The Prudential Insurance Company of America, owned by Prudential Financial, is a Fortune 500 company and one of the largest disability insurance companies in the United States that offers group disability and life insurance policies. Disability insurance benefits from insurance companies like Prudential are meant to replace a portion of your wages if an illness or injury interferes with your ability to work for a certain amount of time.
However, when disabled individuals try to claim disability benefits, there is a high probability that their claims will be denied or terminated prematurely. Policyholders that have been denied disability insurance benefits may need the help of a Prudential disability attorney to overturn Prudential disability claim denials.
Termination Language
If you had been receiving LTD benefits from Prudential, you may have received a letter that states something like:
“We have completed our review of your first request for reconsideration of our decision to terminate your claim for Long Term Disability (LTD) benefits under the Group Policy No. 1234567890 issued to Your Employer, We have determined that our decision was appropriate and have upheld our decision to terminate your claim for LTD benefits.”
Sample Prudential determination language states: “We have determined that the information in your file does not support impairment that would prevent you from engaging with reasonable continuity in the occupations identified. As a result, we have upheld our decision to terminate your claim for LTD benefits.”
Exclusions
A sample reason for denying a claim may be that certain medical conditions “are considered pre-existing and excluded from LTD coverage”.
What Evidence Did Prudential Consider in Its Determination?
This is sample language of what Prudential considers in issuing an “Appeal Determination”:
“We have completed our review of your request for reconsideration of your claim. We have reviewed the information in file and submitted for the purposes of this appellate 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 a physician Board Certified in Occupational Mcdicine/Pain Management who provided their opinions as to your functional capacity.”
What To Do After You Receive a Prudential Insurance Company of America Denial of Disability
Unfortunately, the Prudential Insurance Company of America (hereinafter referred to as “Prudential”) does not always act in good faith and will try to avoid paying disability insurance benefits even when presented with evidence that a claimant is disabled. Many disabled Prudential policyholders are denied the disability insurance benefits they rightfully deserve.
Some disabled individuals are denied both short-term and long-term disability (LTD) benefits from the time of the initial application for Prudential benefits. Some claimants are approved for short-term disability benefits only to later find that their long-term disability insurance claim has been denied. Others have their long-term disability benefits terminated or cut off after having initially been approved.
Receiving a disability claim letter can be upsetting and frustrating, especially 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 disability claim and the language of the disability insurance policy affording your coverage, you may be able to either: (1) appeal the decision through an internal administrative appeal process directly with Prudential, or (2) file an ERISA lawsuit in federal court with assistance from an experienced Prudential disability insurance lawyer. If your long-term disability claim has been wrongfully denied our firm will fight to get your disability claim approved.
Get Legal Support During the Prudential Long-Term Disability Insurance Claim Process
We understand how important your insurance benefits can be to you and your family when you are sick and injured and unable to work. We also understand how difficult it can be to maintain the physical and mental stamina to file a disability insurance claim and deal with an insurance companies’ tricks when you are already drained due to dealing with an injury or disability. Fortunately, you do not have to fight Prudential alone. We will fight for your long-term disability benefits so you can focus on your health.
Mr. Ortiz is an experienced long-term disability claim lawyer with the skill and insight to help you understand your disability insurance coverage and to help you file a winning claim for the benefits you are entitled to. He has experience with group disability insurance policies and disability claims well as individual disability insurance policies and claims. We will use that experience to ensure that your claim is properly supported with the medical evidence needed to get your claim approved.
Appealing Prudential Disability Claim Denials
Unfortunately, a large number of the long-term disability claims filed with Prudential are denied. Prudential policyholders have contacted us regarding the wrongful denial of insurance benefits or the improper termination of benefits. Despite the fear that this is “the end of the road”, 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 you are unable to perform your occupation and Prudential denied your claim for disability benefits do not hesitate to contact us to schedule a free consultation. We work closely with our clients in developing the claim file. Mr. Ortiz and his staff will help you understand the reason why your claim was denied by Prudential and help you understand what medical records are most important for your appeal. In doing so, we advise our clients on the steps to take to maximize the chance of winning an appeal and receiving LTD benefits from Prudential:
- If you’re asking yourself “why did Prudential deny my claim?”, we can assist you in understanding the reasoning behind the disability denial letter, such as a pre-existing condition or mental health exclusion (most policies will only pay benefits for 24 months if it is a mental health claim);
- We will review the entire claim file to determine if any medical evidence was missing from the file at the time of the decision;
- Gathering any documentation or medical evidence specifically requested by the insurance company;
- Gathering all other necessary evidence, including medical records and job descriptions;
- Working with doctors to obtain their opinions as to the claimant’s “residual functional capacity” given the claimant’s physical and/or mental medical conditions;
- Potentially working with other experts such as accountants and vocational experts to gather expert witness opinions to support the claim;
- Understanding the disability policy and what medical evidence is required to satisfy the claimant’s “Proof of Loss” and “Definition of Disability”;
- Completing the appeals forms; and
- Filing an appeal and submitting all of the necessary medical records within the time limits allowed by your LTD insurance policy.
Filing a Lawsuit Against Prudential Disability Insurance Company
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), which is a federal law that relates to employee benefits such as disability and life insurance. Under ERISA law you are required to go through the appeals process with Prudential before you can file a lawsuit. ERISA disability claims are usually obtained as part of a group benefits plan with an employer.
However, not all disability claims are governed by ERISA. If you have an individual disability income policy, or if you are a government employee, you may have a non-ERISA claim. If so, you may not have to go through Prudential’s LTD appeal process. Claims that are not governed by the Employee Retirement Income Security Act (also known as 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 long-term disability denial overturned. We have experience with disability law and will make sure that your LTD insurance carrier acts in good faith.
I Was Approved for Social Security Disability Benefits, So Why Did Prudential Deny My Claim?
You may be denied disability insurance benefits even if the Social Security Administration (SSA) approved your claim for Social Security Disability benefits. The insurance company is not bound by the SSA’s decision. However, you should still notify the insurer that your claim was approved so that the information is included in your file.
Hire a Prudential Long Term Disability Claim Lawyer
Don’t let Prudential deny you the benefits you deserve. You can make sure you have the best chance of being approved for LTD benefits by working with a Prudential Financial LTD lawyer. Nick A. Ortiz and the experienced legal team at Ortiz Law Firm have successfully handled disability claims nationwide and have helped 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. We assist claimants in filing an appeal, and if the appeal is denied, we can help claimants take Prudential to court.
Did Prudential Deny Your Claim? Call us for a Free Consultation
If you are cannot work and your claim has been improperly denied or terminated, call (888) 321-8131 to request a free consultation with a disability lawyer. We are experts in disability law and are not afraid to take on Prudential or any of the other major insurance companies. Our firm would welcome the opportunity to review your denial letter, your medical information, and to help you appeal the denial of your benefits.