The Prudential Insurance Company of America (Prudential) is a division of Prudential Financial. It is one of the largest disability insurance companies in the United States that offers group disability and life insurance policies.
Disability insurance benefits replace a portion of your wages if you cannot work due to an illness or injury. However, there is a good chance that Prudential will deny the claim. Claimants may need the help of a Prudential long term disability lawyer to overturn a Prudential Financial disability denial.
Top Reasons Why Prudential Denies Long Term Disability Insurance Claims
Denial Language
If you have not received any LTD benefits, you may have received a letter that states something like:
“We have completed our review of your claim for Long Term Disability (LTD) benefit and are unable to approve any benefits. Your medical condition would not prevent you from performing your regular occupation as outlined above. Therefore, you would not be considered disabled as defined by the policy.”
Here, Prudential is stating that the claimant does not meet the “definition of disability” under the “own occupation” standard of review:
“You are disabled when Prudential determines that:
- You are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury; and
- You are under the regular care of a doctor; and
- You have a 20% or more loss in your monthly earnings due to that sickness or injury.
The loss of a professional or occupational license or certification does not, in itself, constitute disability.”
Termination Language
If you have received some LTD benefits, you may have received a letter that states something like:
“We have completed our review of your claim for Long Term Disability (LTD) benefits under the Group Policy No. 1234567890. Your conditions would not prevent you from performing any gainful occupation as outlined above. Therefore, you would not be considered disabled as defined in the policy.”
Here, Prudential is stating that the claimant does not meet the “definition of disability” under the “any occupation” standard of review:
“After 24 months of payments, you are disabled when Prudential determines that due to the same sickness or injury:
- You are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience; and
- You are under the regular care of a doctor.
The loss of a professional or occupational license or certification does not, in itself, constitute disability.”
What Evidence Does Prudential Consider?
This is sample language of what Prudential considers in issuing a claim determination:
“We have completed our review of your claim. We have reviewed the information in file and submitted for the purposes of this review. We have considered the opinions expressed by your treatment providers and we have considered your own self-report of functioning. We have had your claim file reviewed by an Occupation Medicine physician who provided their opinions as to your functional capacity.”
Most policies include language that permit the insurer to have you or your file examined by medical or vocational experts. Here is an example of such policy language:
“Prudential will assess your ability to work and the extent to which you are able to work by considering the facts and opinions from:
- Your doctors; and
- Doctors, other medical practitioners or vocational experts of our choice.
We can require examinations as often as it is reasonable to do so. We may also require you to be interviewed by an authorized Prudential Representative. Refusal to be examined or interviewed may result in denial or termination of your claim.”
Click here to view the complete (redacted) Prudential LTD policy.
What To Do After You Receive a Denial
Unfortunately, Prudential does not always act in good faith. Prudential will try to avoid paying disability insurance benefits even when presented with evidence that a claimant is disabled.
Receiving a disability claim letter can be upsetting and frustrating. This is especially true if the disabled individual is the primary breadwinner in the household.
However, an insurance companies’ decision to deny or terminate disability claims is not the end of the process. You have the right to fight for the long-term disability insurance benefits you deserve. Experienced long-term disability lawyers can help you identify and protect those rights.
Depending on the circumstances of your claim and the language of your disability insurance policy, you may be able to either:
- Appeal the decision through an internal administrative appeal process directly with Prudential.
- File an ERISA lawsuit in federal court with assistance from an experienced Prudential disability insurance lawyer.
Prudential Long Term Disability Appeals
Unfortunately, Prudential denies a large number of the long-term disability claims. Prudential claimants have contacted us regarding the wrongful denial of insurance benefits or the improper termination of benefits. It is important to remember that the insurance company’s denial or termination of benefits is not final. You have the right to file an appeal directly with the insurance company.
If Prudential has denied your claim for disability benefits, don’t hesitate to contact us and schedule a free consultation. We work closely with our clients to develop their claim files. We will review your claim to determine why it was denied and what evidence is most crucial for your appeal. After reviewing your claim, an experienced attorney will explain why your claim was denied.
Insurance policies often exclude certain conditions or limit payments. In many cases, policies only pay benefits for 24 months for mental health claims. We will assist you in completing the appeals forms accurately. We will also submit all necessary medical records within the time limits set by your LTD insurance policy.
Our review of your entire claim file will help determine if any medical evidence was missing. We will gather any necessary evidence like medical records and job descriptions.
We can collaborate with your doctors to obtain their opinions regarding your functional capacity based on your medical conditions. If needed, we may engage other experts, such as accountants and vocational experts, to provide witness opinions supporting your claim.
It is vital that you understand the requirements of your disability policy. This includes the necessary medical evidence to satisfy the “Proof of Loss” and “Definition of Disability” criteria.
Filing a Lawsuit Against Prudential
If Prudential denied your administrative appeal, we also assist claimants in filing a lawsuit in federal court. Most disability insurance lawsuits are governed by the Employee Retirement Income Security Act (ERISA).
ERISA is a federal law that relates to employee benefits such as disability and life insurance. ERISA law requires you to go through the appeals process with Prudential before you can file a lawsuit. ERISA-governed disability plans are usually part of a group benefits plan with an employer. However, ERISA does not govern all disability insurance claims.
If you have an individual disability income policy, you may not have an ERISA claim. Claims by church or government employees may also be exempt from ERISA law. If so, you may not have to go through Prudential’s LTD appeal process. Non-ERISA claims can proceed straight to filing a lawsuit.
Whether you have a group policy or an individual policy, our experienced disability lawyers are here to help. We will protect your interests from Prudential’s bad faith dealings while we fight to get your denial overturned. We have experience with disability law and will make sure that your LTD insurance carrier acts in good faith.
Hire a Prudential Long Term Disability Attorney
Has Prudential wrongfully denied your long term disability insurance claim? Do not let Prudential deny your long term disability claim without a fight. Our firm will fight to get your disability claim approved so you can focus on your health.
We understand how important your insurance benefits can be to you and your family. We also understand how difficult it is to maintain the physical and mental stamina to defend a disability insurance claim. An insurance companies’ tricks are too much when you are already dealing with an injury or disability.
Nick A. Ortiz and the experienced legal team at Ortiz Law Firm have successfully handled disability claims nationwide. We help claimants in their fight to obtain or maintain their disability benefits. We are familiar with Prudential’s tricks and tactics and will use that experience to help win your claim.
Have You Received a Prudential Disability Denial? Call Us for a Free Consultation
Mr. Ortiz is an experienced long-term disability claim lawyer. He has the skill and insight to help you understand your disability insurance coverage. He has experience with group disability insurance policies and disability claims well as individual disability insurance policies and claims.
We are experts in disability law and are not afraid to fight back against Prudential disability claim denials. We welcome the opportunity to review your claim and discuss how we can help you appeal the denial of your benefits. If you have received a denial letter, call us at (888) 321-8131 to request a free consultation.