Los Angeles and San Francisco Disability Insurance and ERISA Claim Attorneys Fight Broadspire Claim Denials
At McKennon Law Group PC, we pursue all available avenues to vindicate your right to receive life, disability, long-term care, medical and other insurance benefits, often despite the improper conduct of third-party administrators like Broadspire. At McKennon Law Group PC, we pride ourselves on our successful track record, which we owe in part to our years of experience working for and against insurers and third-party administrators like Broadspire. McKennon Law Group PC’s founder, Robert J. McKennon, represented insurance companies in the past, which is part of the reason why so many of our cases settle. Indeed, Robert McKennon, the principal and founding shareholder of McKennon Law Group PC, has been handling these types of claims for over 30 years.
Broadspire is part of Crawford & Company, which is one of the largest providers of claims management, risk management and other services to the insurance industry and self-insured entities (usually employers). Unlike some insurance companies, which may both insure and administer their claims, Broadspire is referred to as a “third-party administrator” or a “TPA.” Insurers and employers with group benefits plans hire TPAs like Broadspire to deal with the claims handling process. Basically, those insurers and employers have outsourced the claims process and as such, TPAs are responsible for requesting the necessary medical records, documents and other information regarding the processing of the claims. In this situation, it is the TPA, and not the insurer, that will be evaluating and ultimately deciding your claim. TPAs are often used when employers who provide group insurance policies to their employees want to self-insure (i.e., they pay the claims from their assets).
In theory, third-party administrators should improve the claims experience because it separates the financial motive of the insurer/employer (the one ultimately responsible for paying the benefits) from the decision-making process. Again, in theory, this should reduce the potential for a conflict of interest. However, in actuality, the TPA still relies on the insurer’s/employer’s business. Insurers/employers are more likely to hire a TPA who denies claims since it is the insurer or employer who ultimately pays those claims. Accordingly, the TPA understands that the financial incentive to deny claims is good for its business.
How does Broadspire Deny Life and Disability Insurance Claims?
Broadspire denies claims for numerous reasons, including the following:
- Broadspire claims that there is insufficient evidence to support the life or disability claim
- Broadspire claims the claimant did not supply adequate medical support for the life or disability claim
- Broadspire claims the claimant failed to comply with the proof of loss requirements in a timely manner
- Broadspire claims the illness, injury or other conditions or symptoms that are the subject of the claim are “preexisting” conditions
- Broadspire claims the insurance application contained materially false information, and thus the policy can be rescinded
- Broadspire conducts surveillance of the claimant, which it uses to support its determination that the claimant is not totally disabled
- Broadspire suggests that there has been a lapse in the claimant’s policy, focusing on a failure to pay premiums
- Broadspire overemphasizes the role of the exclusions in the life or disability policy, suggesting that the claimant’s illness or injury precludes coverage
What Should Disability or Life Insurance Claimants Look for When Broadspire Denies a Claim?
- Did Broadspire improperly investigate your claim? For example, did they request authorizations for medical records, but never follow up with your physicians?
- Did Broadspire improperly obtain opinions from unqualified persons/supposed experts? For example, did a peer review physician or onsite clinical consultant who has never seen you in person conclude you are not disabled contrary to the opinions of your long-time, in-person treating physicians?
- Broadspire improperly misreading or misinterpreting medical records
- Broadspire improperly hiring and using biased “independent” medical reviewers and examiners
- Broadspire improperly denying a claim without any medical examination
- Broadspire improperly refusing to acknowledge subjective disabling conditions such as mental disorders, autoimmune disorders, fibromyalgia, and chronic fatigue syndrome because there is no objective evidence of the condition
- Broadspire improperly asserting a pre-existing condition
- Broadspire improperly attempting to rescind the policy
- Broadspire improperly denying a claim with the intent to wear the claimant down to a lower settlement
- Broadspire improperly over-relying on surveillance evidence to conclude a claimant can work
- Broadspire improperly over-relying on social media evidence to conclude a claimant can work
- Broadspire improperly failing to have a meaningful dialogue with the claimant
- Broadspire improperly failing to use findings by the Social Security Administration to support a disability claim
If you feel you have a wrongfully denied ERISA or nonERISA claim for disability, life or other insurance involving Broadspire, the McKennon Law Group PC will aggressively pursue your insurance benefits
Having an aggressive and experienced ERISA on nonERISA California disability, health and life insurance litigation attorney is the most crucial decision you can make for the success of your insurance claim. If your claim for health, life, accidental death or dismemberment, short-term disability or long-term disability insurance has been wrongfully denied or suddenly terminated, fill out a free consultation form or call 1-800-682-4137 to schedule a free consultation with the attorneys of the McKennon Law Group PC, several of whom previously represented insurance companies and are exceptionally experienced in handling ERISA and nonERISA, bad faith insurance claims.