Claims Denied by Berkshire Life Insurance Company? Join the Club. Don’t Take “NO” For an Answer
Disability insurance is intended to provide financial security during times of need. Many of Berkshire Life Insurance Company customers feel that Berkshire fails to deliver on this promise. Berkshire Life Insurance Company at one time was a very friendly company and always seemed to give the policyholder the benefit of the doubt. That has changed in the past 10 years.
Berkshire Life Insurance Company was acquired by Guardian Life Insurance Company of America almost two decades ago but seemed to operate independently. But that is not the case today.
Some of the root causes of dissatisfaction include complex claims processes, delays in processing, denial practices, and lack of transparency. These practices cause stress during an already challenging time for the disabled individual. Too much emphasis seems to be on process over substance.
Jonathan Feigenbaum, a skilled disability levels the playing field against the insurer’s resources and helps you navigate the technicalities and psychological demands of the disability claim process, maximizing your chances for a successful outcome.
If your disability claim has been denied by Berkshire Life Insurance Company call our Boston, MA attorney Jonathan Feigenbaum at 617-357-9700 today for a complimentary review of your claim.
The Claims Evaluation Process
Initial Submission
Policyholders begin by submitting a claim form, which includes detailed information about the disabling condition, medical history, and financial impact. Required documentation typically includes:
Attending Physician Statements (APS) verifying the medical diagnosis and restrictions.
Employment records confirming job duties and earnings.
Personal statements detailing the nature of the disability and its impact on daily life.
Review of Medical Evidence
Berkshire’s claims adjusters consult medical professionals to assess the severity and legitimacy of the condition. They may request additional medical records, diagnostic tests, or evaluations by independent medical examiners (IMEs).
Occupational Analysis
For policies with an “own-occupation” clause, the company evaluates whether the disability prevents the insured from performing specific job duties. If the insured states he is an oral surgeon, for example, Berkshire will look for proof that the insured is not a general dentist but an oral surgeon.
Financial Assessment
For income-replacement benefits, Berkshire examines the claimant’s financial records to verify the loss of earnings. This includes reviewing tax returns, pay stubs, and business income if applicable.
Ongoing Monitoring
Claims are monitored regularly, especially long-term ones, to verify continued eligibility. Policyholders may be required to submit periodic updates or undergo follow-up examinations.
Reasons Berkshire Life Denies Disability Claims
Insufficient Medical Evidence
A lack of comprehensive medical documentation supporting the severity of the disability is a common reason for denial. Berkshire may argue that the condition does not meet the policy’s definition of disability.
Failure to Meet the Elimination Period
Most policies include a waiting or elimination period before benefits begin. If the policyholder’s condition resolves before this period ends, the claim will be denied.
Exclusions and Limitations
Certain policies exclude coverage for specific conditions, such as pre-existing illnesses, self-inflicted injuries, or disabilities caused by illegal activities. Claims tied to these exclusions are typically denied.
Discrepancies in Documentation
Inconsistent information between medical records, employment data, and personal statements can lead to claim denials. For example, a claimant who reports severe restrictions but is observed engaging in activities inconsistent with their condition may face denial.
Non-Compliance with Requests
Policyholders who fail to provide requested documentation, attend IMEs, or comply with rehabilitation recommendations may have their claims denied for non-cooperation.
Demands for records not required in the policy
Berkshire will almost always now require dentists and doctors to provide a great deal of CDT and CPT coding on excel spreadsheets. Under the older Berkshire policies there is no reasonable basis to request this information as CDT and CPT coding were not created to assess occupational duties. The codes exist mainly for insurance billing purposes.
How Jonathan Feigenbaum Will Help Your Navigate Your Disability Insurance Denial
Jonathan can significantly improve your chances of winning a disability claim by providing expertise, guiding documentation, managing communication with the insurer, and preparing for appeals if necessary. Here’s how we will assist at every stage of the disability claim process:
Understanding Policy Terms and Eligibility
Disability policies are often complicated, filled with technical jargon and specific definitions, such as “own-occupation” or “any-occupation” terms. We will thoroughly review the policy to understand the insurer’s exact criteria for disability. We assess whether a claim aligns with these criteria and advise on any potential weaknesses that could lead to a denial. This insight allows the attorney to help you frame the claim in a way that aligns closely with the policy’s requirements.
Gathering Strong Medical Evidence
Insurers typically demand comprehensive medical documentation to prove the severity of a disability. Jonathan can collaborate with your doctors to ensure medical records clearly support your claim. He may request specific tests, evaluations, or statements that directly address the policy’s disability definitions. He understands the level of detail insurers are looking for and can assist in compiling documentation that is difficult for insurers to dispute.
In cases where subjective symptoms are involved (such as chronic pain or mental health conditions), Jonathan can help gather supplemental evidence, like vocational assessments, expert opinions, and statements from family or colleagues, that solidify the case.
Managing Communication with the Insurer
Insurance companies often communicate in ways that may seem benign but are designed to elicit information that could hurt your claim. Jonathan handles all correspondence with the insurer to prevent unintentional misstatements or omissions that might lead to a denial. He knows how to address questions that insurers commonly use to challenge claims, ensuring responses stay within the scope of policy terms.
Handling Denials and Appeals
If an insurer denies a claim, the appeals process can be lengthy and complex. Attorneys understand the appeals process and can quickly identify why a claim was denied. They can request copies of the claim file, interpret the insurance company’s rationale, and gather additional evidence if necessary. Most importantly, they prepare persuasive appeal letters or briefs that address each reason for denial and reinforce the validity of the claim.
Protecting Against Surveillance or Misinterpretation
Insurers sometimes use surveillance or Independent Medical Examinations (IMEs) to dispute claims. An attorney can advise you on how to handle these situations, ensuring you comply with requests while protecting your rights. They also prepare you for IME appointments, emphasizing consistency in your reported symptoms and behaviors.
Appealing a Denied Claim
Policyholders have the right to appeal denied claims. This involves submitting additional evidence, such as updated medical records or expert opinions, to challenge the denial. Consulting an attorney specializing in disability insurance can help navigate the appeals process effectively.
If your disability claim has been denied by Berkshire Life Insurance Company call our Boston, MA attorney Jonathan Feigenbaum 617-357-9700 today for a complimentary review of your claim.
