkshire lawsuits and court opinions throughout the country.

We also invite you to post comments, complaints, or general questions about a Berkshire disability claim which our lawyers will respond to.

If your claim was denied or you are considering filing for benefits, then you should contact us privately for a free consultation.

There are 6 opinions so far. Add your comment or complaint now.

Joe Vice:

I have been disabled with the Guardian Insurance Co. but Berkshire handles my claim now. I was disabled in 1993 and my benefits were $6000 per month; now they are almost $9800 per month. I get benefits untill I am 65 which will be 9/30/2021. Which means I have 7 years and 3 months left. My increase each year is based on the CPI. I have asked for a lump sum buyout and my Berkshire person I deal with says they aren’t buying out claims. Is that her or is Berkshire not buying out claims for lump sums. I am a prime candidate for a buyout as I’ve been receiving benefits for 21 years so far.

Attorney Stephen Jessup:

Joe,

From our experience, Guardian/Berkshire does not offer lump sum buyouts of uncontested disability claims. Meaning if your claim is not denied or a lawsuit is pending they will not offer a lump sum buyout.

John:

I just want to say that when I filed my claim initially back in 2008, the process with Guardian/Berkshire was dreadful. They were skeptical of my claim at every turn, and it took a total of 9 months to get my claim approved. Guardian/Berkshire repeatedly asked me to send them the same records over and over again. They were paying me under reservation of rights, but I absolutely loathed dealing with them. They were combative and at times insidious, and they became very upset with me when I instructed that they communicate only in writing. My doctors were frustrated because their representatives would insist on speaking with them and would call several times a day requesting information. I finally just pulled the plug on all of it and instructed my docs not to speak with them. The person handling my claim nearly accused me of malingering, and tried to get me to admit that I was filing a claim because I had no income due the economy collapsing, it was ridiculous. I laughed at these baseless accusations and told them I would never have left my 250K a year career for 60K in disability benefits. They continued with the harassment, and informed me that they were sending me for an IME. I told them they were wasting their time and money, but they didn’t care. I completed the IME and their own doctor confirmed everything we had told them and agreed with us, but they still did not want to pay. They continued to drag their feet, accused me of falsifying my income on the initial application, and it was clear that they were engaging in “post claims underwriting” or adding stipulations to a contract after the fact. It was appalling. I also informed them that I was receiving 100% VA disability and SSDI, but they didn’t care. Finally, I sent a registered letter to the president of their New York office, informing them that if they didn’t approve my claim, I was filing a lawsuit. Finally, they gave up the fight and approved it. I continued to get hassled from them in the first year, but it gradually got better. Now, I only have to send in a report twice a year and my doc only has to do it on a yearly basis. I learned that they moved my claims to long-term claims management and they never bother me at all now. Stephen is correct – they will not do a buyout if you have a considerable amount of time left to collect your benefits. I inquired about it once because I was tired of the hassles and Guardian informed me that they would not consider it unless a claimant was in the last couple of years in the life of the policy.

Attorney Stephen Jessup:

John,

Thank you for sharing your story – please do not hesitate to contact our office if Guardian attempts to challenge your claim again.

Chris L.:

I’m a physician resident researching to purchase an individual specialty specific disability policy and have a question about Berkshire. Berkshire has two contracts. 1. Provider Choice Premier and 2. Provider Choice Select. Both contract versions have exactly the same contract language for Total Disability that includes their “enhanced medical occupation definition”. The big difference appears to be in the residual definitions. The “Premier” contract provides access to their “Enhanced” residual definition. The “Select” contract only offers their “Basic” residual definition.

I’m considering their Provider Choice Select version with Basic residual. One of my primary goals at this stage of my career is to protect future access to (top shelf) coverage by inclusion of their (no cost) Benefit Purchase Rider on the Select contract or Future Increase Option Rider on the Premier contract. If I go with the select contract version I can get a lower benefit amount (to supplement my group plan that is also with Guardian) and still protect future access to Berkshire’s issue limits without any future medical underwriting. This will keep cost down until I finish training and allow me the peace of mind to not have to worry about any potential medical exclusions or being declined. I realize I would have less coverage if something bad happened during residency, but the finances are really tight now. If I go with their Premier contract then I would need to purchase more coverage and therefore higher cost to accomplish the same objective.

I’m wondering if you’re familiar with the difference between Berkshire’s Enhanced and Basic residual contract language and how material the language difference could be at claim time? Your perspective would be immensely appreciated.

Attorney Greg Dell:

Chris, thank you for asking this important question. Without actually seeing the exact policies that you are reviewing, I am not able to provide an accurate opinion as to the difference in the language. The disability companies constantly offer new products with different language and I really need to see the definitions in order to answer your question. As a general answer I always tell people to buy as much coverage as you can possibly afford. I have represented numerous residents that unfortunately had a disability claim when they never thought they would. The other thing is that you Group coverage will only continue as long as you continue to work for your employer or the organization you bought it from continues to renew the contract. A group organization does not need to renew the policy whereas a private policy is guaranteed to be renewed each year. I know you finances are tight now, but they hopefully won’t be in the near future and you will really appreciate the piece of mind of having the highest possible coverage you are eligible for.

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