Guardian Life

Guardian Disability Claims, Appeals And Lawsuits

Guardian Life Insurance Company of America has been in the insurance business since 1860. While Guardian has been around longer than our law firm, we have been helping claimants with Guardian disability insurance claims since the mid 1980s.

Through the representation of numerous disability claimants in ERISA Appeals, lawsuits and the application for benefits, we have gained an invaluable understanding as to how Guardian evaluates every disability claim.

Unlike most other disability insurance companies, you are lucky to have a Guardian disability policy. Guardian is a large company with more than 5,000 employees and over 5 million customers, but they are managed very well by experienced disability claim managers and examiners.

However, despite Guardian’s efforts to conduct business in good faith, there are still numerous claims every year that are wrongfully denied.

Top Five Reasons Your Guardian Disability Claim Could Be Denied

There are dozens of reasons that could result in a Guardian disability denial, but five most common are:

  1. Guardian hires a physician to review your medical records and the hired doctor drafts a report stating that the claimant is not disabled.
  2. Guardian hires a private investigator to follow you around with a video camera. Guardian then uses the video surveillance footage to argue that you can return to work.
  3. Guardian will send you to either be examined by a doctor of their choice (IME Exam) or to a functional capacity exam (FCE) to evaluate your restrictions and limitations.
  4. A Guardian hired doctor or nurse speaks with your treating doctor and receives information that you can return to work.
  5. Your definition of disability changes from “own occupation” to “any occupation” and Guardian hires a vocational expert to find jobs that you probably cannot perform on a daily basis.

Most Guardian Disability Denials Are Governed By ERISA

The majority of the disability Policies sold by Guardian are sold to Employers. If a claimant receives their disability coverage as an Employer provided benefit, then the policy is usually governed by ERISA.

We encourage you to watch any of our videos discussing ERISA. ERISA is a pro-insurance company law that creates a very high burden for claimants to overcome if a lawsuit needs to be filed.

Our disability attorneys litigate and Appeal ERISA claim denials on a daily basis throughout the USA.

If your claim has been denied by Guardian it is important that you take immediate action. The time period to submit an ERISA appeal is usually 180 days and following an ERISA denial you may have a very limited period of time to file a lawsuit.

Our lawyers are available to provide you with a free consultation to discuss your options regarding a denial of disability benefits by Guardian.

Read 4 Lawsuit Summaries

Leave a comment or ask us a question

There are 96 comments

  • Robert, this is very unfortunate and sad to hear. You would think that Guardian might understand that the great majority of the country is “shut down” and getting documentation might be delayed. We are more than happy to assist you with appealing what sounds like a wrongful denial. Please contact us at once so that we can review the denial letter and assist you any way that we can.

    Alex PalamaraApr 15, 2020  #96

  • Denying my LTD due to doctor’s office was delayed in send records due to office closed because of Corona virus.

    Robert W.Apr 14, 2020  #95

  • Virginia: This is a very unfortunate situation they’ve put you in. You should request in writing an extension of time to submit the information and documentation. You should complete and submit what you can. Normally this would be the time of the 24-month change in the definition of disability, but your comments suggest that would not be the case. Your Policy may have other limitations that the company if exploring that would apply to certain types of medical or mental health conditions and limit your benefits to a 24-month maximum pay period but you would need to review your Policy to confirm/rule this out. Yours seems like a complex situation so I suggest you contact our office and speak with one of the attorneys to address any additional specific questions you may have.

    Jay SymondsMar 21, 2020  #94

  • I became disabled in 2018 (Lupus and Sjogren’s). I’m 54 and I worked over 30 years (for the government) before I became disabled. I received Guardian STD and then LTD through my company. I received my SSD on the first application. Yesterday I received a letter from Guardian stating I need to prove disability – complete new basic physical packet with medical history, work history, education, etc… to complete like the initial one years ago, by, get this, 14 April, or my LTD deposits will be “interrupted.” They have ALL of this information already – Lupus and Sjogren’s do not miraculously get better. In the middle of a Pandemic they suddenly forget my Lupus and Sjogren’s diagnosis by my doctor at National Jewish? They forget they have my medical and work history? They have year’s worth of tests and doctor’s diagnosis, reports and detailed notes – plus the SSD award specifics.

    I feel like they’re trying to mitigate their losses caused by the Pandemic. I can’t get an appt with my doctor before April. I see her every four months – NJ is a world class hospital and you schedule three months out, and I just saw her a month ago. She can easily send them her very detailed Drs notes from that appt and past visits but the intake physical paperwork they sent me to fill out is five pages long – they want everything from hearing, vision, heart testing, psychiatric evaluation, etc – all before mid April or my check “will be interrupted.” They have all of this. All of it already. I wonder how many other people got this same letter. It’s sickening that they do this. My LTD plan was for my occupation. Period. Not “any job.” I cannot afford for my LTD to be cut, but the main point is they are gaming the Pandemic. You’d have to be blind not to see it. I responded politely telling them this, but don’t expect a response, if any, until next week.

    For now I’m contacting my Congress Members and other state employees I’m familiar with – if they go through with this I’m contacting my local news (a producer is a friend of my partner’s) and hope it makes the national circuit. I see a potential class action suit after this Pandemic because I’m sure I was not the only one surprised by a letter like this. Given 30 days to prove disability again and get medical, psychological, vision, hearing, and heart testing by then. I’m disgusted by this. And guess what, after receiving this yesterday I wake up this morning with a full blown Lupus flare. Any recommendations?

    Virginia Z.Mar 21, 2020  #93

  • Lia, each claim depends on the specific facts and circumstances of the case in conjunction with the specific terms and provisions of the relevant Policy. Consequently, it is impossible to predict what the carrier might do. I suggest you contact our office and speak with one of the attorneys to address the specific questions you have regarding your situation.

    Jay SymondsSep 14, 2019  #92

  • Hello,
    I am a dentist and I was diagnosed with Osteoarthritis of the left thumb which limites the range of motion in the joint and affects my daily work. I been advised to have surgery but the down time can go from 6 to 8 months and the results are not 100% guaranty. This down time will be detrimental for my practice and I just can’t do it.

    Do you think I can claim a permanent disability and not do the surgery? With this diagnosis can Guardian argue and not approve it?

    Thanks

    Lia

    LiaSep 14, 2019  #91

  • Kate, it is common for benefit checks to be accompanied with claim forms as a matter of course. You can make inquiry to Guardian to see if they do need to be completed as sometimes they do not. That being said, even with a Presumptive Total Disability, Guardian can still request an update as to your treatment and status – so if they want the forms completed we would recommend you do.

    Stephen JessupJun 25, 2019  #90

  • Four months ago I had tongue cancer, went through surgery and radiation. I lost my speech due to surgery and Guardian approved my claim. A letter was sent to me stating “you are eligible for Presumptive Total Disability” and my waiting period was waived and refunded. This month, an EOB was attached asking me to fill out a questionaire regarding how I’m doing and a form for my oncologist to fill out. My question is, being deemed eligible for Presumptive Total Disability, do I still need to turn in these requests? Isn’t Presumptive Total Disability means you’re presumed to be disabled for life?

    KateJun 25, 2019  #89

  • Nicole, unfortunately we cannot tell you which carrier to choose over another but I can tell you both Principal and Guardian are good companies and that the primary concern should be the coverage they are offering you for the cost.

    Victor PeñaFeb 21, 2019  #88

  • I am currently shopping around for an individual Own Occupation disability insurance policy for my husband. He is a highly specialized medical professional whose work is almost exclusively hands-on patient care with a high level of manual and cognitive skill required (anesthesia) .

    The two disability insurance agents I have spoken with both claimed that all six true “own occ” insurance companies are similar and there there are no substantive differences between them. They both recommended going with the one that comes back with the lowest cost. However, after watching a few videos on your site (thank you for those, by the way), it seems that there is a pretty big difference between these companies insofar as their willingness to pay claim benefits is concerned. It seems as if some of the companies are worse than others when it comes to paying out claims and will put the policy-holder through the wringer. This is upsetting when you consider the astronomical cost of these DI policies.

    Would you be willing to offer advice about which company has the best history of paying for legitimate disability claims? Right now, I am deciding between Principal or Guardian. Guardian is somewhat more expensive but we would be willing to pay extra for peace of mind in knowing that the claim would be paid without a major fight if we were in the unfortunate circumstance of needing to make a claim.

    Any advice you can offer for someone looking to purchase a policy would be much appreciated. Thank you!

    NicoleFeb 21, 2019  #87

  • Dan, Guardian cannot make you file taxes. Only a tax professional can determine whether your benefits are taxable.

    Victor PenaAug 9, 2018  #86

  • I’ve been on an LTD for 20 some years. Guardian life is now trying to make me file taxes on a non-taxable insurance. To me it’s strong-arming me into doing something that I’m not doing so they cut me off my insurance today.

    DanAug 8, 2018  #85

  • John, please feel free to contact me at your convenience so that we can discuss your policy and claim.

    Alex PalamaraApr 25, 2018  #84

  • Hi Alex, Thanks for your comments.

    I was able to verify the 270 page document is the Policy (AKA Certificate) signed by Guardian. Pages 70 to 84 cover STD and pages 85 to 114 cover LTD. The only thing I can make over the “typo”, is that since the LTD only starts 6 months after the STD; its using the same Insured Earnings, so the LTD may be referring to the STD for that. I can send you the file for a free look, if you send me a email or way to upload.

    You hear so many comments regarding scams, I was worried that Guardian may be hiding a surprise when and if my STD needs to become LTD.

    JohnApr 24, 2018  #83

  • John, the document you are describing might not actually be the Long Term Disability Insurance Policy. The 270 document sounds like your employer’s benefits summary. So that document might not be controlling of your LTD claim. The LTD policy governing your claim will be controlling and give all the relevant terms. See if you can get a copy of the LTD policy on your claim and I will gladly review it for you. But keep in mind that STD and LTD policies are typically two separated insurance policies, as such, their terms can differ.

    Alex PalamaraApr 24, 2018  #82

  • Insured Earnings
    My STD Policy Clearly defines Insured Earnings combining Salary, Bonus and Commissions, The same Document goes on to describe LTD but in the Insured Earnings Clause describes it as…
    All Options
    Insured Earnings With respect to short term disability, means your earnings from your employer.
    Including Salary, Bonus and Commissions.

    Please notice the Typo? “with respect to short” (should say “long”)
    Or is this a way for them to recalculate insured earnings when a STD becomes LTD.

    I’m starting my 3rd month in STD, and it seems I may continue on to LTD I read somewhere some insurers could reduce the qualifying income for the LTD. Does Guardian do that? In my case most of my income was commissions and I don’t see any other definition of Insured Earnings in the 270 page policy.

    JohnApr 23, 2018  #81

  • Frank,

    Limitations for mental health conditions are common in disability policies and alcoholism as well as PTSD usually fall within such limitations.

    Victor PenaApr 5, 2018  #80

  • I have been on Gaurdian’s LTD for alcoholism and I’ve been to rehab twice and have since been diagnosed with PTSD. Gaurdian tells me that my LTD is over in September I guess that’s based on the alcoholism . So where does the PTSD fit into my long-term disability I have a therapeutic counselor and a rehab center both that have treated me and therapist that continues to treat me for PTSD.

    They have my therapist diagnosis and records. So what should I do from this point?

    FrankApr 4, 2018  #79

  • Kate, please contact our office to discuss your claim in greater detail with one of our disability insurance attorneys.

    Stephen JessupSep 26, 2017  #78

  • All of a sudden after 12 years Guardian LTD is sending more and more paperwork especially after some stole my identity and filed taxes in my name which the IRS has been investigating and know who did this and so does guardian. However for the last two years I’ve had a few doctors that are refusing to help me and fill out the physicians forms. This happened in Washington state and now in Florida. I started with STD in 2004 and LTD in 2005. I have SSDI since 2007. Doctors have already deemed me permanently disabled. This is starting to cause much stress on me. I went the the Rheumatology doctor today and they flat out said they won’t and can’t fill the forms out. I’m perplexed because the retired doctor I saw in the same office had no issue in filling the forms out. I’m terrified they’ll cut me off. I just had a heart attack induced by stress of relocating to receive better care. What do I do? I’m sending clinical notes and they were aware of my move but I had two heart attacks one in August and just a couple weeks ago fleeing Irma. Please help.

    KateSep 21, 2017  #77

  • Noah, it is not uncommon for a carrier to try to pay a claim through the remaining “own occupation” period and deny for benefits beyond that. That does not mean you wouldn’t have rights to appeal and fight that decision and secure benefits through the maximum benefit period. Please feel free to contact our office to discuss your claim in greater detail.

    Stephen JessupSep 7, 2017  #76

  • Guardian right now is reviewing my case to see if I’m able to do any work. Doctors sent papers in saying it’s unknown when I can return, and right now I can’t work. They told me they will either stop my claim, or if I am able to do some kind of work give me until December or if I’m unable to do any work I’ll have ltd until July. Does that sound right?

    NoahSep 5, 2017  #75

  • James, have you made your request in writing? Also, is your benefit taxable? If it is not, Guardian would likely not send anything.

    Stephen JessupMar 22, 2017  #74

  • Blanca, if your husband’s claim has been denied he will need to go through the administrative appeal process. Please feel free to contact our office to discuss his claim in greater detail.

    Stephen JessupMar 20, 2017  #73

  • I have received Long Term Disability through Guardian. They cut off my checks in July of last year. I appealed their denial and won. Now I am fighting them to get my W-2 from them. It has been almost a month and have not received them. I contacted my previous employer and they say it is Guardians responsibility and Guardian says it is my previous employers responsibility. I am ready to contact the IRS and report them.

    James R.Mar 20, 2017  #72

  • My husband’s have a long term debility started In October 2016. In March 2017 they send a form to my husband where his doctor said that he saw my husband in March 3/2017 and he is ok to go back to work on March 6/2017, but the problems is that my husband didn’t see this doctor, he saw his therapist and premidicare doctor that day. I don’t understand their process for collecting information and making a decision about his claim, they have the right to cheque my husband medical records to confirmed that he never saw this doctor, of curse they cancel my husband claim. He call many times but these people never answer any phone calls regarding our claim. Is it normal how they prolong this process and is totally unacceptable that this happen special when we have children’s to feed and bills to paid.

    Blanca D.Mar 18, 2017  #71

  • Angela, yes, the Elimination Period is typically the length of the STD period, so there would be no additional time before coverage begins.

    Stephen JessupMar 8, 2017  #70

  • If I was on Guardian STD and now going on LTD did the waiting period start from first day I started STD?

    Angela J.Mar 6, 2017  #69

  • Vinny, we would need to review your policy and all the correspondence from Guardian to determine how we may be able to assist you. Please feel free to contact our office to discuss with one of our disability attorneys.

    Stephen JessupJan 26, 2017  #68

  • I have had a non employer Guardian LTD policy since 1991. It is for full disability. I have never had a need for it. Now that i do, i am finding they are doing all they can to deny this claim. I am self employed in the trades. The majority of my work is field work with “office work” to bill and deal with materials, etc.

    My injury prohibits me from doing field work. They are saying that since i do office work I am not totally disabled and therefore not eligible for benefits. Unfortunately, without field work there is no office work.

    the policy is for a stated amount per month after the elimination period. Now they are asking for my tax returns.

    It seems to me they have defined a built in denial for self employed individuals.

    Do you have any suggestions.

    Vinny GJan 24, 2017  #67

  • Jaye, please feel free to contact our office to discuss your husband’s claim.

    Stephen JessupDec 8, 2016  #66

  • Trying to get my husband’s short term debility started after a heart attack. I don’t understand their process for collecting information and making a decision about his claim. They say the dr.’s office hasn’t responded to any faxes and the dr.’s office says they haven’t received any faxes regarding my husband’s claim. all has been sent again, do I just have to stay on this company until they process his information? These folks are rude and won’t let me talk to just one specific person regarding our claim. Is it normal to get so much run around or is this how they prolong this process. We pay premiums in good faith knowing if something happened that we have it covered, yet these are the least helpful folks I have ever met. They have ruined our holiday because I have no idea what needs to be done by who and I keep getting so many different answers.

    Jaye WDec 8, 2016  #65

  • Ryan, please feel free to contact our office to discuss your situation further.

    Stephen JessupNov 15, 2016  #64

  • Thank you for your response. Now, case manager says they need info to simply update my file yet he needs 2 weeks to review. Guardian requires case managers to make decisions within 3-5 days of receiving complete requested info. I am concerned and fearful Of being cutoff. I wonder if IME is involved or are they considering a buyout?

    RyanNov 11, 2016  #63

  • Ryan, it would appear they are certainly investigating your ability, at least to some extent, to work in an alternate occupation. That being said, 13 years later is quite a long time for them to get around to such a review. Please feel free to contact our office to discuss your claim in greater detail.

    Stephen JessupNov 8, 2016  #62

  • My ltd policy is own occupation through entire payment period @age 67.

    RyanNov 7, 2016  #61

  • Hello! I’ve had Guardian Erisa disability for over 13 years due to AIDs and neuropathy and as of recent, brain ischemia after being hospitalized earlier this year. Guardian for the first time is asking for my work history and resume. is this typical or are they they figuring out how to drop me? I am worried. My daily bouts of dizziness and fatigue make it impossible to maintain full time work. I have ssdi. My doctor always is my advocate especially when doing requested forms. Help please.

    RyanNov 5, 2016  #60

  • Cheryl, without knowing your policy language or having an understanding of your medical records we would not be able to reasonably advise you. Please feel free to contact our office to discuss the matter in more detail.

    Stephen JessupOct 17, 2016  #59

  • I need a knee replacement and I am scheduled to have surgery next week. The closer the surgery date gets the more afraid I am to have it. I also have degenerative disc disease in my cervical spine with nureal foraminal encroachment and bilateral hearing loss sloping from mild to profound. Would Guardian approve me for short term disability without the knee surgery? I am a restaurant Manager on my feet from 10-11 hours a day. Can’t keep doing this.

    Cheryl GOct 12, 2016  #58

  • Sam, we would need to see the policy and the information they sent you with respect to the denial of the increase. Please feel free to contact our office to discuss if there is something we might be able to do to assist you.

    Stephen JessupAug 30, 2016  #57

  • Hi
    I am Dentist of 9 years now. I am 40 years old. I had Guradian disability insurance for about 6 or 7. I had the “future increase option rider” included in my policy. It would give me the option to upgrade once a year, if I reject it twice in two consecutive years I loose it. I have kept it active until recently. After a 3 day day hospitalization with irregular heart pulse (atrial fibrillation) which happened twice to me in a 3 month period (last time was over 8 months ago)…..I got a letter from guardian disability saying that due to updated medical information that they got, they are cancelling my option to upgrade. They did say I have the option to call to contest ….I did that, but it was pointless.
    Is that something your company might be able to help me with? (to re-establish my yearly option to upgrade)?
    Thank you

    Sam D.Aug 28, 2016  #56

  • Bill, have you appealed the denial? Please contact our office to discuss your denial and to determine how we may be able to assist you.

    Stephen JessupJul 15, 2016  #55

  • I have been disabled for 15 years or so… The Guardian compelled me to apply for SSDI benefits to offset Guardian liability.. The Guardian even retained the atty… I won the appeal to SSDI and started receiving monthly benefits from the Guardian.. after 10 years they used a clause in the policy under the section/heading of establishing the claim, to request tax forms… I would have submitted them, (reluctantly), but they were unavailable as I was moving, and they were in 1 of the 2 boxes lost during the move from florida to California.

    I offered to provide anything else, but they refused and ultimately stopped my claim. 9 months later, after I moved and finally got a copy of the Guardian policy, I discovered I didnt have to submit the tax forms, as the policy allowed for 3 options.. one of which was copies of my bank statements, (again under the heading of establishing income to determine benefit amount, at the onset of the claim, but they use as PERIOD REVIEW)

    After I discovered that clause and the other option, I sent them a copy of that clause along with several months of bank statements and I asked for an apology as they disrupted my life, ruined my credit score, and my rental credit report for multiple late rent payments and a filing of eviction, (which never was heard in court).

    but, I guess I poked the bear… so now, I my claim is under constant review.. I have been sending in documents for the last three years…and now…

    I rec’d a denial letter from the Guardian telling me I am no longer disabled, as per their IME, independent medical evaluation… They also did some surveillance from 2014, (2+ years ago, where they said I walk with a cane and seemed to walk fluidly). They also cited the IME who saw me for 15 minutes, and didnt have any of the medical history. I had just had a MRI, and Nerve study several months earlier which indicated several issues ranging from minor to more ‘Pronounced’…

    Now, i am faced with a loss of income from a company who refuses to call me back, or return my emails or return my snail mail letters…

    BAD FAITH, you betcha… harassment, NO DOUBT…. but somehow still legal or at least still acceptable to those who make the rules as ERISA is the main problem…. an old law, lobbied for by insurance companies, and set in concrete…

    lawyers might help a claimant, but no one is going to go change the laws …. until then, I and others are at the mercy of animals who call themselves claim managers… those folk have no business dealing with disabled people… money and greed drives that company.. zero compassion.. zero empathy.. zero understanding…all because someone else paid for my hourly / salaried benefit… in essence, I paid for it.. someone else just sent in the check.. and because of that loop hole, the Guardian and other erisa providers offer a smoke and mirror deal.

    If you work for a company who offered Guardian… tell them NO. demand they pay you extra, and go out and get a non ERISA provider…

    as for me.. I am at a loss, as I am unable to find an attorney in my area that handles ERISA cases…so, now, the guardian gets away with it because now, lawyers think it is too difficult to make money from disabled claimants that have been screwed over

    BillJul 12, 2016  #54

  • Cathy, without knowing the language in your policy there is no way for us to be able to advise you. If you have a copy please feel free to reach out to our office to discuss how we may be able to assist you.

    Stephen JessupMay 30, 2016  #53

  • Can I work a minimum wage job and still receive my long-term benefits?

    Cathy D.May 26, 2016  #52

  • Laura, Guardian is one of the more reputable insurance carriers so they will likely agree to a repayment plan, but they will demand the full amount owed back.

    Stephen JessupMay 17, 2016  #51

  • First, thank you so much for helping so many people! This is an invaluable resource. My question is, from your experience with Guardian, can you estimate the overall likelihood of them agreeing to a payment plan for an overpayment of benefits? In other words, if there is an overpayment, how often do they demand the full amount be paid back immediately?

    LauraMay 15, 2016  #50

  • Corrine, so you were denied on the basis of a pre-existing condition?

    Stephen JessupMar 17, 2016  #49

  • Bill, please feel free to contact our office to discuss how we can assist you with monthly claims handling.

    Stephen JessupMar 17, 2016  #48

  • I had surgery on the 23rd of February for tennis elboe and Carpel tunnel I was denied because I was getting treatment in August prior my surgery.

    Corrine T.Mar 16, 2016  #47

  • Hello, this is the second time I am writing you, thanks for the help the first time.

    I am constantly being harassed by the Guardian to supply meaningless forms and information, with threats of denial of benefits.

    the requests are ‘meaningless’, as I have been approved and collecting benefits for more then 15 years, and each year compelled to supply attending physicians statements, as well as meeting with and being examined by independent medical evaluations and FCE’s. but yet, the ‘meaningless’ forms continue.

    I am sure, that the Guardian is looking to find a mistake to allow them to deny benefits until such time that the ‘mistake’/typo’ is corrected.

    there seems to be no understanding that the benefits are a life blood… they pay my rent, my food, my medical treatments and medications.

    currently, the guardian is now asking, (3 months since my last IME), for my employment history… and instead of the 15 years requirment as written on the standard form, they have stated they require 30 years of information.

    I am not sure about others, but, as I have not worked in over 15 years, I am unable to recall the names and dates and other information of my past employers… I can ‘kinda’ recall some names, but certainly not the cities, or the dates… I can also state they were related to construction managment, I worked in refineries, I worked in shopping malls, I worked in movie theaters, and at school districts, but other then that, I don’t recall much.

    in fact, the last time I did any kind of resume/CV, is when I applied for benefits with the Guardian. I would request from them, the form and information I supplied to them when I applied for benefits, but I am positive they will ignore that request, as they have ignored EVERY SINGLE thing I have requested from them…

    I would think a professional could represent me, and maybe convince them of the futility of their ‘WANTS’ and requests. but, I am unable to afford any percentage of my income to get them to act in a human/compassionate way… am I ‘screwed’… just as every other person with limited and fixed income is screwed by corporate greed and or personal vendettas by thier employees?

    Please help if you can.

    thanks

    bill

    Bill B.Mar 15, 2016  #46

  • Mike, please feel free to contact our office to discuss. The carrier may be reducing the monthly benefit due to receipt of SSDI and in some cases that may wipe out the benefit completely if there is no “Minimum monthly benefit” in the policy.

    Stephen JessupMar 8, 2016  #45

  • My wife had a stoke last year.received short term payments but when that ended she was told they did not have to pay long term diss because she is getting social security diss. Been paying this for twenty years now they don’t have to pay why.?

    Mike F.Mar 4, 2016  #44

  • Cleve,

    First and foremost, when was the denial? You only have 180 days to submit an appeal of a denial and if your claim is from February the first concern would be timeframes. Beyond that we would need to see the denial letter as well a copy of the policy to better assess the likelihood of prevailing on an appeal. Please feel free to contact our office to discuss same.

    Stephen JessupDec 8, 2015  #43

  • I have had a seizure disorder (Grand Mal) for 15 years. The disorder has always been controlled with medication and I have always been able to work. In September 2015, my wife started noticing changes in my behavior and memory. We thought it was due to my diabetes. As it turned out, I was having absence seizures. The doctors have told me that I can not drive anymore, or at least not until we can get the absence seizures under control with a new dosage of medication. I became eligible for STD through Guardian on February 1, 2015. I was denied STD due to it being considered a “pre-existing condition.” The doctor reports clearly state that the “absence seizures” are totally new as I’ve not had them before, but I was still denied. Do I have any recourse? Would filing an appeal be a complete waste of my time?

    CleveDec 7, 2015  #42

  • Mike,

    First and foremost I would suggest you contact Guardian (or your claims manager if one has been assigned) and find out the status of the claim.

    Stephen JessupSep 10, 2015  #41

  • My 90 day waiting period ended today and I was not contacted as to the status of my LTD claim one way or the other. I provided all medical documents as requested by Guardian through this 90 day process, and my doctors support my disability and retirement. I have copies of it all. What do I do now?

    MikeSep 9, 2015  #40

  • Roxy,

    The policy will define elimination period as the period of days that one must be disabled before benefits become payable. Benefits are not typically paid for elimination period days.

    Stephen JessupJul 28, 2015  #39

  • My husband and I were both in an accident. My neck is broken. I have Unum and a 5 day elimination period. They have approved my short term claim and sending a check out already. My husband has been employed over 30 years with same company and has Guardian. He also has a 5 day elimination period. My husband was off 11 days, but Guardian says the elimination period does not count as a paid period. They will only cover 6 of the 11 days, claiming elimination periods don’t qualify for pay. Why would my policy pay for those days while his doesn’t…when both policies have the 5 day elimination period?

    RoxyJul 27, 2015  #38

  • Kelly,

    Your employer is responsible for providing the policy. I would recommend that you put your request for same in writing. With respect to SSDI and DSSDI- if they are enumerated sources of other income subject to offset under the policy then you will be responsible for any applicable overpayment of benefits by Guardian. The chances are your policy indicates the same.

    Stephen JessupJul 3, 2015  #37

  • I have been out of work since November 2013, due to being Diagnosed with MS, on my employer provided LTD policy (Guardian), which was an elective in our benefits package. I’ve been being paid on my LTD policy since March 2014. I get 60% of my gross until I’m 67, I am now this year 50. I did apply for SSDI, my hearing is next week. I did use Guardian’s Advocator Group for my attorney. My questions are; 1) Do you know how I can get an actual copy of my policy? When I asked Guardian they told me to ask my employer. When I asked my employer, they told me that they changed companies in January 2014 and no longer have it available. 2) Do I have to give Guardian all of the back pay if approved for SSDI to offset payments already made? 3) I have a minor child, if awarded income for her do I have to give Guardian back payments made on her behalf? And will that income count then monthly as well or should any income for her be a separate issue? Thanks for your help.

    KellyJul 2, 2015  #36

  • Susan,

    We believe choosing representation of your choice is the best option. Please feel free to contact our office and we can assist you in finding a SSDI attorney who can assist you.

    Stephen JessupJun 17, 2015  #35

  • I have been on Guardian Longterm disability for about 6 months now and have been out of work for almost 10 months due to a Fusion in my ankle that also develovped RSD. This last surgery was the fourth surgery on my foot/ ankle. Still in a lot of pain, that I see a pain management Doctor for. Guardian is pushing me towards using there advocator group to help me with the process to start get qualified for SSDI. This is all very confusing to me. Should I go with my my own lawyer or go with the advocator group?

    Thank you,

    Confused

    SusanJun 16, 2015  #34

  • Larry,
    They are sending you to the IMEs to verify restrictions and limitations that prevent you from working (or possibly in an attempt to find a way to deny the claim). If your policy is employer provided then it would allow for the offset of your monthly benefit by the amount you would receive from SSDI. Therefore, they retain Genex to assist you with the SSDI process so they can assert any potential overpayment as a result of the SSDI.

    Stephen JessupMay 4, 2015  #33

  • Why would Guardian send me to a FCE twice in less than 3 months and why would they retained Genex

    LarryMay 3, 2015  #32

  • ValK,

    You are quite welcome. Please feel free to contact our office should you ever have any additional questions.

    Stephen JessupFeb 21, 2015  #31

  • That is the best information about Guardian I have found. Thank you.

    ValK. SF49Feb 20, 2015  #30

  • JK,

    If your policy is governed by ERISA you may not be able to for two reasons (1) if Guardian only provides one level of review then you could be barred, and (2) ERISA allows 180 days to submit an appeal, which can be limited to a lesser amount in the event of a voluntary appeal. It certainly does not hurt to contact them, but there stands a likely chance it will not change their decision.

    Stephen JessupDec 18, 2014  #29

  • I was denied by Guardian LTD about a year ago. If I’ve recently come into a peace of medical evidence that is very strong in my favor, am I able to file another appeal?

    JKDec 17, 2014  #28

  • Bill,

    The application for benefits under a private disability insurance policy is without a doubt the most important piece of information in a disability claim as it sets the tone for the claim to come. Please feel free to contact our office for a free consultation and review of your disability policy so we can best advise you as to your rights under your policy.

    Stephen JessupNov 14, 2014  #27

  • I have a privately purchased “own occupation” disability policy with Guardian. I suffer from depression and significant anxiety. I am an employee of a financial advisory firm. My job is to perform investment management duties and manage client relationships. My depression and anxiety have caused me to be very uncomfortable in relating to clients. In meetings I often, as if paralyzed, begin shaking uncontrollably. (fortunately it’s not always apparent to others but it certainly renders me “not all there”) On phone calls I often am so overwhelmed with anxiety I am unable to clearly think and reason. I’ve grown more and more afraid to answer phone calls. I typically let phone calls go to voicemail and only reply if I absolutely must. When I speak with clients I am nervous and it shows in the tone of my voice and lack of confidence. All of this further adds to my depression and feelings of lack of self-worth. Clients have been leaving and I fear my inability to perform my role effectively will find me jobless before long. I fret at what I would do as an encore career because I don’t feel qualified to do anything. I am looking for guidance as to whether my situation would be considered a disability that could be claimed? If so, am I best having an attorney handle the initial claim and what’s the likelihood of winning a depression/anxiety claim?

    BillNov 13, 2014  #26

  • RSDS2014,

    Please feel free to contact our office to discuss your claim. Guardian is typically very prompt in their claim review, and 3 months to make a determination under a short term disability policy is excessive.

    Stephen JessupAug 3, 2014  #25

  • I have RSD from carpel tunnel surgery in March of 2010. The surgeon sent me to a pain Dr 3 weeks after surgery not telling me why. He had to send all my info to the pain Dr. before I could get an appt. I met my pain Dr on my bday, April in 2010 with the diagnosis of RSD. It was managed with pain meds and some other meds at first. My hand, 4 years later, is still swollen, numb and is in constant burning pain – but always getting worse. Now my fingers barely move. I was on FMLA for a year before I went out completely. I had the same job for 15 years, so they were always aware of my condition progressing. Now I am on pain Patches and Morphine. I can not even think clearly much less move my hand. It’s pretty horrible. At any rate, my Dr wrote me off work at the end of April, 2014. My employer filled in their section and sent it off to Guardian. STD is 70% for 6 months and LTD is 60% til retirement age. I have sent more than 2 times all of my Dr’s reports – from my monthly pain Dr’s info to my PCP who signed the paperwork. I also now live in London (my husband is British) and even had my current Dr fill out paperwork and signed that I am disabled and evaluating my pain and hand, etc. It has now been over 3 months and I have not received anything besides “they are still working on it” and “I just need this one more piece of info” and “please be patient” and no check yet. I estimate the first check should be about $7k by now (my waiting period is only 7 days). Any suggestions? Do I need a lawyer? Shouldn’t they have to have done something by now? It’s very frustrating. It’s a huge financial strain.

    RSDS2014Aug 2, 2014  #24

  • Joseph,

    Please feel free to contact our office to discuss your rights under ERISA as it relates to filing an administrative appeal of the denial of your benefits.

    Stephen JessupJul 24, 2014  #23

  • Yes, I was also getting 66% of my pay from Guardian; also getting NYS Comp. Guardian forced me to apply for SS disability. When I got payment of $29000 from SSD they forced me to give it to them. It was their or they would stop payment. NYS Comp. settled with me and I am 75% disabled. Guardian dropped me saying I can work full time and I can make in my field of work min. $18.00 an hour. So far no one will hire me, not even Walmart.

    Joseph P. CzarneckiJul 24, 2014  #22

  • Carolina,

    It is a fancy way of saying there is not enough evidence to support that your medical condition would prevent you from working.

    Stephen JessupJul 10, 2014  #21

  • Guardian will only state that I have not established “proof of loss.” What does that lingo mean?

    CarolinaJul 9, 2014  #20

  • Katina,

    Guardian is one of the most reputable insurance carriers, so your treatment is not necessarily surprising. Many doctors are just hesitant to complete forms as they are concerned that they may one day be pulled into some legal action.

    Stephen JessupJun 6, 2014  #19

  • I have been receiving LTD from Guardian for almost a year now. Finally being released to work June 13th. I have had really no problems with Guardian other than having to secure alot of the paperwork for them. I’ve actually been quite surprised and because of Guardian have been able to keep my home, cars… etc. Even though I have a Doctor’s note saying I can return to work I foumd out yesterday that they will continue to pay untill I secure appropriate employment. Worse problem I have been up against is the Doctors being so scared to fill out the paperwork. None will say exactly why that is but I wonder how much they are intimidated by Guardian and why.

    KatinaJun 5, 2014  #18

  • Mike,

    Has Guardian approved the STD claim at this point? Have they begun the LTD process? Please feel free to contact our office should you have any questions.

    Stephen JessupMay 30, 2014  #17

  • I have recently had to start the disability process, my plan calls for 9 weeks of STD and then LTD until Social Security age (I worked for a great company who setup a good plan). I have a rare condition les than 200 people in the world have been diagnosed with. I took the time to provide Guardian with 200+ pages of documentation from every doctor/hospital I have seen (world renown), 8 CD’s od MRI’s, MRV’s etc. Guardian acknowledged receipt but chooses not to use the information for the purpose to approve my claim. They approved my STD for 2 weeks the first time, then ask my Dr. to fill out the exact same paperwork and have now bumped it up to 5 weeks but with all the information at their finger tips they still refuse to extend it for the full 9 weeks. I have a friend who works for another STD/LTD company and he has told me word for word what they would say and do. When you talk to an agent, you feel like your talking to a robot or corpse. They cannot answer the basic questions related to terminology definitions in the policy, own occupation, part time work, rehabilitation clauses etc. I am dreading when the LTD portion begins, I can only imagine how hard they are going to try and get out of paying even though I have Drs. that are the top in their field that have already written letter’s stating I can’t be cured, my condition will only progress etc. I can’t imagine people having jobs and being so heartless when others are at their weakest moment. Good luck to everyone.

    Mike JonesMay 29, 2014  #16

  • Robert,

    I reviewed your previous comment from Christmas 2011. Based on the fact pattern as presented, it would seem your claim for benefits with Guardian was denied in 2006. If your policy was in fact an ERISA based policy as you have indicated there stands a greater than likely chance that any applicable statute of limitations may have run. Typically, ERISA governed disability policies provide a three year statute of limitations to file a lawsuit. If that is the case with the policy you had, then that time frame may have expired some time in 2009. In that event there would have most likely be nothing any attorney could have done in 2011 or today.

    Stephen JessupMar 4, 2014  #15

  • I was checking your web site, and found a message I sent to your firm. I also found several other messages from others, and all were replied to by your lawyer’s. My message had no reply or response to my knowledge. Please look into my claim denial and advise as quickly as possible. Thank you, Robert Bantom.

    Robert BantomMar 3, 2014  #14

  • Lisa,

    I am sorry to hear about your experience. From reading your story, with specific attention to your “P.S.”- please note that we are not representatives of Guardian, or any insurance company for that matter. We are a law office focused on securing disability insurance benefits for people such as yourself. Please feel free to contact our office should you wish to explore your options from a legal standpoint.

    Stephen JessupFeb 22, 2014  #13

  • I had a policy for several years for LTD provided by my employer (I was a teacher) as part of a benefit package. After over six years of faithfully paying premiums (even when they increased), when it was it was time for Guardian to come through and honor the plan, I was denied benefits.

    I went through the appeal process, and once again I was denied benefits. As informed consumers, we are all aware of the claims and legal departments and their mandate to DENY, DENY, DENY! Guardian was provided documents regarding my neck and back surgery from the neurosurgeon, a list of all the medications that were required prior to and after surgery from my pharmacy, and my primary doctor also responded. Physical therapy notes were also included. This doesn’t include records from the psychiatrist. (THANK YOU Guardian for adding to my stress and anxiety levels.)

    It is important to note that my state Department of Education office has all of this information, which by the way they had their own separate medical board review, and they have classified me as permanently disabled. Still Guardian does not come through. By the way, records regarding my recent shoulder surgery and therapy haven’t even been submitted yet.

    I would warn anyone considering enrolling for a LTD policy ( or any policy for that matter) with Guardian to be very cautious. RUN WHILE YOU CAN! After having no income for 11 months (that doesn’t even include the 91 day elimination period), all I have from Guardian is a copy of a Benefit Plan catalog, check stubs with monthly payments deducted for Guardian, a letter of denial, and another letter denying my appeal.

    With over several billions of dollars collected by Guardian annually for premiums from the paychecks of hardworking subscribers, and thanks to their company mandate to deny claims as well as appeals, and their attempt to intimidate anyone who seeks recourse from their highly staffed and paid legal department, Guardian still generates billions in profits.

    Now you tell me, does such actions by a company who you have placed your trust in and paid them to safeguard that trust seem ethical let alone morally correct?

    Even with a post-graduate college degree, I was scammed. I considered myself to be an educated person and an informed consumer. I cannot say that anymore thanks to Guardian. I suggest the company name be changed because they sure did not guard my policy or provide aid to sustain me when needed. A guardian-hah! The joke is on the policy holder who only receives pieces of paper. If I had a fireplace, I guess I could burn the benefit catalog, etc. for heat to save on the power bill. Unfortunately, I do not have a fireplace.

    P.S. I welcome a response from Guardian because I certainly did not receive assistance with my claim. From past actions, I will assume my comments will be MODERATED or even not posted. Let’s see what happens.

    LIsa P.Feb 21, 2014  #12

  • Bill,

    It seems like you have multiple issues with your claim that a short response is not going to answer adequately. Failure to provide requested information can certainly result in a denial of benefits. However, once that information is received it is not uncommon for the carrier to at least pay benefits under a reservation of rights. With respect to requesting IMEs – it doesn’t appear that the number they have requested is egregious, but it does appear that they are setting up your claim for a potential denial. Please feel free to contact us if you would like to discuss how we may assist you with your claim.

    Stephen JessupSep 15, 2013  #11

  • Hello,

    How often can the Guardian request medical evaluations? I was asked for an attending physician’s statement in January, and then again in May. That seems a bit too frequent? Does the Guardian need to pay for those evaluations?

    Also, if the Guardian issues a denial of claim, for not submitting the tax forms “in a timely manner”, then once they receive those tax forms, then keep suspending the benefits for another reason? IE the new medical evaluation that they just asked for (after the tax forms were turned in).

    Seems to me that they should reinstated the benefits, as I submitted the tax forms, and then be given an opportunity to comply with the medical evaluations?

    Thanks.

    Bill BergovoySep 14, 2013  #10

  • I was sent by Guardian to take an FCE exam. I was a “Maintenance Tech”, I was T-boned in a car accident and it screwed up my back. MRI says minimal facet arthropathy throughout the lumbosacral spine and minimal chronic anterior wedging is also present at T12 with slight reversal of lordosis of the cervical region. Now to Guardian these things may be nothing but for me I no longer can lift, bend, twist, sit, walk, or even sleep the same since the accident. I’ve participated with Guardian and done everything they’ve asked of me from Vocational Rehab to now taking this FCE exam. The Exam had me in pain the entire time but the examiner didn’t seem to care at all. I took this exam a week ago today, so I called Guardian to get some insight on the exam and I was told the results of the exam had not come back as of yet but my benefits are approved through early September. What can I expect from Guardian once the results of the exam come back?

    Tyrone HollomanAug 12, 2013  #9

  • Tyrone,

    Depending on what Guardian determines the physical demand level of your former occupation is based upon the Department of Labor description, and the results of the FCE, you could very well expect a denial of continued benefits. If it is determined your job was “light duty” in nature and the results of the exam indicate you maintain the residual physical ability to work at that level, then definitely expect a denial. However, if the FCE results come back that you cannot perform at the required level, expect Guardian to continue to pay at this point. Please feel free to contact our office if you have any additional questions.

    Stephen JessupAug 12, 2013  #8

  • I was denied a claim based on a pre-existing condition. I appealed and Guardian hired the services of an outside vendor “BMI” to get a doctor to talk to my doctors in a peer-to-peer review.

    It seems as though the system is designed to get the claims denied rather than approved.

    StephenMay 26, 2013  #7

  • Ryan,

    They are both good companies, but they both offer very different definitions of disability.

    Northwestern Mutual recently started selling a policy with their own special definition of own occupation which they argue is better.

    I have published an article discussing the Northwestern Mutual “medical occupation” definition of disability which you can read here.

    Guardian offer a true own occupation definition of disability.

    Gregory DellApr 10, 2013  #6

  • Thank you for all the info!

    You have listed Guardian and NWM as among the top 3 DI companies. Would you recommend Guardian or NWM for disability insurance for a Cardiologist?

    Thanks!

    Ryan PhilipApr 9, 2013  #5

  • Ardi,

    You can blackout any information that is related to your wife or anyone else. You should send in the return as you have nothing to lose by submitting it. Cross out anything related to your wife.

    Gregory DellApr 23, 2012  #4

  • Am I obligated to provide my Tax returns to Guardian for my LTD Disability? I just received a letter from Guardian asking for “complete tax return with all schedules and attachments … Please note, pursuant to provisions in your Group Long-Term Disability plan, copies of an insured’s complete tax returns with all schedules and attachments are required as acceptable proof of earnings for the ongoing adjudication of your claim.” My policy documents do not mention anything about “tax returns”.

    I have been receiving LTD from Guardian for many years. The payments are offset by the SSDI I also receive. My tax returns are filed jointly with my wife. The tax return lists my occupation as “disabled”. I do receive income from dividends and interest from banks and brokerages.

    My wife is very uncomfortable with the idea of sending out our tax return (with her information) to Guardian. Any opinion/suggestions?

    Many Thanks!
    Ardi

    ArdiApr 23, 2012  #3

  • I was protected for disability loss of income by Guardian. In addition, I purchased a separate excess policy for additional monthly limits through Unum.

    I had 2 occurrences affecting my health. The first was November, 1995, a heart irregular rhythm. I was out of work for over 6 months, and not able to do any full time type work for over 18 months. After negotiations, I reached a settlement with both Guardian and Unum. All seemed well until January, 1998 when I had a stroke at work. Again, I was in the hospital for about a week and needed almost 6 months of rehab, and rest. I tried again to return to full time but found the medications and conditions caused me to cut back. I filed with both carriers for partial disability and settled the claim with Unum. Guardian rejected the claim as I was not working a 30 hour work week. I explained and sent them information of applying to Social Security Disability. After SSDI review, my case was approved for payment in 2006.

    So, Unum agreed to settle, and Social Security agreed to settle. Only Guardian gave this very lame reason for not settling. The delays of going back and forth with Guardian allowed them to bring in the ERISA laws and not the time to reach a settlement.

    Now we are almost into 2012, and I had to sell my investments to live and to pay for medications, until the SSDI started. I still believe Guardian should offer a settlement on my case, and I was really willing to work this out with them, but they just plain refused. As in my case with Unum, they terminated my partial disability claim, but when the “class action suit” and verdict came down on them, they had to re-open my case and we eventually settled. I needed an ERISA lawyer, disability lawyer, and my health did not allow me to continue under those stresses.

    Today I thought I should get an opinion, and to see if many others have had the same experience I have had with Guardian.

    Again, Unum tried to cancel off paying disabled people and I can only assume Guardian tried the same plan. Please let me know.

    Many thanks,
    Robert Bantom

    Robert BantomDec 25, 2011  #2

  • Great site!

    Gloria WaltonAug 20, 2011  #1

FAQ

Do you handle ERISA Guardian appeals?

If your disability income claim has been denied by Guardian and your disability income policy has been offered through your employer, then federal ERISA law requires you to file an appeal with Guardian. Our law firm has handled thousands of ERISA appeals against Guardian and we will prepare a very strong appeal on your behalf.

Do you help with Guardian applications?

The application for disability benefits with Guardian is the foundation of your claim. One mistake can result in your claim for disability insurance benefits being denied by Guardian. Our lawyers will guide you through the entire application process and make sure you are in the best possible position to have your claim approved by Guardian. We welcome you to contact our attorneys to discuss important information about applying for disability benefits with Guardian.

Do you file Guardian lawsuits?

If Guardian has denied all of your ERISA disability appeals, then you have the right to file a lawsuit in federal court against Guardian. An ERISA disability lawsuit is different than any other type of lawsuit and you should hire a attorney that has handled thousands of disability denial lawsuits against Guardian. Our disability insurance lawyers know what to expect with the challenges filing a federal lawsuit against Guardian.

Can you help with a Guardian disability Insurance denial?

We have helped thousands of individuals collect long term disability benefits from Guardian and we know the unreasonable denial tactics used by Guardian to deny disability insurance benefits. Our experienced attorneys know the many options available to get your disability benefits paid by Guardian.

Do you manage Guardian monthly claims?

Monthly disability insurance claim management is a unique service we offer. Our goal is to make sure your Guardian disability benefits continue for as long as you need them. Many claimants either don't trust or experience aggravation dealing with Guardian. Disability Insurance Attorneys Dell & Schaefer manages every aspect of your claim for disability income benefits from (Guardian. Guardian only interacts with our law firm. Contact Disability Insurance Attorneys Dell & Schaefer to learn how we can manage your disability claim.

Can you negotiate a Guardian lump sum buyout?

Lump sum buyouts and disability buyouts are occasionally offered by Guardian. Our disability lawyers have established relationships with the people at Guardian that make the decisions on disability buyouts. We have negotiated hundreds of lump settlements with Guardian. Our goal is to get you the highest buyout possible.

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 telephone, e-mail, fax, GoToMeeting.com 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 800-682-8331 or by email. Lawyer 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.

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