When you apply for long-term disability benefits with Guardian, it is crucial to meet the specific definition of disability outlined in your policy. Unfortunately, sometimes claims are denied due to various reasons, leaving individuals in a difficult situation. In this article, we will explore common reasons for claim denials by Guardian and discuss how to navigate the appeals process effectively. Understanding the appeal process is essential for those seeking to overturn a denial and secure the benefits they rightfully deserve.
Reasons for Claim Denials by Guardian
Insufficient Evidence of Disability
To obtain disability benefits, you must provide strong evidence that supports your condition as a disability. A mere diagnosis or medical records might not be enough to warrant benefits. Guardian may deny claims based on weak or inadequate evidence of occupational impairment. To bolster your case, seek evaluations from additional medical and occupational experts who can verify how your condition impairs your ability to work.
Use of Guardian’s Own Medical Experts
Guardian has the right to hire its own medical experts or examiners to evaluate claimants. Unfortunately, these experts too often favor the insurance company, leading to unfair evaluations that could hurt your chances of being considered disabled. Doctors who want repeat opportunities to earn easy money doing “independent medical exams” know who is paying the bill. To get repeat referrals, these doctors know the outcome the insurance company wants.
Meeting all deadlines is crucial for your claim’s success. Failure to adhere to the specified timelines can result in a denial of benefits or the loss of your rights to long-term disability benefits.
Insurance companies, including Guardian, may employ video surveillance to monitor claimants’ daily activities. Guardian and other insurance companies are looking for that “gotcha” moment. Most of the time, surveillance shows nothing of consequence but insurance companies will make a big deal of nothing. Any evidence captured on camera could be used to dispute your disability claim. Being honest with your doctor about your disability, acknowledging your limitations, and avoiding inconsistencies will help strengthen your case.
Own Occupation vs. Any Occupation Policies
Some long-term disability plans will pay you benefits when you are disabled from your own occupation. After a specific period, often 24 months, the policy may switch to the any occupation definition of disability, making it more challenging to prove your inability to work in any occupation. Remember, that any occupation does not mean selling pencils on a street corner. The definition is often broader than the own occupation definition, but is still often cabined by your education, training, experience, age, and station in life.
How to Appeal a Denied Guardian Long-Term Disability Claim
If your long-term disability claim has been denied by Guardian, you must take immediate action to appeal the decision. Strengthening your case during the appeal process is crucial to increase your chances of success. Here are steps you can take:
- Obtain Additional Medical Evidence that explains your symptoms.
- Supplement your medical records with further documentation from health experts to support your disability claim. These added evaluations can counter biased assessments done by Guardian’s hired medical professionals.
- Seek Vocational Evidence. Vocational experts can assess your ability to perform your occupation’s duties while dealing with a disabling health condition. They can also provide valuable input if your policy switches to the any occupation definition of disability.
- Request a Treating Physician Report. Obtaining a personal report from your physician can also help prove your case. Your physician’s input on how your condition specifically affects you can be more compelling than standard medical documentation.
- Get an Independent Medical Exam. Insurers get IMEs. You can too.
- Gather Testimonials from Witnesses. Statements from friends, family, and coworkers who have witnessed the effect of your medical condition on your daily life can bolster your claim.
Navigating the long-term disability insurance appeals process with Guardian can be challenging, but understanding the reasons for claim denials and knowing how to strengthen your case during the appeal are crucial steps to take. By obtaining strong evidence, seeking expert opinions, and meeting all deadlines, you can increase your likelihood of securing the long-term disability benefits you deserve. Remember, perseverance and a well-prepared appeal are key to success here.