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Posts Tagged ‘Guardian’s unfair claims practices’

Guardian seems to be staying in the news lately as the company’s focus on “credibility investigation” reaches over-the-top levels. While no one disputes the right of any insurance company to fully investigate claims, Guardian’s practices exceed investigation levels that would normally be required to determine insureds are “unable to perform their own occupations.”

A good case in point is the insured who was injured as a result of an automobile accident several years ago and who recently claimed disability due to various shoulder muscle tears etc. According to the information I have Guardian’s investigators actually hunt down the driver of the “other car” who promptly said, “the accident was no more than a fender bender and no one got hurt.”

Seems to me the “at fault” driver might have a conflict of interest in reporting a “no one’s hurt” accident, but I have to wonder why Guardian took this line of investigation. If the insured’s medical information certifies the insured’s inability to perform as a dentist today, then what would it matter what the driver of the other car reported?

Guardian also tends to interview ex-spouses, a deliberate attempt to sully insureds’ reputations and credibility. Investigators “show-up” to interview peer workers, or accost them in parking lots with requests for written statements. There does not appear to be any logical reason to investigate the way Guardian does, and in my opinion, it crosses the line of prudent, normal and customary disability claim review.

Guardian’s investigations always seem to focus on credibility in lieu of whether or not insureds meet the definitions of disability in their policies. The company performs complex financial calculations regarding “residual” disability even when insureds are not residually disabled. Misrepresentations of policy provisions are immediately apparent, with little expectation of Guardian reversing its position.

Guardian’s claim investigations obviously have set priorities to investigate to deny rather than investigate to pay. This is the primary difference between fair and equitable insurers and those who seek to discredit insureds at all costs. DMS, Disability Management Services, is also a company who often investigates “credibility” in addition to contract provisional standards.

I can’t tell you what’s happened to Guardian in the last several years, but it’s all been downhill. Professionals looking for private disability and business protection coverage should look more toward Northwestern Mutual products and avoid Guardian’s insane investigations.

 

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If I were a Guardian/Berkshire insured I would be very concerned and vigilant concerning the company’s interpretation of its policy provisions.

In the last two years I’ve had the opportunity to review several claim situations where Guardian’s claims reps deliberately misrepresented policy provisions in order gain profit advantage at the insured’s expense.

Company reps appear to be engaging in claims practices that are out-of-contract leading me to believe reps are acting on behalf of management directives rather than reading actual contracts. At least one attorney reported to me that she had to petition the state department of insurance to intervene when Guardian refused to pay a claim because the attorney had her client sign a limited Authorization. The DOI agreed with the attorney, but it took nearly 6 months to clear up the issue.

It has also been reported to DCS, Inc. that Guardian’s reps are extremely hostile on the phone when actions are challenged, even to the point of hanging up on the insured. I have personally experienced the same hostility with Guardian which actually does not serve the company well. Insureds who are patient enough to deal at all with Guardian on the phone should opt instead for written communications only.

I know of at least two Guardian claims where the company insists on deducting prior business losses that “do not result from disability” from the PMI calculation. The Guardian scam is to conjure calculate a percentage of prior business losses and apply it to the Prior Monthly Income calculation (PMI) so that in carrying non-existent business losses forward insureds are penalized for future losses that do not exist.

I also previously reported Guardian’s “over-the-top” investigation schemes that exceed standards of investigation normally assumed to be necessary for disability claims investigations. Whatever it is that changed the company’s popular status in the disability insurance industry from 2nd behind Northwestern Mutual to a notable “bad faith” insurer is now obvious to most professionals looking to buy disability protection.

Unfortunately, I would not recommend Guardian’s disability policies to any professional given the company’s current erratic patterns of enforcing policy provisions to favor future business losses that do not exist.

The company is no longer reputable as a seller of disability protection because it no longer adjudicates claims in “good faith and fair dealing.”

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