Guardian Crosses The Investigation Line

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.

 

Filed under: Claims Process, Uncategorized
Source: Linda Nee