Guardian Life Insurance acquired Berkshire Life Insurance a number of years ago and now continues to sell long-term disability insurance policies through the Berkshire brand. This pair of companies is extraordinarily difficult on professionals in the claims process.
Both companies make it extremely difficult for doctors, dentists, lawyers, financial planners, and business owners to get their claims approved. Similar to Northwestern Mutual insurance policies, which I’ve also blogged about, they perform an excessive level of scrutiny before paying a claim.
The way that they do this is by focusing on what your occupational duties were before and after the date you became disabled. For example:
•If you said that you’re a trial lawyer, they’re going to try to examine your billing, calendar and other data to “prove” (in reality, disprove) that you’re truly a trial lawyer—and not a combination of trial lawyer, pretrial litigator, administrator, relationship manager, etc.
•If you claim you are a surgeon, they will examine your CPT and CDT codes, your tax returns and, perhaps, your Profit and Loss statements from your practices to search for any evidence that you also offer non-surgical care—in order to reduce your benefit.
Additionally, Berkshire and Guardian will parse through your medical chart looking for evidence that supports the claimed restrictions and limitations that are preventing you from performing your occupation. They are big fans of the in-person field interview, as well as Independent Medical Examinations (IMEs), both of which I have blogged about previously. The field interview is an adversarial process designed to gather facts and information to minimize the possibility that Guardian or Berkshire is going to pay your claim, as opposed to their stated goal of “better understanding your condition and better understanding your claim.”
All insurance companies perform these sorts of analyses because they’re looking to demonstrate that you’re not totally disabled—but if you are about to submit a long-term disability claim to Guardian or Berkshire, you’re going to be in for a far longer road from claim to payout.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack