Let’s Discuss How You Can Win Your Guardian Disability Appeal
Let’s discuss how you can win your Guardian Disability Appeal. Guardian disability denials are usually unreasonable and with preparation of a strong appeal package you can get your benefits paid. There is only one chance to submit a Guardian appeal. Itt must be drafted strategically in order to win your disability benefits. Our disability insurance lawyers have reviewed thousands of Guardian short and long term disability denials on behalf of claimants nationwide and we are available now to provide you with a free phone consultation. We have seen every type of Guardian disability denial and we know exactly what is required in order to give you the best chance to win your Guardian disability benefit appeal.
Why Is It Important to Prepare a Strong Guardian Appeal?
We want you to become educated about the Guardian appeal process and learn how our law firm can help give you the best chance to win your Guardian disability appeal. In our Guardian Disability Appeal Tips video attorneys Gregory Dell and Stephen jessup discuss the following:
- What is your first step to appealing a Guardian denial?
- Can you appeal the Guardian denial more than once?
- What information did the Guardian use to deny your disability claim?
- Can Guardian rely exclusively only on the medical opinions of their hired doctors?
- Should you submit additional medical evidence for your Guardian appeal?
- Why are custom attending physician statements essential?
- Does Guardian require objective medical evidence to win benefits?
- Why is it important for you to submit a strong appeal package to the Guardian?
- How can we help prepare a strong appeal package to the Guardian?
- How does the Guardian determine the duties of a job?
How Can You Win Your Guardian Disability Appeal?
With strategy, collaboration and execution you can get your Guardian disability claim approved. Every Guardian disability benefit denial is unique because everyone has different medical conditions that prevent them from working, the definition of disability is different in most Guardian disability policies, and lastly your prior work experience and education will have a big impact on the ability to perform any job. Our law firm’s history of winning disability appeals comes from working very closely and strategically with you, your treating doctors, and vocational consultants. We take a custom approach to how we handle every appeal and we look forward to discussing your Guardian disability denial with you. As you begin the process to get your Guardian disability denial reversed you should watch our video below:
Most Guardian disability benefit denials are based on Guardian’s determination that you do not have sufficient medical limitations which prevent you from working in a specific occupation or any occupation. While Guardian may first notify you of a disability denial via telephone, the basis for Guardian’s denial is required by The Law to be included in their denial letter and the documents supporting the disability denial must be contained in the claim file. In your Guardian denial letter, Guardian gives you the right to request a complete copy of your claim file and that is the first step we take.
Why is Guardian Required To Send You All Information Used To Deny Your Disability Claim?
ERISA regulations require Guardian to prepare and send your claim file within 30 days of a written request. We draft a very specific request for the claim file so that Guardian cannot hide any documents or information that we think can help to win your appeal. The claim file is supposed to include all information relied upon to deny your disability benefits, which would include medical records, financial records, internal emails, memos and notes, your disability plan documents, video surveillance and any medical reviews and vocational reviews conducted by Guardian.
The Guardian claim files provided are often intentionally disorganized and require legal experience in order to know what information in the claim file is relevant to preparing a strong Appeal. Your claim file may contain thousands of pages of evidence, and once we receive your file, we immediately organize and analyze all information so that we can prepare a plan of attack that puts You in the best position to have Your short term or long term disability benefits reinstated.
There is only one chance to submit a Guardian appeal and it must be drafted strategically.
How Does A Plan of Attack Help You Win a Guardian Disability Appeal?
After our lawyers complete a full review of your Guardian claim file and review all of your up to date medical records, we formulate a plan of attack that we believe must be followed in preparation of your Guardian appeal. Every plan is focused on determining what additional medical documentation and support we can obtain to prove your disability. You only have 180 days from your date of benefit denial to submit an appeal so it’s important to act quickly in order to submit a timely appeal package. 180 days may seem like a lot of time, but you really want to have as much time as possible so that you can obtain as much additional medical and occupational support as possible. It’s not easy to get in quickly for doctor appointments and it takes time for doctors to complete documentation on your behalf.
We Help You Prove That Guardian’s Doctors Are Wrong
Guardian will commonly deny a long term disability claim on the basis that you have insufficient medical documentation and/or support from your doctor. The Guardian usually relies upon their own employed doctors or nurses to deny your disability claim. Regardless of what your doctors may have concluded, the Guardian will almost always favor the opinions of their own doctors over yours. The way to overcome this inherent bias is to present strong medical evidence in support of disability that no reasonable person could disagree with.
As a practical matter, Doctors don’t like dealing with insurance companies, and while they want to help you they get frustrated. Your doctors document your medical records for the purposes of treating you and not for an insurance company review. As a result, most doctors do not document all of your limitations and complaints for purposes of a disability claim. Through our experience in helping thousands of disability claimants we educate your doctors about your disability insurance policy language and work with your doctors to document your medical conditions appropriately.
Obtaining strong written support from all of your treating doctors is usually the most challenging aspect of preparing a Guardian Disability Appeal.
Custom Attending Physician Statements Are Essential
Our job during the appeal process is to work with you and your treating doctors to obtain medical evidence that rebuts Guardian’s doctors (or hired doctors) written opinions. The attending physician statements created by Guardian and previously completed by your treating doctors are generic and intentionally designed by Guardian to offer limited support for your claim.
In every appeal we handle, we draft custom attending physician statements for completion by your doctors. Our physician statements are specific to your Guardian Long Term disability policy definition of disability and your specific medical condition(s). With every type of medical condition we know the exact information Guardian and their doctors are seeking as evidence of disability. If you have more than one condition that may impact your ability to work, and are treating with more than one physician we will reach out to all relevant treating doctors.
In addition to a custom physician statement we may suggest additional diagnostic testing or medical consultations with different medical specialists if we believe it will help bolster your claim. In some appeals, we will have you undergo a Functional Capacity Exam (FCE) or an Independent Medical Exam (IME). The results of an FCE are shared with your treating doctors as they can provide strong support for your functional limitations. In some appeals, we will submit medical literature from leading medical publications which support your symptoms, limitations and potential risks associated with your condition.
Guardian Appeal Success Story
We handled the case of a Pediatrician who had been diagnosed with an eye disorder. Guardian denied the claim but after obtaining counsel, and after submitting an appeal by our office the Guardian reversed the decision to deny the claim and approved disability benefits. In the video below attorneys Gregory Dell and Cesar Gavidia discuss the case in more detail and what was done to prepare an appeal.
Why Must Your Appeal Contain Strong Occupational Evidence?
In most Guardian disability denials, Guardian will argue that if you can sit in a chair for 6 hours a day then you should be able to work. This is obviously a ridiculous conclusion , but you must submit occupational evidence that any job requires more than just an ability to sit. Guardian’s denial letters will usually misrepresent your job duties or list other jobs they think you can perform for 40 hours a week. Depending upon the applicable definition of “disability” at the time you become disabled, it is critical to review how Guardian has determined the duties of a job they say you can perform.
The occupational evidence that must be presented in your appeal will depend upon whether your definition of “disability” is either the inability to perform your “Own Occupation” or the inability to perform “Any Gainful Occupation”. Own Occupation and Any Gainful Occupation are defined terms in your Guardian disability policy. In most Guardian disability policies the definition of disability is Own Occupation for the first 24 months and then it switches to the more difficult definition of Any Gainful Occupation. Most Guardian disability denials happen either at the inception of a disability claim or when the definition of disability changes at the 24 month mark.
How Does Guardian Determine The Duties of an Occupation?
Guardian will rely on their own vocational consultant to determine how either your job is performed in the national economy or how any other job is performed in the national economy. This means that Guardian ignores the way you actually performed your job for your employer and randomly determines how your job is performed nationally. Guardian will also come up with their own opinions about how any job is performed regardless of who the employer may be.
To rebut Guardian’s unreasonable occupational assessments, we regularly work with vocational experts in order to clearly define the duties of a specific job and the physical requirements to perform a specific job for 40 hours a week. A vocational expert will prepare a detailed report which reviews the duties of all jobs suggested by Guardian, review your medical records, review your restrictions and limitations, and explain why you are unable to perform the job duties suggested by Guardian. If necessary, the vocational expert may also perform a labor market analysis discussing the availability and salaries of specific jobs.
In many denial letters, Guardian will come up with jobs that are not available in your area and that make these job suggestions unreasonable. As additional occupational evidence we may also submit employer statements from your co-workers, your job description, a personal statement from you about a typical day at the job, industry reports, and samples of work products produced in your job.
We provide a lot of detail in our Appeals to explain why you cannot perform the specific job duties of either your job or any job. Depending upon your definition of disability when you are denied, we also present evidence in our Appeals that can get you approved for benefits if your definition of disability will change at the 24 month mark. We don’t want you to win an Own Occupation appeal only to be denied again because you don’t qualify under the Any Occupation definition of disability.
Guardian Appeal Success Story
We handled the case of a Vice President of Sales who suffered from psoriatic arthritis and knee pain. Guardian denied his claim, but after obtaining our services and submitting a strong appeal package Guardian reversed the decision to deny his disability claim. Attorneys Gregory Dell and Rachel Alters discuss the case below.
How Courts Review Guardian Disability Appeals
This section contains some technical legal information and we will try to make it as simple as possible. Most Guardian disability appeals are governed by a law called ERISA and you must understand ERISA laws in order to prepare and write a strategic appeal. There is only one chance to submit a Guardian appeal and it must be drafted in a manner so as to not tell the Guardian everything they did wrong. Most people, including lawyers that don’t focus their legal practice on Guardian appeals, will submit appeals where they basically give Guardian a roadmap on how to review the appeal by telling Guardian everything they did wrong on the initial review. They will include unnecessary or dated case law and a detailed criticism of everything Guardian did wrong. This is not the proper way to submit an appeal and really does nothing more than guide Guardian as to how to conduct a “reasonable review” of your initial claim denial.
What Does A Reasonable Review Mean Under ERISA For A Guardian Appeal?
The “reasonable review” language is key because if your appeal is denied by Guardian and an ERISA lawsuit is filed, a judge must review the denial and apply an unfair legal standard called “abuse of discretion”. The abuse of discretion standard requires a judge to first determine if you are disabled. If the Judge concludes you are disabled, then the Judge can only reverse the benefit denial if he or she thinks the review conducted by Guardian was unreasonable. So a Judge can find that you are disabled, but Guardian’s unfavorable review of your claim was reasonable. In this scenario your denial will be upheld as the Judge must defer to the reasonable review conducted by the insurance company.
No matter how big or powerful Guardian may seem, we have recovered disability insurance benefits for more than 95% of our Guardian clients.
Why Drafting A Strategic Guardian Disability Appeal Is Crucial
Because of the abuse of discretion standard that applies to any Guardian disability policy that contains a “discretionary clause”, we always draft a strategic appeal that focuses on your medical restrictions/limitations and how you are disabled in accordance with your disability policy’s definition of disability, rather than simply saying what Guardian did was wrong. By telling them what they did wrong, it actually helps Guardian create a record for litigation that could be perceived as more reasonable. There are a few states where the discretionary clause is illegal and the judge’s decision on the claim will be final regardless of the reasonableness of Guardian’s appeal review.
Regardless of the standard of review that will apply to your Guardian disability appeal denial, our lawyers have a very specific style of organizing, preparing and drafting Guardian disability appeals letters which have helped thousands of disability claimants nationwide to receive their disability insurance benefits.
Let’s Discuss Your Guardian Disability Denial
When we review your claim we will give you an immediate and honest opinion about your chances of recovering disability insurance benefits from Guardian. Don’t let Guardian or anyone else convince you to handle your Appeal without legal help as you are about to go to battle against a company that generates billions of dollars a year in revenue. To help you learn as much as possible about Guardian and the ERISA Appeal process we encourage you to review all of the helpful information listed below. We welcome you to contact any of our disability insurance lawyers for an immediate free phone consultation.
