Disability Insurer Profiles: Guardian/Berkshire

The Guardian Life Insurance Company has been in existence since 1860 and it merged with Berkshire Life in 2001, making it one of the largest disability insurance companies. The company now has about 9,000 employees nationwide, and receives $9.4 billion annually in premiums.[1]

If you are a professional with a Guardian or Berkshire policy, it is important to understand how “occupation” is defined under your policy. Guardian will typically take a very close look at what you were doing immediately prior to disability, to determine if they can either deny the claim or pay a lower “residual disability” benefit, by arguing that you can still perform some of your pre-disability duties.

For example, the case of Shapiro v. Berkshire[2] involved a dentist who filed a disability claim with Berkshire due to neck pain, joint pain and osteoarthritis in his elbow. Berkshire agreed to pay him “total disability” benefits for a very limited period following his arm surgery; however, Guardian also maintained that, after he recovered from the surgery, he would only be entitled to “residual disability” benefits, and only if he had the required threshold loss in income.

Although the dentist had an “own occupation” definition of disability, Berkshire maintained that he was both a “dentist” and a “business owner,” because he owned a second practice that he rarely treated patients at and a for-profit organization that provided personnel for his dental office. Berkshire acknowledged that the dentist could no longer do chair dentistry, but argued that he was not “totally disabled” because he could still perform administrative duties.

Fortunately, in this particular case, the dentist had still been practicing four to five days a week prior to his date of disability. Consequently, when the dentist’s attorneys sued Berkshire, the court held that the dentist’s occupation was “chair dentistry” and ordered Berkshire to pay the dentist “total disability” benefits. While things ultimately worked out for this dentist (albeit only after costly and time consuming litigation), in our experience, many dentists prejudice their ability to collect by modifying their job duties prior to filing and not understanding what their policy says.

In addition, in Shapiro, the dentist’s policy defined “occupation” as “the occupation you are engaged in immediately preceding the onset of disability.” Notably, many of the newer disability policies (including Guardian/Berkshire policies) now contain a broader definition that defines “occupation” as “the regular occupation (or occupations, if more than one), in which you are engaged in at the time you become disabled” (emphasis added).

These are just a few examples of things to be aware of if you have a Guardian/Berkshire policy or claim with Guardian/Berkshire. Guardian/Berkshire policies are not all identical, and they are updated frequently. Your policy may or may not include the provisions mentioned above. If you are considering filing a disability claim, you should consult with an experienced disability insurance attorney to learn more about your policy and any potential issues related to your particular claim.

[1]
https://www.guardianlife.com/s3fs-public/downloads/Guardian_2017_Fact%20Sheet.pdf?f96r91a.aNjb75tKlnKbV2Ylf9inNPQA.

[2] Shapiro v. Berkshire Life Ins. Co., 212 F.3d 121, 123 (2d Cir. 2000).

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